Treatment of the agitation of late-life psychosis and Alzheimer's disease.

In older as well as younger people, antipsychotic medication is commonly used to treat psychoses. In clinical practice, antipsychotic medication is also used to control severe behavioral disturbances such as agitation, wandering, self-mutilation, as well as assaultiveness. Neuroleptic and non-neuroleptic drug treatments are used to control severe agitation and disruptive behavior. Among typical neuroleptics, very low doses (e.g., 0.25 mg of haloperidol 1-4 times per day) may be effective and limit the development of severe extrapyramidal reactions. Recent experience suggests that the atypical neuroleptics, olanzaine, risperidone, and quetiapine, are also useful for controlling severe agitation in elderly demented nursing home residents. The benzamides are also known for the treatment of behavioral disturbances in Europe, but there is little experience in the U.S.A. Although research studies in this area are virtually nonexistent, growing clinical experience suggests that the following may be quite useful: 1) trazodone; 2) buspirone (Buspar); 3) anticonvulsants (e.g., valproate); and 4) beta-blockers.