مرض الزهايمر مع الهياج والعدوانية — الخطوة التالية عندما لا يحقق السيتالوبرام السيطرة الكافية

References

DOI: 10.1016/S0140-6736(25)01329-7

• Only the atypical antipsychotics risperidone (Europe and Canada) and brexpiprazole (USA, Canada, and Switzerland), and the typical antipsychotic haloperidol (Germany), are licensed for the treatment of agitation aggression for people with dementia.
• Following a risk–benefit assessment, person C is switched to risperidone over 4 weeks with a cross-taper switch scheme. Brexpiprazole would have been equally indicated.
• Doses of risperidone or brexpiprazole should be started low and increased over 2–4 weeks to identify the lowest effective dose, with careful monitoring for oversedation, reduced mobility, or other adverse effects.
• Personal experience and evidence from the literature suggest that citalopram and atypical antipsychotics, such as quetiapine, confer small, but significant, benefits for agitation, at least for the first 3 months of treatment, and even smaller benefits are found for psychosis.
• As it usually takes at least 4 weeks for the benefits of slow-tapering antipsychotic medication to become evident, it is also important to help to reduce potential triggers—eg, by enabling person C to spend more time in a quiet lounge or his room (with regular interaction).