Primary Care Physicians' Use of Antipsychotics for the Treatment of Behavioural and Psychological Symptoms of Dementia in Japan

Objective: We aimed to investigate how primary care physicians (PCPs) in Japan use antipsychotics for treating the behavioural and psychological symptoms of dementia (BPSD). Materials and Methods: A nationwide cross-sectional online survey was conducted of PCPs who annually treated patients aged over 65 years with dementia. Responses from 509 PCPs were analysed by binominal logistic regression analysis. Results: Approximately one-third of the PCPs had treated excitatory BPSD (delusion, hallucination, agitation and violence), with half of them prescribing antipsychotics for this. Some PCPs still prescribed antipsychotics for non-excitatory BPSD, such as wandering. More than half of the PCPs had opportunities to learn about the appropriate use of antipsychotics and understood the increased mortality risk in elderly people with dementia. Referring to the Japanese Governmentʼs BPSD guideline for PCPs was negatively associated with antipsychotic dosage (odds ratio=0.491, 95% confidence intervals 0.32-0.75, p-value=0.001) and positively associated with a greater awareness of increased mortality with antipsychotics (odds ratio = 2.149, 95% confidence intervals 1.41-3.27, p-value=0.0004). Conclusion: PCPs continue to prescribe antipsychotics for excitatory BPSD in clinical practice despite official information about mortality risks. Educational material about the appropriate use of the antipsychotics should include specific mention of the risks of using antipsychotics for dementia.