BPSD - Devon Partnership NHS Trust

Prescribing Guideline 

Pharmacological Management of 

Severe Behavioural & Psychological 

Symptoms of Dementia (BPSD) 

PG14 

Document Control 

Version Date Issued Author Name / Job Title / Email 

1.0 March 2011 Amanda Gulbranson Christopher Sullivan 

Clinical Effectiveness Lead Lead Clinical Pharmacist 

Amanda.gulbranson@nhs.net Christopher.sullivan@nhs.net 

2.0 September 2013 Amanda Gulbranson Richard Mccollum 

Clinical Effectiveness Lead Consultant Psychiatrist 

Amanda.gulbranson@nhs.net richard.mccollum@nhs.net 

Target Audience/staff groups Clinical staff responsible for the prescribing of treatment for Behavioural and 

Psychological Symptoms of Dementia. 

Ratifying group 

Drug and Therapeutics Committee 

Date Ratified 4 th September 2013 

Implementation date October 2013 

Review date September 2015 

Document History 

Version Start End date Author History 

date 

0.1 Nov 2010 AG First draft of new Prescribing Guideline 

0.2 Dec 10 CS Multiple changes post MHPF meeting Dec 10 (CS) 

0.3 Feb 2011 AG/CS Changes following discussion with Denise Cope & Steven Pearson 

( Consultant OPMH Psychiatrist Dorset & Devon respectively) 

0.4 Feb 2011 01.03.11 AG/CS Minor corrects/typos and abbreviations. Presented to Mental 

Health Prescribing Forum for comment 

0.5 Feb 2011 07.03.11 CS Changes made post OPMH meeting 

1.0 22.03.11 KS Document signed off. 

1.1 Mar13 AG Table of treatment strategies removed and included in Appendix 1 

Reference to ‘FACE’ form removed 

Decision aid for specialist treatment updated 

Link to standard GP letter added 

2.0 Oct13 KS Document ratified at DTC and signed off. 

PG 14 – Pharmacological Management of BPSD 

Approved by Drug and Therapeutics Committee: September 2013 

Review date: September 2015 

Page 1 of 10

Pharmacological Management of Severe Behavioural & Psychological 

Symptoms of Dementia (BPSD) 

The aim of these guidelines is to promote evidence based, cost effective prescribing and 

support adherence to: 

o NICE Clinical Guideline CG42: Dementia (Nov 2006) 

o The use of antipsychotic medication for people with dementia: Time for action. 

(Banerjee 2009: Department of Health) 

o NICE Quality Standard QS01: Dementia (June 2010) 

o Alzheimer’s Society (2011): Optimising treatment and care for people with 

behavioural and psychological symptoms of dementia- A best practice guide for 

health and social care professionals 

The guidelines are NOT intended to replace prescribing information contained in the BNF or 

Summary of Product Characteristics. 

Treatment choice and duration 

Behavioural and psychological symptoms occur in about 90% of individuals with dementia, 

(frequency increases with severity of dementia), causing considerable distress and/or risk of harm 

to the individual, increasing distress to the family/carer and potentially interfering with/preventing 

the provision of required care. 

The presenting neuropsychiatric symptoms include psychosis, agitation, aggression, mood 

disorder and wandering and are collectively referred to as ‘behavioural and psychological 

symptoms of dementia’ (BPSD). 

For people with a diagnosis of dementia, behaviours that challenge are best ‘managed’ by good 

nursing care, the correct environment and use of ‘ABC’ (antecedents, behaviours and 

consequences) to try and identify causes and possible triggers for the presenting behaviour (e.g. 

hunger, pain). 

Non-pharmacological approaches must always be considered first 

(but are beyond the scope of, and not covered in, this guideline) 

Pharmacological treatment is not a substitute for non-pharmacological approaches and these 

techniques must always be used concurrently. 

Where non-pharmacological interventions have failed or are inappropriate, other possible causes 

(i.e. physical illness) should be eliminated prior to considering an individual trial of medication for 

the management of BPSD using the Pharmacological Treatment Algorithm below. 




Page 2 of 10

No further intervention needed at this time. Continue to provide care for individual in accordance 

with current care-plan 

Individual presents with behaviours that challenge (e.g. agitation, wandering, aggression, tearfulness, 

sexual disinhibition shouting, hallucinations, delirium) 

Identify and document target symptoms, severity and level of distress caused to individual 

(Use suitable assessment tool i.e. Cohen–Mansfield Scale or Neuropsychiatric Inventory ) 

Could presenting 

symptoms be a 

result of underlying 

physical cause 

(including pain) 

YES 

Assess, 

diagnose and 

provide 

appropriate 

treatment 

Symptoms 

resolved 

NO 

YES 

NO 

Could 

presenting 

symptoms be sideeffects 

of 

concurrently 

prescribed 

medication 

YES 

Complete a 

medication 

review and 

rationalise 

treatment 

Symptoms 

resolved 

YES 

NO 

NO 

Could presenting 

symptoms be 

caused by 

underlying 

depressive illness 

and/ or anxiety 

disorder 

YES 

Assess, diagnose 

and provide 

appropriate 

treatment (refer to 

local prescribing 

guidelines) 

Symptoms 

resolved 

YES 

NO 

NO 

Consider and implement 

appropriate nonpharmacological 

interventions 

(e.g. environmental changes, 

psychological therapies, 

multisensory stimulation, 

massage, aromatherapy) 

Symptoms 

resolved 

YES 

Consider, discuss and provide 

appropriate pharmacotherapy 

in accordance with this 

prescribing guidance (PG14) 

NO 

Symptoms 

resolved 

NO 

YES 

Review prescribed 

medication regularly. After a 

period of 3 months, aim to 

reduce and stop medication 

when presenting behaviour 

has settled. 

Advise GP of plan to reduce 

and stop medication if still 

prescribed medication (after 

a trial of reduction) on 

discharge from in-patient 

unit or community team 

Where a medication has been ineffective, always stop it before introducing a subsequent treatment 




Page 3 of 10

Pharmacological Management: 

The expected benefits must outweigh the potential risks/side effects of medication for each individual. 

Pharmacological management of severe BPSD (agitation and aggression in particular) should only be 

considered if behaviours cause severe distress to the individual and/or there is immediate risk of 

harm to other patients or carers. Remember- wandering behaviour does NOT respond to medication. 

Medication prescribed for the management of BPSD should be considered as an individual 

therapeutic trail, with the choice of medication based upon an individual risk-benefit analysis. 

Always “START LOW AND GO VERY SLOW”. 

Treatment choice and duration: 

Once a decision has been reached to start medication for the management of BPSD the first choice 

of treatment considered should be; 

Risperidone 

Initial dose of 250micrograms twice a day recommended. 

This may be increased according to response in steps of 250micrograms twice a day on alternate 

days. Usual dose 500micrograms twice a day (but doses up to 1mg twice a day may be beneficial 

for some individuals). 

Risperidone is the only medication with UK Marketing authorisation for this indication, licensed for 

“the short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to 

severe Alzheimer's dementia unresponsive to non-pharmacological approaches and when there is 

a risk of harm to self or others”. 

Antipsychotic drugs are known to be harmful and can have severe side-effects and it is vital that 

any person prescribed risperidone (or other antipsychotic) is monitored for side-effects and 

progression of symptoms. 

Exercise caution if risperidone is prescribed together with furosemide (higher incident of mortality 

observed although mechanism unclear). The risks and benefits of combining risperidone with 

furosemide or other potent diuretics must be considered prior to use. Refer to Risperidone SPC for 

more information. 

The most important adverse effects associated with antipsychotics are parkinsonism, falls, 

dehydration, chest infections, ankle oedema, deep vein thrombosis/pulmonary embolism, cardiac 

arrhythmia and stroke (highest risk in first four weeks of treatment). Antipsychotics are also 

associated with increased mortality in the long term (often related to pneumonia and thromboembolic 

events) which can be caused by over-sedation and dehydration. 

Complete a cardiac risk assessment prior to initiating treatment. 

Weekly monitoring of sedation, fluid intake and early indicators of chest infection is strongly 

recommended. 

Caution: antipsychotics should not be used in someone with Lewy Body Dementia (LBD) 

Where 

without 

risperidone 

specialist 

is contraindicated 

advice. 

or where no clinical benefit is achieved and/or the individual 

experiences intolerable side effects, it may be appropriate to consider alternative pharmacological 

treatment options (to be initiated by or on the recommendation of a specialist). 

The available evidence base is insufficient to support specific recommendations on preferred 

choices of medication or the order in which different medicines/different classes of medication 

should be prescribed. 

Refer to the Decision aid for specialist treatment strategies-Severe BPSD (Appendix 1) 




Page 4 of 10

Initiation of medication (by, or on the recommendation from, a specialist): 

Identify, quantify & document target symptoms including severity and level of distress caused 

to the individual (and family/carers where appropriate) and set realistic treatment goals. 

Suitable assessment tools include Adapted Cohen –Mansfield Agitation Inventory (Adapted 

CMAI) or Neuropsychiatric Inventory (NPI). 

The Adapted Cohen–Mansfield Agitation Inventory is available here 

Document which non-pharmacological interventions have been used and/or offered to the 

individual (as appropriate) and level of effectiveness. 

Complete baseline physical monitoring, appropriate to the individual drug prescribed. 

Complete baseline assessment of cognition. 

Clearly record rationale for treatment and choice of medication in the clinical notes, including 

agreed start date and initial treatment review date (& person responsible for completion). 

It is recognised that when medication is prescribed for the management of BPSD it will 

generally arise from a ‘best interest decision’. The prescriber must ensure that a formal record 

of capacity assessment is completed (using RiO capacity assessment form) and a summary 

of multi-professional team discussion and rationale for treatment clearly documents in the 

notes (including information provided to family and/or carers where applicable). 

Communication of information to family/carers: 

The prescriber must discuss the possible treatment options with the individual and/or 

family/carers, including the anticipated benefits and potential risks of treatment (in particular, 

cerebrovascular risk factors should be assessed and the possible increased risk of 

stroke/transient ischaemic attack and possible adverse effects on cognition discussed). 

Provide information in an appropriate format to support discussion about expected benefits 

and possible risks of treatment (see user-friendly resources). 

A summary of the discussion (and note of any additional information provided) must be clearly 

documented in the clinical notes. 

During treatment: 

Regularly monitor response to treatment/changes in target symptoms & document in notes 

Assess cognition at regular intervals, and document any required action(s)/treatment plan to 

address any deterioration in cognition in the notes 

Monitor for emergence of side effects associated with mediation. Discuss with individual 

and/or carer and review treatment if side effects intolerable or severe. (NB people with DLB 

have increased sensitivity to antipsychotic side effects, including acute & severe physical 

deterioration- monitor carefully). 

Ensure on-going physical monitoring is carried out appropriate to the medication prescribed. 

Document subsequent treatment review dates (& person responsible) in the clinical notes at 

each clinical review. Treatment should be time-limited and regularly reviewed. 

Reviewing and stopping treatment: 

Treatment should be reviewed at 6 and/or twelve weeks (with more frequent review 

considered according to clinical need). 

Following review, unless there is severe risk or extreme distress, the recommended default 

management is to discontinue antipsychotic medication. 

When stopping medication, if the daily dose of risperidone is 500micrograms or less 

immediate discontinuation is recommended. For higher doses a gradual reduction is 

preferable to abrupt withdrawal, i.e. reduce dose by 50% of total daily dose every 1-2 weeks 

until dose of 500micrograms or less/day reached, then stop minimum dose after 1-2 weeks. 




Page 5 of 10

Acute management in an emergency situation: 

For individuals, receiving treatment on an in-patient ward only, where physically violent and 

aggressive behaviour has or may imminently result in harm to the individual and/or others, it may be 

appropriate to consider ‘rapid tranquillisation’ where repeated attempts at non-pharmacological 

interventions and oral medication has failed to produce any benefit (or has been refused). Refer to 

the Trust Policy for Rapid Tranquillisation (C36) and Clinical Protocol (CP11). This protocol states 

antipsychotic medication is not suitable for use in rapid tranquilisation in this population. 

Communication of information on transfer of care: 

Following a treatment review, it may be appropriate for the medication to be continued for an 

agreed period of time following discharge from an in-patient unit, or after review by a specialist 

in a community team. 

Where it is appropriate for treatment to be continued in primary care, the Trust prescriber 

(Consultant or Associate specialist) will: 

o Contact individual’s GP to request that they accept on-going responsibility for 

prescribing 

o Where prescribing is to be continued by GP- provide them with a clear treatment plan 

to cover the reduction and discontinuation of medication for BPSD and who to 

contact if they need to seek further advice on the clinical management of the 

individual (i.e. original symptoms re-emerge on discontinuation of treatment). 

o Include a summary of the information documented in the clinical notes regarding 

target symptoms and choice of medication and rationale for treatment. 

A standard letter template for communicating prescribing information to GPs is available here 

User-friendly resources 

Patient decision aid (intended to assist healthcare professionals in consultations with people with 

dementia and their family/carers) when treatment with antipsychotic drugs is being considered for 

BPSD: http://www.npci.org.uk/therapeutics/cns/dementia/resources/pda_dementia_antipsychotics.pdf 

Leaflets for patients/family/carers on dementia can be found on the Alzheimer’s Society website: 

www.alzheimers.org.uk/Facts_about_dementia/factsheets.htm) 




Page 6 of 10

Appendix 1 

Decision aid for specialist treatment strategies: Severe BPSD 

There is a lack of high quality clinical trial evidence to support the effectiveness of medication for BPSD 

(with evidence base generally based on Alzheimer’s dementia rather than vascular/stroke related, frontotemporal 

lobe, mixed or DLB), however increasingly there is information which questions their safety. The 

table below is designed to provide you with a summary the available evidence for drugs used for the 

management of BPSD (specific to aggression, agitation and/or psychosis), along with a summary of 

possible side effects and precautions required. 

ANTIPSYCHOTICS 

Evidence of efficacy in BPSD, though limited, is greatest for risperidone and olanzapine, however, clinical 

efficacy is at best only modest and this must be balanced against elevated risk of cerebrovascular adverse 

events, mortality, upper respiratory infections, oedema, extrapyramidal symptoms and an increase in overall 

mortality rate which applies to ALL ANTIPSYCHOTICS (first and second generation) and not just 

risperidone and olanzapine as originally reported in the Committee of Safety of Medicines alert (2004). 

Summary of risks and benefits for treating1000 people with dementia for BPSD over a 12 week period with 

an second generation antipsychotic would result in; 

91-200 people with behavioural disturbance showing clinically significant improvement in symptoms 

10 deaths 

(Evidence suggests that risk of mortality increases over time, therefore longer term treatment may result in 

up to 167 additional deaths over a 2 year period 

18 CVAEs of which ~50% would be severe 

(Evidence from observational studies suggests increased risk of CVAE may be confined to the 2-3 month 

period typically encompassed in RCT follow-up studies, therefore extrapolation of data in the original CSM 

alert, 2004, proposing that NNH of 37 would translate to NNH of 6.3 over 1 year, resulting in an additional 

159 CVAEs per 1000 people treated, may be an over-estimation). 

No additional falls or fractures 

58-94 people with gait disturbance 

Intervention 

Risperidone 

Olanzapine 

(Off-license use) 

Amisulpride 


Aripiprazole 


Quetiapine 


First Generation 

antipsychotics 


Rationale 

(Where stated, doses derived from published studies) 

Licensed for the short-term treatment (up to 6 weeks) of persistent 

aggression in patients with moderate to severe Alzheimer's dementia 

unresponsive to non-pharmacological approaches and when there is a risk of 

harm to self or others (500micrograms- 2mg/daily). 

Significant improvement in aggression & psychosis compared to placebo 

Significant improvement in aggression compared to placebo (5-10mg/daily) 

ONLY consider as a 2nd line option where risperidone not appropriate/not 

tolerated 

Reported doses prescribed 200mg/daily. Preliminary observation suggests 

that amisulpride may be useful to control agitation and disruptive behaviours. 

RCT (open prospective) demonstrated equivalent efficacy to risperidone. 

Only small open-label studies available. Evidence weak. 

Improvement in psychosis demonstrated with 2-15mg/day compared with 

placebo (Schneider et al 2006; NNT=13.8) 

Reported doses prescribed: 50-200mg/day. 200mg/day reported superior to 

placebo for agitation where 100mg/day not superior to placebo, BUT showed 

harm compared with placebo at 26 weeks for severe impairment battery (SIB) 

Potential risks outweigh possible benefits: (Associated with increased risk of 

CVE and mortality (mortality risk ≥ second generation antipsychotics) 

DPT use 

approved 

YES 

YES 

NO 

NO 

NO 

NO 




Page 7 of 10

ACETYL-CHOLINESTERASE INHIBITORS (If not already prescribed for management of AD) 

Intervention Rationale (Where stated, doses derived from published studies) DPT use 

approved 

Donepezil 


Meta-analysis demonstrated a small by significant overall advantage of 

AChEIs over placebo with regard to the treatment of BPSD in Alzheimer’s 

Disease, although no short term benefit for treatment of clinically significant 

agitation with donepezil observed in 12 week RCT. 

Current evidence appears to demonstrate that AChEIs have their greatest 

effects on depression and dysphoria, apathy, indifference and anxiety and 

are probably not an effective treatment for the management of agitation or 

aggression in Alzheimer’s dementia. 

YES 

Galantamine 


Rivastigmine 


Evidence equivocal at doses of 16-24mg/day. In placebo controlled trials, 

Rockwood et al (2001) reported no statistically significant difference in 

behavioural symptoms between groups (n=386). Cummings et al (2004) post 

hoc analysis of Tariot et al (2000) reported slight improvement (NPI) 

observed with galantamine (p=0.04) at 16 & 24mg/day but not 8mg/d (n=978) 

Not approved because available evidence equivocal and increased treatment 

cost cannot be justified due to lack of evidence demonstrating increased 

efficacy compared with donepezil. 

Reported doses prescribed 1.5-4.5mg bd (6-12mg/day). Evidence equivocal 

(most studies open-label and behaviour a secondary end-point). Metaanalysis 

reported rivastigmine may be tolerated and effective for BPSD (6- 

12mg/d) (Finkel et al, 2004) 

Not approved because available evidence equivocal and increased treatment 

cost cannot be justified due to lack of evidence demonstrating increased 

efficacy compared with donepezil. 

NO 

NO 

NMDA ANTAGONIST 

Memantine Systemic metaanalysis suggested that memantine (10mg bd) decreases 

(Off-license use) NPI scores and may have a role in BPSD (reducing agitation/aggression) but 

effect size small. Could be considered for management of severe symptoms 

of agitation/aggression and psychosis in people who have failed to respond 

to other medication and who are otherwise prone to a rapid decline. 

Maidment et al (2008). 

However, a randomised DB PC trial (Fox et al 2012) reported no 

improvement in significant agitation in people with moderate to severe AD, 

suggesting that memantine should not be routinely prescribed to treatment 

agitation in AD. 

YES 

ANTIDEPRESSANTS 

Intervention Rationale (Where stated, doses derived from published studies) DPT use 

approved 

Mirtazapine 


Citalopram 


Trazadone 


Limited evidence available. One 12 week open-label study reported 

mirtazapine (15-30mg/day) could be a well-tolerated treatment option for the 

management of agitation in people with Alzheimer’s Disease (AD). 

YES 

Whilst not clinically effective for the treatment of depression in people with 

AD, mirtazapine may act to improve general behavioural and psychological 

Banerjee (2013) 

symptoms in dementia rather than depression 

Limited, but encouraging, evidence available. More studies needed. 

Trazadone most widely used antidepressant prescribed for people presenting 

with BPSD despite lack of robust evidence to support efficacy. 

NO 

NO 




Page 8 of 10

BENZODIAZEPINES 

Intervention Rationale 


Diazepam 1-2 mg up to 3 times a day (increase if necessary to 

(Off-license use) Max 15mg/24 in divided doses) Licensed for anxietyshort 

term use only for acute & severe distress 

and/or where sedation is required 

T1/2 ~32 hours (21-50) longer in older adults 

No systemic reviews of RCTs examining the 

usefulness of benzodiazepines in the management 

symptoms associated with dementia (including 

anxiety) were identified. 

Lorazepam 


NB 5mg diazepam ~equiv to 0.5mg lorazepam 

Usual max dose= 2mg/24hours (in divided doses) 

Short term use for only for acute & severe distress 

and/or where sedation is required 

Licensed for anxiety 

T1/2 ~12 hours (8-25) Similar in older adults 

No systemic reviews of RCTs examining the 

usefulness of benzodiazepines in the management 

symptoms associated with dementia (including 

anxiety) were identified 

May 

cause/hasten 

cognitive decline 

Paradoxical 

disinhibition may 

occur 

Contribute to falls 

and hip fractures 

Accumulation 

leading to 

excessive 

sedation/adverse 

effects and/or 

tolerance over 

time 

DPT use 

approved 

YES 

ONLY 

for short 

term use for 

acute & 

severe 

distress 

and/or where 

sedation is 

required 

ANTI-CONVULSANTS: 

Intervention Rationale 


Carbamazepine Uncontrolled studies & case reports have reported improvement in 

(Off-license use) presenting hostility & aggression in people with dementia who had not 

responded to antipsychotics as well as short term efficacy for agitation, 

however a review of placebo controlled RCTs to date provides equivocal 

information about efficacy for BPSD, and the safety and tolerability of 

therapeutic doses in people with dementia/older adults still needs to be 

established. 

DPT use 

approved 

NO 

Valproate 


Adverse effects include: Impairment of balance & increased risk of falls, 

Drug interactions, Impaired cognition, Blood dyscraisias, Hyponatraemia, 

Hepatic dysfunction, Serious skin reactions 

Despite positive treatment responses documented in case reports, 

retrospective chart reviews and open-label studies, the existing d/b, p/c, 

RCTs do not support the proposal that valproate is effective in the 

management of agitation, aggression or other BPSD in people with 

dementia. 

NO 

Adverse effects include: GI side effects, Impaired cognition, 

Hepatotoxicity- monitor liver function before & during treatment 

Oxcarbazepine No evidence to demonstrate efficacy NO 

Gabapentin Limited data reporting treatment well tolerated and effective, but 

NO 

evidence weak (small open-label &case reports only) and incomplete. 

Pregabalin No available published evidence reporting use or efficacy for BPSD NO 

Lamotrigine 

Topiramate 

Limited data reporting treatment well tolerated and effective, but 

evidence very weak (case reports only). 

Limited data (non-random retrospective study n=15). Reduction in 

Cohen-Mansfield Agitation Inventory noted but evidence very weak. 

NO 




Page 9 of 10

References 

Alzheimer’s Society (2011) Optimising treatment and care for people with behavioural 

and psychological symptoms of dementia .A best practice guide for health and social 

care professionals. 

Available at http://www.alzheimers.org.uk/site/scripts/download_info.phpfileID=1163 

Ballard C.G.; Gauthier S.; Cummings J.L.; Brodaty H.; Grossberg G.T.; Robert P.; 

Lyketsos C.G. Management of agitation and aggression associated with Alzheimer 

disease 

Nature reviews. Neurology, May 2009, vol./is. 5/5(245-255), 

Ballard C.; Corbett A.; Chitramohan R.; Aarsland D. Management of agitation and 

aggression associated with Alzheimer's disease: Controversies and possible 

solutions Current Opinion in Psychiatry, November 2009, vol./is. 22/6(532-540), 

Banerjee S, Hellier J, Romeo R et al (2013) Study of the use of antidepressants for 

depression in dementia: the HTA-SADD trial- a multicentre, randomised, DB, PC trial of 

the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health 

Technol Assess 17(7) DOI: 10.3310/hta17070 www.alzheimers.org.uk/bpsdguide. 

Accessed 14 Aug 2013 

Bazire S (2012) Psychotropic Drug Directory 2012. Warwickshire.UK 

Cakir S, Kulaksizoglu I (2008) The efficacy of mirtazapine in agitated patients with 

Alzheimer’s Dementia: A 12 week open label pilot study. Neuropsychiatric Disease and 

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Corbett A.; Smith J.; Creese B.; Ballard C. Treatment of behavioral and psychological 

symptoms of Alzheimer's disease Current Treatment Options in Neurology, April 

2012, vol./is. 14/2(113-125), 

Fox C, Crugel M, Maidment I et al (2012) Efficacy of memantine for agitation in 

Alzheimer’s Dementia: A randomised double-blind placebo controlled trial PLoS ONE 

7(5): e35185 doi:10.1371/journal.pone.0035185 

Konovalov S, Muralee S, Tampi R (2007) Anticonvulsants for the treatment of 

behavioural and psychological symptoms of dementia: a literature review. International 

Psychogeriatrics 20:2, 293-308 

Pollock B.G.; Mulsant B.H.; Rosen J.; Mazumdar S.; Blakesley R.E.; Houck P.R.; Huber 

K.A. (2007) A double-blind comparison of citalopram and risperidone for the 

treatment of behavioral and psychotic symptoms associated with dementia The 

American journal of geriatric psychiatry, vol./is. 15/11(942-952) 

Pollock B.G.; Mulsant B.H.; Rosen J.; Sweet R.A.; Mazumdar S.; Bharucha A.; Marin R.; 

Jacob N.J.; Huber K.A.; Kastango K.B.; Chew M.L. (2002) Comparison of citalopram, 

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disturbances in hospitalized, demented patients American Journal of Psychiatry, 

vol./is. 159/3(460-465), 

National Institute for Health and Clinical Excellence (2006) Dementia (CG42): Supporting 

people with dementia and their carers in health and social care 

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Issue 2. Art. No.: CD008191. DOI: 10.1002/14651858.CD008191.pub2 




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