That the decline in antipsychotic use started well before 2005-2007, when the black-box warning was in effect, surprised her,
Kales told Psychiatric News. She believes that the decline was due to a number of factors, including emerging concerns about significant side effects
of atypicals, such as diabetes and stroke, national VA internal communications about potential side-effect concerns, and the
Office of the Inspector General of the Department of Health and Human Services issuing compliance guidelines restricting the
ability of drug companies to market off-label uses of medications, such as the use of antipsychotics for patients with dementia.