Agitation, aggression and psychotic symptoms

Drugs used in treatment

Major tranquillisers (also known as neuroleptics or antipsychotics) are medicines that were originally developed to treat younger people with schizophrenia.

They are frequently prescribed to people with dementia for symptoms including agitation, delusions (disturbed thoughts and false beliefs), hallucinations (seeing and hearing things that aren't there), sleep disturbance and aggression.  Commonly used medicines include thioridazine, haloperidol and risperidone.

Side-effects

Side-effects include excessive sedation, dizziness, unsteadiness and Parkinsonism, when the symptoms resemble those of Parkinson's disease (mask-like face, shakiness, slowness and stiffness of the limbs).  Tranquillisers may be dangerous for those with dementia with Lewy bodies or Parkinson's disease.

A new generation of major tranquillisers may be less prone to produce troublesome side-effects and these include risperidone.

Whichever medicine is used, treatment with major tranquillisers should be reviewed regularly and the dose reduced or the medicine withdrawn if side-effects become unacceptable.

Excessive sedation with major tranquillisers may reduce symptoms such as restlessness and aggression, but at the same time, reduce mobility and worsen confusion.

Anticonvulsant drugs such as sodium valproate and carbamazepine (Tegretol) are sometimes also used to reduce aggression and agitation, as is the antidepressant drug trazodone.