In the behavioral management of dementia, antipsychotics should be avoided unless which condition is met?

• A. Nonpharmacologic options have failed or are not possible and the patient threatens substantial harm to self or others
• B. They are the first-line therapy
• C. They are always avoided
• D. They should be used only in hospital

Answer: (A)

Antipsychotics for behavioral symptoms in dementia are not used routinely. They are reserved for situations where nonpharmacologic strategies have failed or aren’t feasible and the patient poses a substantial risk of harming themselves or others. This reflects the safety concerns and the evidence that these medications can increase mortality in older adults with dementia-related behaviors. If they are used, it should be for the shortest duration at the lowest effective dose, with careful monitoring and regular reassessment, along with continuing nonpharmacologic approaches. The other statements aren’t correct because this approach is not treated as first-line, it isn’t an absolute avoidance, and their use isn’t limited to hospital settings.