Evidence-Based Treatment and Monitoring Strategies for Dementia-Related Psychosis

Antipsychotics can be used in the short-term to manage dementia-related psychosis, but serious adverse effects can outweigh benefits. Novel antipsychotics or other agents may offer superior efficacy and safety. Explore the evidence in this CME activity.

Abstract

Atypical antipsychotics play a limited role in the management of dementia-related psychosis (DRP). Major adverse outcomes are associated with most antipsychotics in patients with dementia, and guidelines recommend that these drugs not be prescribed for long durations. When treating symptoms of DRP, clinicians should follow guidelines such as using medication only if the patient or others are in distress or danger and starting with low doses. Novel antipsychotics or alternative agents may offer superior efficacy and safety.

From the Series: Dementia-Related Psychosis: Recognition and Treatment

To cite: Ballard C. Evidence-based treatment and monitoring strategies for dementia-related psychosis. J Clin Psychiatry. 2021;82(3):AD19038BR4C.

To share: https://doi.org/10.4088/JCP.AD19038BR4C

© Copyright 2021 Physicians Postgraduate Press, Inc.

Target Audience

Neurologists, Psychiatrists, NPs/PAs

Learning Objectives

  • Initiate evidence-based therapies to manage psychosis in patients with dementia as soon as symptoms are identified
  • Monitor treatment of psychosis in patients with dementia
Activity summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation
Activity opens: 
04/15/2021
Activity expires: 
04/30/2023
Cost:
$0.00
Rating: 
5

Support Statement

Supported by an educational grant from ACADIA Pharmaceuticals Inc.

Learning Objective

After completing this educational activity, you should be able to:

  • Initiate evidence-based therapies to manage psychosis in patients with dementia as soon as symptoms are identified
  • Monitor treatment of psychosis in patients with dementia

Release, Review, and Expiration Dates

This brief report activity was published in April 2021 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2023. The latest review of this material was March 2021.

Statement of Need and Purpose

Hallucinations and delusions are key behaviors contributing to behavioral crises in patients with dementia, and a lack of consistency in assessment of behaviors has been found. Clinicians may lack awareness of the incidence of psychotic symptoms in different forms of dementia, as dementia pathology has been incorrectly diagnosed on the basis of the presence or absence of psychosis. Some patients may not be able to describe their psychotic symptoms, requiring caregiver input to aid clinicians in recognition. Rating scales can be implemented to aid identification. Clinicians need education about assessing patients with dementia for hallucinations and delusions and about the incidence of psychotic symptoms in different forms of dementia. In addition, many patients with dementia-related psychosis (DRP) receive antipsychotics and are on treatment for over a year, although guidelines recommend tapering after 4 months. Clinicians need education to implement guideline-concordant care that is tailored to the individual patient, incorporating current information on the risks and benefits of nonpharmacologic and pharmacologic interventions for DRP. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on DRP.

Disclosure of Off-Label Usage

Dr Ballard has determined that, to the best of his knowledge, risperidone, aripiprazole, olanzapine, quetiapine, clozapine, citalopram, and masupiridine are not approved by the US Food and Drug Administration for the treatment of dementia-related psychosis.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

Acknowledgment

This activity is derived from the teleconference series “Dementia-Related Psychosis: Recognition and Treatment,” which was held in May and June 2020 and supported by an educational grant from ACADIA Pharmaceuticals, Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

Faculty Affiliation

Ballard, Clive
Clive Ballard, MDChB, MMedSci, MRCPsych, MD
University of Exeter College Medicine and Health, United Kingdom


Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
 

Dr Ballard is a consultant for and has received honoraria from Acadia, Roche, Lundbeck, Exevia, AARP, Synexus, and Novo Nordisk; has received grant/research support from Synexus and Novo Nordisk; and is a member of the speakers/advisory boards for Acadia, Roche, AARP, Synexus, and Novo Nordisk.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

Available Credit

  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation

Price

Cost:
$0.00
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