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Choosing Wisely UK

Royal College of Psychiatrists

If benzodiazepines or antipsychotics drugs have been initiated during an acute care hospital admission, make sure there is a clear plan to review their use, ideally tapering and discontinuing prior to discharge. Both benzodiazepines and antipsychotics have serious side effects in the elderly, in particular, addiction, falls, worsening cognition, infections, stroke and death.

Choosing Wisely UK

Royal College of Psychiatrists (2018)

There is little evidence to support the effectiveness of physical restraints to manage people with delirium who exhibit behaviours that risk injury. Physical restraints can lead to serious injury or death and may worsen agitation and delirium. Restraints should therefore be used as a last resort and should be discontinued at the earliest possible time, particularly given that effective non-pharmacological alternatives are available.

Choosing Wisely UK

Royal College of Psychiatrists

Antidepressant drugs are designed to correct an imbalance of certain chemicals in the brain which may happen in people with depression. Taking antidepressant medicines may improve symptoms of depression and make people feel better. They are more effective in people with severe depression than in those with mild to moderate depression. Symptoms should improve within two to four weeks of starting treatment. If there is no improvement after 6 weeks, a review of the proposed treatment should be ...

Choosing Wisely UK

Royal College of Psychiatrists

As initial and ongoing management, offer psychosocial and environmental interventions to reduce distress in people living with dementia. If there are significant risks that make treatment with an antipsychotic necessary, this should be discussed with the patient and their family, and the lowest possible dose used. Only offer antipsychotics for people living with dementia who are either: 1. At risk of harming themselves or others or 2. Experiencing agitation, hallucinations or delusions that ...

Choosing Wisely UK

Royal College of Psychiatrists (2018)

Research commissioned by the Department of Health and non governmental reports have confirmed various aspects of discrimination, infringement of human rights, unmet need or neglect of older people. Deep-rooted cultural attitudes to ageing are particularly evident in mental health. An arbitrary age is not a satisfactory criterion to determine the service a person receives. Services must recognise the equal value of all people and be based on need not on age. Age is a continuous variable and ...