Paradoxical side effect in treatment with antipsychotics for aggression/agitation and psychosis in dementia: case-series
Paradoxical side effect in treatment with antipsychotics for aggression/agitation and psychosis in dementia: case-series

Summary/Abstract: Antipsychotic treatment is widely used for treating aggression/agitation and psychosis in theelderly population. The doses used are lower, administering medication is done over aprolonged time period, tests done and clinical observation is more frequent compared to thenon-geriatric population. The objective of this case-series was to present a particularityencountered in the use of antipsychotics. Three patients suffered from increased aggressionand agitation during treatment with antipsychotics. After medication administration wasceased the symptomatology remitted. Tests used for this study included Mini-Mental StateExam (MMSE), Neuropsychiatric Inventory Nursing Home Version (NPI-NH). We found thatthe elevation of the NPI-NH score was significant with increased dosage, thus after reachingthe maximum allowed doses for patients with dementia, the decision was made to stop theantipsychotic and change to another agent (antipsychotic or anticonvulsant). These resultssuggest that more studies should focus on fast management of the antipsychotics’ side effects,and the dynamics between symptom development and treatment decisions. The delay betweenthe start of medication and the decision to switch could have a negative impact for thepatients. Future treatment algorithms should take into consideration the possibility ofworsening the symptoms and more in-depth studies should be conducted to widen the pictureof antipsychotic treatment in the geriatric population, especially for patients with severedementia.

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