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Physicians will disclose the risks as these medications are only used on an ‘as needed’ basis

Atypical Antipsychotic medication can be helpful for individuals with dementia who are experiencing aggression or psychosis - a break with reality. Symptoms of psychosis include:

  • Delusions: a fixed, false belief in something that is not true (in keeping with the culture)
    • Convinced someone is taking their things (theft)
    • Believe a spouse has cheated on them (infidelity)
    • Think people are trying to hurt them
    • Delusion that their life is at risk (very distressing for the individual)
  • Hallucinations: a sensory experience that is not real.
    • Seeing people or animals that are not there
    • Hearing noises or voices when there is no one in the room.

Types of atypical antipsychotics

  • Risperidone
  • Olanzapine
  • Aripiprazole
  • Quetiapine

Side effects of antipsychotics

While evidence shows that antipsychotics can help reduce symptoms, these medications do not work for everyone and they may have side effects. Physicians will disclose the risks as these medications are only used on an ‘as needed’ basis when it is likely that the benefits of the medication will improve the quality of life and reduce fear and distress for the patient. It is important to discuss with the physician a plan for monitoring the risks on an ongoing basis.

Possible risks and side effects include:

  • Stroke (one per cent risk)
  • Death (one to two per cent risk)
  • Metabolic
    • Blood sugar – development of type 2 diabetes
    • Weight gain or weight loss
  • Psychological
    • Dyskinesia – involuntary movement of toes, fingers, mouth, tongue
  • Cardiac episodes
  • Balance or risk of falls
  • Drop in blood pressure
  • Stiffness
  • Increased likelihood of falls
  • Increased sedation

Eighty per cent of patients with dementia will develop some form of behavioural or psychological symptoms. A small percentage will require medication to manage their symptoms.

Medication is used as treatment for behaviours that are severe, persistent and distressing for either the individual with dementia or the people around them.

Medication is only to be used when the:

  • Behaviour continues after holistic strategies have failed.
  • Behaviour is related to delusions or hallucinations.
  • The individual is physically violent.

The medications available for treating behaviours are not great. They work some of the time but not all of the time and they have side effects and risks.

Medication is used:

  • Only when absolutely necessary.
  • In the lowest dose possible.
  • For a short period of time.

Neuroleptic or antipsychotic medications are used most often and have the most evidence behind them but have significant risks and side effects associated with them.

Patients should be monitored and drugs discontinued at the first sign of a problem.