So this is the latest in a flurry of Clinical Problems in Consultation Psychiatry (CPCP) presentations, this one by Family Medicine resident, Dr. Neel Patel, MD. He reported on the much talked about risk for increased mortality in elderly patients with dementia. Dr. Patel has an interest in psychiatry which may be propelling him into a new career direction.
I see elderly patients with dementing illness of one kind or another in the general hospital nearly every day. Many times the families and I are faced with the difficult decision to use an antipsychotic in an effort to manage behavioral disturbance that could result in harm to their loved one or someone else. It can be one of the most agonizing times for a family.
We have to carefully discuss the risks including the FDA Black Box Warning about using antipsychotics. It can be mystifying to them partly because so many patients get quetiapine as a hypnotic, an off-label use which many find disconcerting and confusing, especially after they hear about the potential risks.
The discussions about the potential risks and benefits of antipsychotics for the elderly with a major neurocognitive disorder can feel like difficult and sad conversations. But we sometimes have to talk about our sorrow.
We don’t always have to do that with a psychiatrist. Any humanistic doctor willing to listen and bear witness will do.
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