Pharmacological interventions
With behavioural and psychological symptoms of dementia (BPSD) look for activating causes and contributing medical issues (e.g. pain).
Always seek non-pharmacological interventions in the first instance. Pharmacological approaches should only be the first resort if the person, carer or family are severely distressed, pain is thought to be the cause, or there is an immediate risk of harm to self and or others (i.e. the symptoms are very severe).
Antipsychotic medication should be used judiciously for problems that actually need treatment i.e. high risk or marked distress.
Use antipsychotic medication in an evidence based manner, using the lowest effective dose possible.
All antipsychotics are known to have adverse effects and increase the risk of stroke. AVOID in Lewy Body Dementia. Frequent monitoring is essential.
Atypical antipsychotics work best for hallucinations, delusions, aggression and psychosis. They are not usually effective for symptoms of calling out, wandering, pacing or resisting care unless the patient is over-sedated.
See Medications for BPSD.
Antipsychotic treatment principles
Always use antipsychotic medications in the context of a comprehensive care plan:
- Person-centred and family-centred approaches
- Tailored diversional activities
- Flexible routines to minimise resistance to care
- Prosthetic environment designed specifically for people with dementia
- Room for physical activity to assist those with motor overactivity e.g. pacing or wandering
Use of antipsychotic medications in dementia
- Obtain consent
- Consider risk factors for adverse effects
- Determine a stopping rule at initiation of drug
- Do not expect immediate results from low-dose antipsychotic medication
- Maintain hydration and check for postural BP drop
- Monitor for Parkinsonism (can develop late)
- Check for other adverse effects
- Cease drug if ineffective
Significant adverse effects of antipsychotic medication
There are significant adverse effects which include:
- Parkinsonism
- Falls
- Hip fractures
- DVT
- Cognitive impairment
- Cardiovascular
- Cerebrovascular
- Death
Information courtesy of Associate Professor Mark Yates, Consultant Geriatrician, Meredith Theobald, Director of Nursing Subacute Services and Michelle Morvell, CNC Cognition, Ballarat Health Services: Dementia Care in Hospitals Program
Clinical Practice Guidelines for Dementia in Australia: Recommendations 2016