(Kim Painter) 
Anti-psychotic medications should not be the first treatments doctors or patients think of when dealing with dementia in an elderly person, behavior problems in a child or insomnia in an adult, a leading group of psychiatrists says in a new statement.
The American Psychiatric Association’s (APA) new list of questionable uses of anti-psychotic medications is part of a broader campaign to educate patients and doctors about unneeded and possibly harmful medical treatments and tests. The campaign is called Choosing Wisely, and so far more than 50 medical groups have chimed in with lists of common practices that patients and doctors should question — everything from ordering too-frequent colonoscopies to using antibiotics for colds.
The latest list focuses on an area that has been especially controversial: the potential misuse of anti-psychotic medications. These medications include older drugs traditionally used for conditions such as schizophrenia and bi-polar disorder. But newer types, called atypical anti-psychotics, have been more widely used for patients ranging from unruly nursing home residents to children with with aggressive behaviors or attention deficit hyperactivity disorder. That’s despite growing concerns about misuse and side effects.
Doctors who overprescribe the medications “are doing what they think might help,” often without first trying safer or more effective alternatives, says Joel Yager, a psychiatry professor at the University of Colorado-Boulder, who helped develop the new list.
The group cautions against using the medications without full evaluations and ongoing monitoring or using them in combinations of two or more, without trying several single medications first.
It also says it’s questionable to use them as routine or first-choice treatments for:
• The behavioral and psychological symptoms of dementia. This is a common practice in nursing homes. But side effects can include confusion, sedation and hastened death.
• Children and teens with any condition other than a psychotic disorder. Use in children has risen rapidly, especially among poor and minority children, despite research linking the medications to weight gain, cardiovascular changes and an increased risk of type 2 diabetes.
•Adult insomnia. There’s inadequate evidence they work for the sleeping problem, the psychiatric group says.
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