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Treatment Options for Dementia Related Psychosis

Medically Reviewed by Christopher Melinosky, MD on March 06, 2021

Almost everyone with dementia will have at least one symptom of psychosis. They see, hear, or believe things that aren't real. Some people get angry, aggressive, and can become dangerous to themselves or to other people.

Dementia-related psychosis can be scary and upsetting if it happens to you or a loved one.

Finding the right treatment isn't always easy. Doctors often prescribe strong antipsychotic drugs, which can cause serious side effects. Plus, these medicines don't always help.

There are things you can do to help you manage dementia-related psychosis more safely for yourself or someone you care about.

Look for a Cause

One of the first things to do is a medicine check. A few drugs cause side effects that look like psychosis, including drugs that treat:

  • Anxiety
  • Depression
  • Pain
  • Heart disease
  • High blood pressure
  • Parkinson's disease
  • Cancer

Switching to another medicine may change things. Talk with your doctor about it. Don't stop taking any drug until your doctor says it's OK.

A few health conditions also cause psychosis, including:

  • Certain infections
  • Constipation
  • Vision or hearing problems
  • Sleep problems
  • Pain

A doctor can figure out if one of these problems is to blame, and if so, how to treat it.

Remove Triggers

Many things in your environment can trigger psychosis symptoms. Those things include:

  • Shadows on the wall that looks like monsters
  • Changes in routine
  • Too much or too little activity

To help manage those triggers, you can:

  • Remove or cover mirrors.
  • Clear floors.
  • Install bright lights to prevent shadows.
  • Try to stick to the same schedule every day.

Plan activities throughout the day that you or your loved one enjoys.

Ask the Doctor About Medicine

The FDA hasn't approved any drugs for dementia-related psychosis. Doctors often prescribe atypical, or second-generation antipsychotics meant to help with schizophrenia and bipolar disorder.

Examples of these drugs include:

  • Aripiprazole (Abilify)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)

Antipsychotic drugs may help a bit with symptoms. But they can be risky in people with dementia because they cause side effects like:

  • Low blood pressure
  • Sleepiness and confusion, which can make falls more likely.
  • Shaking or tremors
  • Pneumonia
  • Stroke

Doctors are very cautious about prescribing these medicines because they also raise the chance of sudden death.

It's safer to try non-medicine treatments first. Or you might try an antidepressant or a drug that treats memory loss. Those treatments are less likely to cause serious side effects.

Try to avoid antipsychotic drugs unless your loved one is at serious risk of hurting themselves or others. Even then, start on the lowest dose possible, and use the medicine for just long enough to ease symptoms.

 

Get Help

It can also help to see a therapist or other mental health care provider. Certain types of therapy, like music or pet therapy, seem to benefit people with psychosis. Your therapist can suggest ways to prevent psychosis without medicine.

Don't Use Restraints

Restraints prevent people with dementia from moving so they don't hurt themselves or anyone else. Examples are belting someone into a chair, tying them to the bed, or locking them in a room.

While they do prevent someone from moving or hurting anyone, restraints can be harmful. First, they're distressing to the person who's restrained. And they can lead to falls, bladder leaks, and pressure sores.

There are safer ways to protect someone with dementia. For example, you might lock the door to keep them out of a dangerous room like the kitchen.

The Alzheimer's Association doesn't recommend restraining anyone unless they are in real danger.

WebMD Medical Reference

Sources

SOURCES:

Alzheimer's Association: "Challenging Behaviors."

Alzheimer Society: "Using restraints."

American Addiction Centers: "How to Identify Substance-Induced Psychosis."

American Family Physician: "Behavior Disorders of Dementia: Recognition and Treatment."

Brain & Life: "What Is Dementia-Related Psychosis?"

Choosing Wisely: "Treating Disruptive Behavior in People with Dementia."

CNS Drugs: "Management of Dementia-Related Psychosis, Agitation and Aggression: A Review of the Pharmacology and Clinical Effects of Potential Drug Candidates."

Rethink Mental Illness: "Antipsychotics."

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