When agitation and psychosis symptoms are severe, is an antipsychotic medication an option? Not always.
When agitation and psychosis symptoms are severe, is an antipsychotic medication an option? Not always. The American Psychiatric Association (APA) has announced new treatment guidelines for the use of antipsychotics for patients with dementia that take into account behavioral and other symptoms that antipsychotics may not address. The APA Practice Guideline Writing Group developed the guidelines and emphasize that medication for dementia should be just one part of a constellation of both drug and non-drug treatments.
Clinical trials have shown little benefit from antipsychotic use for the ever-growing group of elderly patients in whom agitation and psychosis often develop. In addition, the adverse effects (eg, cognitive deterioration, morbidity) often outweigh perceived benefits of antipsychotic use.
With these factors in mind, the guidelines recommend "assessment of psychological and behavioral symptoms of dementia, development of a comprehensive treatment plan, assessment of the benefits and risks of antipsychotics, and judicious use of antipsychotics, including specifics for dosing, duration and monitoring.” With a focus on antipsychotic therapy, it is hoped that the new guidelines will help clinicians, patients, and caregivers make informed decisions.
APA President RenÃ©e Binder, MD noted, “While the use of antipsychotics is appropriate for some patients with dementia, it can be difficult to identify the individuals and the specific circumstances. A decision should be made only after thorough assessment and review of potential benefits and harms of antipsychotic treatment as well as other possible treatment options.”
Among the recommendations:
The Executive Summary of the guidelines are published in The American Journal of Psychiatry and available at PsychiatryOnline.
Also see: 3 Features of Psychosis