The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on management of behavioral and psychological symptoms in dementia

Chen, Anderson; Copeli, Frank; Metzger, Eran D.; Cloutier, Annie; Osser, David N.

doi:10.1016/j.psychres.2020.113641

Cited by 22 publications

(13 citation statements)

References 77 publications

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“…The second line drug in these situations is haloperidol. If symptom severity persists, these authors recommend 0.5 mg of lorazepam intramuscularly every 4 h, 2 mg being the maximum daily dosage 25 . In countries in which lorazepam is not available in parenteral formulation, 3.5 mg of midazolam every 4 h would be an adequate option.…”

Section: Aripiprazole Position In Management Algorithms For Bpsdmentioning

confidence: 99%

“…The third option, in case of the two previous drugs not providing the expected results, would be prazosin, at a dose of 1 mg at night and increasing it by 1–2 mg/day for 3–7 days until reaching a maximum daily dose of 2 mg in the morning and 4 mg at night. The last alternative would be electroconvulsive therapy 25 . In a Non‐Emergent Situation, the first step would be decreasing acetylcholinesterase inhibitors and adjusting treatment of pain; the second step would be trazodone to optimise sleep.…”

Section: Aripiprazole Position In Management Algorithms For Bpsdmentioning

confidence: 99%

“…In a Non‐Emergent Situation, the first step would be decreasing acetylcholinesterase inhibitors and adjusting treatment of pain; the second step would be trazodone to optimise sleep. Then, as a third step, the addition of donepezil and memantine would be indicated; the fourth step includes the use of escitalopram and, if all the previous drugs do not work, antipsychotics would be indicated, starting with ARP 25 …”

Section: Aripiprazole Position In Management Algorithms For Bpsdmentioning

confidence: 99%

“…The main adverse effect of ARP is mild–moderate somnolence, which did not increase the risk of falls or gait disorders and led to study withdrawal only in two patients 10,12,13 . Thus, ARP has gained a relevant position in current management algorithms for dementia patients, mainly due to its efficacy regarding rapid control of agitation and aggressiveness 24,25 . All this helps to establish the patient profile that would benefit the most from ARP treatment: patients with very severe behavioural and disruptive symptoms and anxiety.…”

Section: Final Considerationsmentioning

confidence: 99%

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Role of aripiprazole in the management of behavioural and psychological symptoms of dementia: a narrative review

2021

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Behavioural and psychological symptoms of dementia affect in a great way quality of life of both patients and their caregivers, which increases the risk of patient institutionalisation when such symptoms are poorly controlled. One of the drugs that are used for controlling behavioural and psychological symptoms of dementia (BPSD) is aripiprazole. This narrative review aims to solve three basic questions. Is aripiprazole useful for the management of these symptoms? Does aripiprazole play a substantial role regarding safety and efficacy, compared with the other pharmacological options available for the same purpose? Has aripiprazole gained importance in treatment regimens of these symptoms, in current clinical practice? We conclude that aripiprazole is effective to manage BPSD. Moreover, it has shown a good safety profile compared with other antipsychotics in advanced disease and frail patients. Thus, aripiprazole has gained importance in current management algorithms for dementia patients mainly due to its efficacy regarding rapid control of agitation and aggressiveness.

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Section: Aripiprazole Position In Management Algorithms For Bpsdmentioning

confidence: 99%

Section: Aripiprazole Position In Management Algorithms For Bpsdmentioning

confidence: 99%

Section: Aripiprazole Position In Management Algorithms For Bpsdmentioning

confidence: 99%

Section: Final Considerationsmentioning

confidence: 99%

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Role of aripiprazole in the management of behavioural and psychological symptoms of dementia: a narrative review

2021

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“… 38 The Harvard South Shore algorithm describes three separate algorithms for the treatment of BPSD during emergent, urgent and non-urgent situations. 39 For emergent BPSD, the authors recommend using intramuscular (IM) olanzapine as first-line treatment with IM haloperidol being recommended as the second choice, followed by the possible use of an IM benzodiazepine. In urgent situations, the recommendation is to use either oral aripiprazole or risperidone as first-line agents.…”

Section: Introductionmentioning

confidence: 99%

Prazosin for the management of behavioural and psychological symptoms of dementia

Tampi¹,

Tampi²,

Farheen³

et al. 2022

DIC

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Prazosin, a centrally acting α1 adrenoceptor antagonist, has been included in two published algorithms amongst the list of medications that may be used in the management of behavioural and psychological symptoms of dementia (BPSD). However, a review of PubMed, Ovid and Cochrane Collaboration found that there was only one small published randomized controlled trial (RCT) that evaluated the use of prazosin amongst individuals with BPSD. Evidence from this good quality RCT indicates that prazosin appears to benefit individuals with agitation and aggression amongst individuals with BPSD and this medication is well tolerated. When compared to other treatments for BPSD, including atypical antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, repetitive transcranial magnetic stimulation and electroconvulsive therapy, where there are multiple studies for each of these treatment modalities, the data for the use of prazosin for BPSD are limited to just one good quality RCT. Given the limitations in available data, the routine use of prazosin for the treatment of BPSD cannot be recommended at this time. However, prazosin may be used for the management of agitation and aggression amongst individuals with dementia when other medication classes, like acetylcholinesterase inhibitors, memantine, antidepressants and/or atypical antipsychotics, have been ineffective or not tolerated.

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Mental Health Crisis

Rembisz,

Shahal

2024

Managing Mental Illness After COVID‐19 Infection

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The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on management of behavioral and psychological symptoms in dementia

Cited by 22 publications

References 77 publications

Role of aripiprazole in the management of behavioural and psychological symptoms of dementia: a narrative review

Role of aripiprazole in the management of behavioural and psychological symptoms of dementia: a narrative review

Prazosin for the management of behavioural and psychological symptoms of dementia

Mental Health Crisis

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