Pharmacological agents to treat severe neuropsychiatric symptoms in major neurocognitive disorders

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are challenging to recognize and treat effectively. Despite very effective nonpharmacologic strategies, there are cases where severe BPSD may require biological intervention. The purpose of this review was to clarify safe and evidence-based use of pharmacological agents based on available clinical trial evidence. METHODS: A structured search strategy was used in PubMed, Embase, and Psyclnfo to obtain the most relevant data regarding treatment of BPSD in patients with any-cause dementia. RESULTS: We screened 1,442 English-language abstracts. Following initial screening, we had 184 unique references to review. A secondary search of these and review articles gave a total of 117 to tabulate and discuss. We categorized the results based on the following classifications: antidepressants, first-generation antipsychotics, second-generation antipsychotics, anticonvulsants/mood stabilizers, sedatives, stimulants, steroid therapies, other medications, other medication strategies, and medication withdrawal. CONCLUSIONS: The judicious use of pharmacotherapy does seem to be appropriate in select cases where behavioral and psychological interventions have been partially effective or where symptoms confer imminent risk of harm.