Psychotic symptoms

There are few hard data on which to base decisions about antipsychotic drug prescribing for relieving psychotic symptoms in dementia. The choice of antipsychotic is therefore likely to be determined by its profile of side-effects. For example, psychotic patients who are also agitated may need a more sedative drug, while the newer atypical antipsychotics with less extrapyramidal side-effects will be required if these side-effects of the older drugs become troublesome.

Psychosocial measures also need to be considered. For example, delusions of theft, common in people with dementia (34>, may be founded on memory impairment, which results in the patient losing things and then attributing the loss to someone having stolen the item. Strategies to help the person keep tags on where they put things etc. may then be helpful.

A risk assessment is an important part of the management plan. Are the psychotic symptoms associated with worrying behaviours, or are they, for example, just one manifestation of general disorientation and confusion? Given the risks of treatment with antipsychotics the risk-benefit analysis for starting antipsychotics needs to be considered and discussed with the patient and his or her family/carers.

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