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STEP 16: Manage any BPSD
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➤ Prior to instituting any treatments, rule out reversible causes and try
non-pharmacological management strategies first. Refer to Appendix C.
➤ Document target symptom. Clearly document treatment targets, i.e.
what symptoms are we treating and what monitoring strategy will be
used to determine effectiveness.
➤ Always justify use of an antipsychotic. The treatment target symptom
must present a danger to the person or other persons according to
CMS guidelines for the use of an antipsychotic in nursing homes.
Refer to Appendix G.
• Appropriate antipsychotic treatment targets
▶ Aggressive behavior causing physical harm to self or others
▶ Hallucinations causing distress to the patient
▶ Delusions distressing to patient or other residents
▶ Agitation causing severe distress to patient
• Inappropriate antipsychotic treatment target symptoms
➤ Evidence supports modest symptom improvement with aripiprazole,
haloperidol, olanzapine, quetiapine, and risperidone. Refer to
Appendix A.
➤ Special populations
• Frontotemporal dementia, some evidence for trazodone or selective serotonin
reuptake inhibitors (SSRIs).
• Parkinson's disease and Lewy body dementia, quetiapine or clozapine are preferred
due to lower incidence of extrapyramidal symptoms.
• Renal impairment, reduced dose of risperidone. Titrate slowly.
• Hepatic impairment, reduced dose of olanzapine.
▶ Wandering
▶ Insomnia
▶ Poor self-care
▶ Restlessness
▶ Nervousness
▶ Fidgeting
▶ Mild anxiety
▶ Impaired memory
▶ Uncooperativeness without
aggressive behavior
▶ Inattention or indifference to
surroundings
▶ Sadness or crying alone that
is not related to depression or
another psychiatric disorder
