Post-traumatic stress disorder in Japanese prisoners of war.

Stephen T icehurs t , Training Fellow in Psychogeriatrics, NSW Institute of Psychiatry, Hunter Regional Mental Health Services, Newcastle NSW 2300: In a comprehensive review of the assessment of dementia, Dr McLean refers to the use of antipsychotics in dementia. [Journal 1987; 21: 284-3041. He points out the lack of agreement in the literature as to the indications and efficacy of these drugs. His review of their use in relation to delusions and hallucinations does not, however, highlight the methodological problems in the studies published to date. These have been generally retrospective case reviews, open, uncontrolled and with a failure to define what exactly constitutes a delusion in a dementing population, [e.g. Leuchter and Spar 19851. Others [Cummings 19851, although prospective, have used a small number of highly selected, diagnostically heterogeneous patients and not used control groups or provided blind assessment uf their treatment. In Cummings' series of 20 patients only 4 had Alzheimer's disease. These all had simple or transient paranoid beliefs. He does not tabulate the results to justify his assertion that simple delusions respond best to antipsychotics. The only relevant case history presented is that of a patient with Alzheimer's disease and a simple paranoid "delusion" that disappeared without treatment. Most antipsychotics used in dementing patients are probably used in institutions for the control of behavioural symptoms such as agitation, non-cooperativeness, wandering and aggression. These uses have been subject to better evaluation and have been reviewed recently [Risse & Barnes 19861. The literature would suggest that as many as 60% or more of the patients with dementia who receive anti-psychotics are gaining little benefit from its prescription for these purposes. It is also apparent that the risks of side effects such as tardive dyskinesia, hip fractures etc. are greatly increased in the dementing elderly. Such risks need to be balanced against the perceived benefits and alternatives to drug management should be sought. References: CUMMINGS JL [ 19851 Organic delusions: phenomenology, anatomical correlations and review. British Journal of Psychiatry 146. 18497. LEUCHTER AF & SPAR JE [I9851 The late onset psychoses: clinical and diagnostic features. Journal of Nervous and Mental Diseases