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Antipsychotic therapy for behavioural and psychological symptoms of dementia

According to Alzheimer’s Australia, about 269,000 Australians suffer from dementia. It commonly affects people above the age of 65 years, but it can also occur in people in their 40s and 50s.

Many people with dementia will experience behavioural and psychological symptoms such as anxiety, wandering, calling out, aggression and depression. These problems tend to come and go and may only occur for a few months at a time; so long-term treatment with an antipsychotic medicine is unlikely to be needed. In fact improvements seen with antipsychotics are often counterbalanced by significant adverse effects such as stroke, pneumonia and even death.

Non-drug strategies are recommended as first-line treatment since they have a low risk of harm compared with antipsychotic medicines. Approaches that may be useful in controlling the behavioural and psychological problems associated with dementia include muscle relaxation therapy, personalised music, video or audio tapes of family members and changing bathing routines.

A trial with antipsychotics medicines should only be considered when non-drug approaches have been unsuccessful and psychotic symptoms, aggression or agitation is causing severe distress or a risk of harm to the person with dementia or others.

Before prescribing, a doctor should conduct an individual risk-benefit assessment; assess tolerability, adverse effect profile, ease of use and goals of treatment. Once on an antipsychotic medicine, a doctor should review the need for the treatment regularly to determine when it can be stopped.


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