People with dementia often exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including premature death. Use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others. Identifying and addressing causes of behaviour change can make drug treatment unnecessary.

Conditions: Dementia, Alzheimer's Disease

Treatments: Antipsychotics (Olanzapine, Zyprexa, Quetiapie, Seroquel, Risperidone, Risperdal)

Sources

• Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry. 2012 Sep;169(9):946-53. (PubMed)
• Gill SS, Bronskill SE, Normand SL, Anderson GM, Sykora K, Lam K, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007 Jun 5;146(11):775-86. (PubMed)
• Gill SS, Rochon PA, Herrmann N, Lee PE, Sykora K, Gunraj N, et al. Atypical antipsychotic drugs and risk of ischaemic stroke: Population based retrospective cohort study. BMJ. 2005 Feb 26;330(7489):445. (PubMed)
• Joller P, Gupta N, Seitz DP, Frank C, Gibson M, Gill SS. Approach to inappropriate sexual behaviour in people with dementia. Can Fam Physician. 2013 Mar;59(3):255-60. (PubMed)
• Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: Systematic review. BMJ. 2004 Jul 10;329(7457):75. (PubMed)
• Rochon PA, Normand SL, Gomes T, Gill SS, Anderson GM, Melo M, et al. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med. 2008 May 26;168(10):1090-6. (PubMed)
• Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: Meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry. 2006 Mar;14(3):191-210. (PubMed)
• Seitz DP, Brisbin S, Herrmann N, Rapoport MJ, Wilson K, Gill SS, et al. Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: A systematic review. J Am Med Dir Assoc. 2012 Jul;13(6):503,506.e2. (PubMed)