As a massive wave of Japanese enter their twilight years, an expert is calling for prudent use of psychotropic drugs to treat dementia patients, some of whom have suffered ill health due to over-prescription.
The Health, Labor and Welfare Ministry released guidelines on how to prescribe such drugs for dementia patients in 2013 to avoid casual prescription by doctors. The Japanese Society of Psychiatry and Neurology is also training doctors on the appropriate application of the drugs.
Dr. Yoshimasa Takase, director of the Takase Clinic in Ota Ward, Tokyo, warns that psychotropic drugs, while known to improve the condition of some patients, come with risks of side effects, including falls.
During his recent visit to the home of Etsuko Okizaki, 79, Takase made a flower circle, a gold star awarded to children for good work at school, with his hands after examining her. A dementia patient who had left a psychiatric hospital in Tokyo two months before, Okizaki beamed.
“She looks like a completely different person. I never expected her to be this much better,” said her husband, 81, at her side.
Okizaki is one of 330 patients Takase visits regularly in and around Ota Ward. Most of them suffer from dementia.
Psychotropic drugs — such as antipsychotics and antidepressants — are widely used to control the so-called behavioral and psychological symptoms of dementia (BPSD), which result in loitering, hallucinations and aggressive behavior.
BPSD also causes some patients to become depressed or caught up in delusional thinking, leading some to mistakenly believe that someone is trying to steal from them.
From around last year Okizaki suddenly lost her appetite and then weight, saying food didn’t taste as good as before. She became depressed, would throw food and tableware at others, and began to require assistance to use the toilet.
Her family consulted Takase and checked Okizaki into a hospital in April. She was prescribed psychotropic drugs and administered intravenous feeding. After a while, her BPSD symptoms subsided, and she left the hospital in July.
She has received visits by Takase twice a month since, and now she enjoys knitting and spends her days calmly.
The health ministry guidelines urge doctors to use psychotropic drugs with caution because their effect is particularly pronounced on elderly patients with a low metabolic rate.
The guidelines further recommend that doctors explore nondrug options first, and that if drugs are deemed necessary, the prescription begins with low doses.
Takase said some of his patients, before coming to his clinic, had been prescribed several different drugs. Some had suffered from falls and bone fractures because of the side effects they caused. Such drugs can cause a patient to suffer impaired consciousness.
“They can be a medicine or a poison,” Takase said. “If you have concerns about the drugs, please consult with patient groups or talk to doctors who can help reduce their dosage.”