All typical and atypical antipsychotic medications include an FDA black-box warning against use in individuals with dementia.

What is the recommended treatment for patients diagnosed with dementia who are suffering with paranoia and/or hallucinations? — Dennis Love, PA-C, Butler, Pa.

The behavioral issues related to patients with dementia are complex. There are a number of factors that can contribute to behavioral disturbances. Carefully assess the patient and consider such other causes of paranoia and hallucinations as infections, drug abuse, and dehydration.

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Risperidone (Risperdal) and olanzapine (Zyprexa) may be useful in reducing aggression. Risperidone can help reduce psychosis but can be associated with serious adverse cerebrovascular events and cause extrapyramidal symptoms, usually with long-term use. Neither drug should be used routinely.

Close monitoring is essential during initiation and maintenance. Low dosing is generally well-tolerated and results in fewer side effects. For more specific details regarding medication management and dosing, see the 2008 report, Guidelines for Alzheimer’s Disease Management. — Deborah L. Cross, MPH, CRNP, ANP-BC (171-3)

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