Behavioral and psychological symptoms of dementia Management Initial management Evaluate for general medical, psychiatric, environmental, or psychosocial problems that may underlie the behavioral and psychological symptoms, and manage any underlying causes appropriately. A Use of restraints Q Does the patient pose an imminent risk of harm to themselves or others? Yes Avoid physical restraints in patients who do not pose an imminent risk of physical harm to themselves or others. D No Use physical restraints for the management of behavioral symptoms of dementia only in patients who pose an imminent risk of physical harm to themselves or others. A Pharmacologic treatment APA Q Does the patient show an inadequate response to nonpharmacologic measures? Q Does the patient experience symptoms that are dangerous or particularly distressing? No to all Implement environmental measures, such as reassurance and redirection, to address persistent symptoms that do not cause significant danger or distress to the patient or others. A Yes to any Consider the judicious use of psychotropic agents in patients with BPSD in whom nonpharmacologic measures are unsuccessful, or if the behaviors are particularly dangerous or distressing. C Antipsychotic agents APA Q Does the patient have severe agitation? Q Does the patient have psychotic symptoms? Yes to any Consider using antipsychotic medications for the treatment of psychosis in patients with dementia. C Consider using antipsychotic medications for the treatment of agitation in patients with dementia. C Use antipsychotic medications with caution, and at the lowest effective dose, recognizing that they are associated with a number of severe adverse events, including increased risks for death, cerebrovascular accidents, tardive dyskinesia, neuroleptic malignant syndrome, hyperlipidemia, weight gain, diabetes mellitus, sedation, parkinsonism, and worsening of cognition. A No to all Benzodiazepines APA Q Does the patient have predominant anxiety? No Reevaluate the use of psychotropic agents and document their benefit on an ongoing basis. A Yes Consider using benzodiazepines in treating patients with prominent anxiety, who may derive a modest benefit from their use. C Re-evaluation of pharmacologic treatment Reevaluate the use of psychotropic agents and document their benefit on an ongoing basis. A