neuropsychiatric symptoms of dementia

Q: 72 years old male with a known history of dementia is admitted to ICU with sepsis. It was noted that patient developed severe and refractory neuropsychiatric symptoms. All of the following can be used for the management of neuropsychiatric symptoms of dementia except?

A) Benzodiazepines
B) Olanzapine
C) Risperidone
D) Quetiapine
E) Carbamazepine


Answer:   A

Dementia may exacerbate with an underlying medical condition. The mainstay of the treatment is to treat the underlying disease and use nonpharmacologic interventions. Most of the atypical antipsychotics (choices B, C, and D) are helpful but should be used only in severe or refractory situations. 

Unfortunately, two drugs are commonly used by clinicians in such situations, may not be of any help but may be harmful - Benzodiazepines (choice A) and diphenhydramine. Benzodiazepine may worsen the gait and may cause paradoxical agitation. Similarly, many clinicians used antihistamines under the false pretext that they are benign but they may also tend to exacerbate the neuropsychiatric symptoms of dementia.

Interestingly, carbamazepine (choice E), Gabapentin and Lamotrigine may be of help as adjuvant treatments. 

#psychiatry
#neurology
#pharmacology


References:

1. Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293:596.

2. Meehan KM, Wang H, David SR, et al. Comparison of rapidly acting intramuscular olanzapine, lorazepam, and placebo: a double-blind, randomized study in acutely agitated patients with dementia. Neuropsychopharmacology 2002; 26:494. 

3. Tariot PN, Erb R, Podgorski CA, et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998; 155:54.