8 Strategies for Managing BPSD

1. Complete a risk-to-benefit analysis before prescribing antipsychotics to individuals with behavioral and psychological symptoms of dementia (BPSD)

2. If antipsychotics are indicated, initiate treatment at the lowest possible dose and titrate to the minimum effective dose

3. Re-evaluate the risk-to-benefit analysis if clinically significant adverse effects occur

4. If there is no appreciable benefit after a 4-week trial at an adequate dose, taper and discontinue the medication

5. If there is good response attempt to taper and withdraw the medication within 4 months of initiation of treatment, after discussions with the patient and his or her caregiver

6. Evaluate the patient monthly for at least 4 months during taper and after the medication is discontinued

7. In the absence of delirium, haloperidol should not be used as a first-line agent for management of BPSD

8. Patients with BPSD should not receive long-acting injectable antipsychotics, unless they have a co-occurring chronic psychotic illness

Source: Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173:543-546.