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. 2018 Nov 1;8(6):284-293.
doi: 10.9740/mhc.2018.11.284. eCollection 2018 Nov.

Pharmacologic management of behavioral and psychological symptoms of major neurocognitive disorder

Monica Mathys  1
Affiliations

Pharmacologic management of behavioral and psychological symptoms of major neurocognitive disorder

Monica Mathys. Ment Health Clin. .

Abstract

Behavioral and psychological symptoms of dementia (BPSD) occur in approximately 80% of patients who receive a diagnosis of major neurocognitive disorder. Nonpharmacologic strategies are the first-line treatment for BPSD. However, psychotropic medications are often necessary when nonpharmacologic methods are not effective in treating symptoms that are distressing or are causing behaviors that are dangerous to the patient or the patient's caregivers. The article provides a review of evidence-based recommendations for the use of antipsychotics, cognitive enhancers, and serotonin reuptake inhibitors for the treatment of BPSD. Different pharmacologic approaches are demonstrated through 2 patient cases in which nonpharmacologic management was not effective. The severity of BPSD must be weighed against the risks and benefits of pharmacologic intervention in order to implement an optimal medication regimen.

Keywords: antipsychotics; behavioral symptoms; cholinesterase inhibitors; dementia; memantine; neurocognitive disorders; psychological symptoms; selective serotonin reuptake inhibitors.

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Conflict of interest statement

Disclosures: I have nothing personal to disclose. Psychopharmacology Pearls are review articles intended to highlight both the evidence base available and/or controversial areas of clinical care for psychiatric and neurologic conditions as well as strategies of clinical decision-making used by expert clinicians. As pearls, articles reflect the views and practice of each author as substantiated with evidence-based facts as well as opinion and experience. Articles are edited by members of the Psychopharmacology Pearls Editorial Board as well as peer reviewed by MHC reviewers. This article was developed as part of the 2018 Psychopharmacology Pearls product for BCPP recertification credit. The course information and testing center is at cpnp.org/353267.

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