Beers Criteria recommendations for dementia-related behavioral symptoms state that antipsychotics should be used:

• A. Routinely for all behavioral problems.
• B. Only after documented nonpharmacologic options have failed or if the patient threatens substantial harm.
• C. Only if there is a confirmed diagnosis of schizophrenia.
• D. For long-term management of agitation.

Answer: (B)

Beers Criteria stress that antipsychotics in dementia-related behavioral symptoms are high-risk and should not be used as a routine first-line approach. The recommended path is to try nonpharmacologic strategies first—such as environmental modifications, structured routines, and caregiver education—and only move to antipsychotics if those options have failed to control the behavior or if there is a real danger of substantial harm to the patient or others. If an antipsychotic is used, it should be at the lowest effective dose and for the shortest possible duration, with careful ongoing monitoring and reassessment to discontinue when feasible. This is why the guidance favors using antipsychotics after nonpharmacologic options have been tried and safety concerns are present, rather than for routine or long-term management.