Rational and nonrational use of antipsychotics in gerontopsychiatry

In gerontopsychiatry, states of agitation or other disorders requiring sedation are often encountered. They are most commonly behaviour

disorders in dementias, deliria, and psychotic conditions at older age (sometimes associated with the dementia syndrome, sometimes not).

There is a general trend to calm such states as soon as possible. First, attempts are made to ease agitation or other unwanted behaviour

disorders with nonpharmacological methods, but these efforts are not always successful. Therefore, antipsychotics are used at a large

scale. Their use often is nonrational resulting in their overuse. At times, their use is necessary since severe agitation, delirium, or psychotic

symptoms may be life-threatening to patients. Antipsychotics with minimal adverse effects should be used. For that reason, first-generation

antipsychotics are not routinely used. There are exceptions – melperone, whose properties are close to those of the second-generation

antipsychotics, is normally used, and, in severe agitation, haloperidol is used in a single dose or in a short term. For deliria and agitation in

dementia, tiapride is widely used; however, its antipsychotic potential is low. When psychotic symptoms are predominant, other atypical

antipsychotics are used. Their benefits and risks are discussed. In behaviour disorders associated with dementia, the use of acetylcholinesterase

inhibitors and memantine is appropriate.

Keywords: antipsychotics, delirium, dementia, agitation, behaviour disorders.