Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-20T06:41:46.532Z Has data issue: false hasContentIssue false

Treatment of the agitation of late-life psychosis and Alzheimer’s disease

Published online by Cambridge University Press:  16 April 2020

C. Salzman*
Affiliation:
Harvard Medical School, 74 Fenwood Road, Boston, MA02115, USA
*
*Correspondence and reprints.
Get access

Summary

In older as well as younger people, antipsychotic medication is commonly used to treat psychoses. In clinical practice, antipsychotic medication is also used to control severe behavioral disturbances such as agitation, wandering, self-mutilation, as well as assaultiveness. Neuroleptic and non-neuroleptic drug treatments are used to control severe agitation and disruptive behavior.

Among typical neuroleptics, very low doses (e.g., 0.25 mg of haloperidol 1–4 times per day) may be effective and limit the development of severe extrapyramidal reactions.

Recent experience suggests that the atypical neuroleptics, olanzaine, risperidone, and quetiapine, are also useful for controlling severe agitation in elderly demented nursing home residents.

The benzamides are also known for the treatment of behavioral disturbances in Europe, but there is little experience in the U.S.A.

Although research studies in this area are virtually nonexistent, growing clinical experience sugests that the following may be quite useful: 1) trazodone; 2) buspirone (Buspar®); 3) anticonvulsants (e.g., valproate); and 4) β-blockers.

Type
Original article
Copyright
Copyright © 2001 Éditions scientifiques et médicales Elsevier SAS. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sweet, RA, Pollock, BG.Neuroleptics in the elderly: guidelines for monitoring. Harvard Rev Psychiatry 1995; 2: 327–35.CrossRefGoogle ScholarPubMed
Salzman, C.Treatment of agitation in the elderly. Meltzer, HY., Ed.; Psychopharmacology: the third generation of progress. New York: Raven Press; 1987. 1167–76.Google Scholar
Elon, R, Pawlson, LG.The impact of OBRA on medical practice within nursing facilities. J Am Geriatr Soc 1992; 40: 958–63.CrossRefGoogle ScholarPubMed
Rovner, BW, Edelman, BA, Cox, MP, Shmuely, Y.The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes. Am J Psychiatry 1992; 40: 958–63.Google Scholar
Shorr, RI, Fought, RL, Ray, WA.Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations. JAMA 1994; 271: 358–62.CrossRefGoogle ScholarPubMed
Jeste, DV, Eastham, JH, Lohr, JB, Salzman, C.Treatment of disordered behavior and psychosis. Salzoman, C, Ed.; Clinical geriatric psychopharmacology. Third ed. Baltimore: Williams & Wilkins; 1998. 106–49.Google Scholar
Caligiuri, MP, Lacro, JP, Rockwell, E, McAdams, LA, Jeste, DV.Incidence and risk factors for severe tardive dyskinesia in older patients. Br J Phychiatry 1997; 171: 148–53.CrossRefGoogle ScholarPubMed
Verma, SD, Davidoff, DA, Kambhampati, KK.Management of the agitated elderly patient in the nursing home: the role of the atypical antipsychotics. J Clin Psychiatry 1998; 59 Suppl 19: 50–5.Google ScholarPubMed
Devenand, DP, Marder, K, Michaels, KS, Sackeim, HA, Bell, K, Sullivan, MA.A randomized placebo-controlled dose-comparison trial of haloperidol for psychosis and disruptive behaviors in Alzheimer’s diseases. Am J Psychiatry 1998; 155: 1512–20.CrossRefGoogle Scholar
Wengel, SP, Roccaforte, WH, Burke, WJ.Donepezil improves symptoms of delirium in dementia: implications for future research. J Geriatr Psychiatry Neurol 1998; 11: 159–61.CrossRefGoogle ScholarPubMed
Magnuson, TM, Keller, BK, Burke, WB.Extrapyramidal side effects in a patient treated with risperidone plus donepezil [letter]. Am J Psychiatry 1998; 155: 1458–9.CrossRefGoogle Scholar
Wengel, SP, Roccaforte, WH, Burke, WJ, Bayer, BL, McNeilly, DQ, Knop, D.Behavioral complications associated with donepezil [letter]. Am J Psychiatry 1998; 155: 1632–3.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.