The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on management of behavioral and psychological symptoms in dementia.


:Geriatric patients with dementia frequently present with agitation, aggression, psychosis, and other behavioral and psychological symptoms of dementia (BPSD). We present an update of our previously published algorithms for the use of psychopharmacologic agents in these patients taking into account more recent studies and findings in meta-analyses, reviews, and other published algorithms. We propose three algorithms: BPSD in an emergent, urgent, and non-urgent setting. In the emergent setting when intramuscular (IM) administration is necessary, the first-line recommendation is for olanzapine (since IM aripiprazole, previously favored, is no longer available) and haloperidol injection is the second choice, followed by possible consideration of an IM benzodiazepine. In the urgent setting, the first line would be oral second-generation antipsychotics (SGAs) aripiprazole and risperidone. Perhaps next could be then prazosin, and lastly electroconvulsive therapy is a consideration. There are risks associated with these agents, and adverse effects can be severe. Dosing strategies, discontinuation considerations, and side effects are discussed. In the non-emergent setting, medications are proposed for use in the following order: trazodone, donepezil and memantine, antidepressants such as escitalopram and sertraline, SGAs, prazosin, and carbamazepine. Other options with less support but potential future promise are discussed.


Psychiatry Res


Psychiatry research


Chen A,Copeli F,Metzger E,Cloutier A,Osser DN




Has Abstract


2021-01-01 00:00:00












  • The association between short and long nocturnal sleep durations and risky behaviours and the moderating factors in Taiwanese adolescents.

    abstract::Sleep quantity and risky behaviours are important health issues in adolescents. This cross-sectional study aimed to examine the association between short and long nocturnal sleep durations and a variety of adolescent risky behaviours, including suicidality, violence, regular alcohol consumption, illicit drug use, trua...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Yen CF,King BH,Tang TC

    更新日期:2010-08-30 00:00:00

  • Cognitive performance in schizophrenia: relationship to regional brain volumes and psychiatric symptoms.

    abstract::In an all-male sample of schizophrenic patients stabilized by medication (n=62) and normal controls (n=27), we obtained neuropsychological test data and high-resolution whole brain magnetic resonance scans, as well as detailed psychiatric rating scales on a subset of the patients (n=47). Schizophrenic patients had sig...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Sanfilipo M,Lafargue T,Rusinek H,Arena L,Loneragan C,Lautin A,Rotrosen J,Wolkin A

    更新日期:2002-11-30 00:00:00

  • Are Schizophrenic disorders with or without early cannabis use neurobiologically distinct disease entities? A meta-analysis of magnetic resonance imaging studies.

    abstract::Cannabis use is considered an important risk factor for the development of psychotic illness and is associated with worse outcomes of the disorder. This study aimed to determine through a meta-analytic approach whether patients at the onset of schizophrenia with comorbid cannabis use (SCH CU+) show a different pattern...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Luca P,Rafael T,Emilio B,Antonio V

    更新日期:2021-01-16 00:00:00

  • Relationships between neuropsychological variables and factor-analysed symptom dimensions in obsessive compulsive disorder.

    abstract::Despite mounting evidence for the distinctiveness of symptom dimensions in obsessive-compulsive disorder, neuropsychological studies have been few, focused on small samples, and relying on classification of participants based on mutually exclusive symptom categories, resulting in lack of concordance across neuropsycho...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Kashyap H,Kumar JK,Kandavel T,Reddy YC

    更新日期:2017-03-01 00:00:00

  • Effects of mood induction on consumers with vs. without compulsive buying propensity: an experimental study.

    abstract::Compulsive buying (CB) is excessive and leads to impairment and distress. Several studies aimed to explore the phenomenology and antecedents of CB, especially affective states. However, these studies mostly used retrospective self-report and mostly focused on compulsive buyers only. Therefore, this study aims to direc...

    journal_title:Psychiatry research

    pub_type: 杂志文章,随机对照试验


    authors: Vogt S,Hunger A,Türpe T,Pietrowsky R,Gerlach AL

    更新日期:2014-12-15 00:00:00

  • Bleuler revisited: psychomotor slowing in schizophrenia as part of a catatonic symptom cluster.

    abstract::In schizophrenia, psychomotor slowing and stereotypy are poorly delineated from cognitive deficits like diminished processing speed. Inpatients' performance outcomes on a line-copying task, a task assessing stereotypy and a processing-speed task are compared. Results suggested that psychomotor slowing and stereotypy a...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Morrens M,Hulstijn W,Lewi P,Sabbe B

    更新日期:2008-10-30 00:00:00

  • The relationship between jumping to conclusions and neuropsychological functioning in schizophrenia.

    abstract::Jumping to conclusions (JTC) is defined as a tendency to make decisions based on insufficient information. JTC has been reported in patients with psychosis, but the mechanisms of this cognitive bias remain unknown. The main aim of our study was to investigate the relationship between JTC and neuropsychological functio...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Krężołek M,Pionke R,Banaszak B,Kokoszka A,Gawęda Ł

    更新日期:2019-03-01 00:00:00

  • Personality disorders improved after arachnoid cyst neurosurgery, then rediagnosed as 'minor' organic personality disorders.

    abstract::The prevalence of arachnoid cysts (AC) is considerably increased in psychiatric patients, suggesting a possible causal relationship between AC and certain psychiatric disorders. Neurosurgery of AC in psychiatric disorders is, however, not recommended if no accompanying neurological symptoms or signs of increased intra...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Bechter K,Wittek R,Seitz K,Antoniadis G

    更新日期:2010-12-30 00:00:00

  • [123I]Iomazenil SPECT benzodiazepine receptor imaging in schizophrenia.

    abstract::Deficient inhibitory neurotransmission of gamma-aminobutyric acid (GABA) has been implicated in the pathophysiology of schizophrenia based on postmortem studies. However, in vivo studies have shown predominantly negative or conflicting results. The goal of this study was to better characterize possible changes of the ...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Verhoeff NP,Soares JC,D'Souza CD,Gil R,Degen K,Abi-Dargham A,Zoghbi SS,Fujita M,Rajeevan N,Seibyl JP,Krystal JH,van Dyck CH,Charney DS,Innis RB

    更新日期:1999-10-11 00:00:00

  • Reduced risk of stroke among psychiatric patients receiving ECT: A population-based cohort study in Taiwan.

    abstract::Electroconvulsive therapy (ECT) as well as the diseases it treats have been associated with stroke and cognitive impairment. We investigate the relationship between ECT and the subsequent development of stroke in patients with different severe mental illnesses. Tapping Taiwan's National Health Insurance Research Datab...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Hsieh KY,Tsai KY,Chou FH,Chou YM

    更新日期:2019-06-01 00:00:00

  • Double jeopardy in the United States: Early onset bipolar disorder and treatment delay.

    abstract:BACKGROUND:Evidence is emerging that early onset bipolar disorder and the duration of the delay to first treatment are both risk factors for poor treatment outcome. We report on the incidence and implications of these two risk factors in patients from the United States (US) versus Europe. METHODS:Age of onset and age ...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Post RM,Altshuler LL,Kupka R,McElroy SL,Frye MA,Rowe M,Grunze H,Suppes T,Keck PE Jr,Nolen WA

    更新日期:2020-10-01 00:00:00

  • Role of C-reactive protein in schizophrenia: an overview.

    abstract::Over the years, schizophrenia is speculated to be associated with immune or inflammatory reactions mediated by cytokines. It is proposed that chronic inflammation might damage the micro-vascular system of brain and hamper cerebral blood flow. Scientific evidence suggests that an increase of stress hormone like norepin...

    journal_title:Psychiatry research

    pub_type: 杂志文章,评审


    authors: Singh B,Chaudhuri TK

    更新日期:2014-05-15 00:00:00

  • Insomnia symptoms, behavioral/emotional problems, and suicidality among adolescents of insomniac and non-insomniac parents.

    abstract::The aim of this study was to examine insomnia symptoms, behavioral problems, and suicidality among adolescents of insomniac parents (IP) and non-insomniac parents (NIP). A family survey of sleep and health was conducted among 1090 adolescents and their parents in Jinan, China. Adolescents completed a sleep and health ...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Liu X,Zhao Z,Jia C

    更新日期:2015-08-30 00:00:00

  • Accuracy and reproducibility of brain and tissue volumes using a magnetic resonance segmentation method.

    abstract::Magnetic resonance (MR) imaging now allows the qualitative and quantitative assessment of the human brain in vivo. As MR imaging resolution has improved, precise measurement of small brain structures has become possible. Methods of measuring brain regions from MR images include both manual and semiautomated methods. D...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Byrum CE,MacFall JR,Charles HC,Chitilla VR,Boyko OB,Upchurch L,Smith JS,Rajagopalan P,Passe T,Kim D,Xanthakos S,Ranga K,Krishnan R

    更新日期:1996-10-07 00:00:00

  • Relationship between PTSD and pathological personality traits in context of disasters.

    abstract::One of the recurrent outcomes after a stressor event as a disaster is post-traumatic stress disorder (PTSD), which appears to be mediated, in part, by emotional, behavioral, and psychological responses, arising from the belief system associated with the traumatic experience. Studies suggest that personality traits are...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Reis AM,de Francisco Carvalho L,Elhai JD

    更新日期:2016-07-30 00:00:00

  • Dysfunctional parental styles perceived during childhood in outpatients with substance use disorders.

    abstract::People who suffer from substance use disorders (SUDs) frequently report to have undergone childhood adversity that is often associated with father or mother dysfunction, or both. Yet that issue has been barely addressed in opiate dependent patients. Therefore we sought to evaluate parent-specific dysfunctional styles ...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Icick R,Lauer S,Romo L,Dupuy G,Lépine JP,Vorspan F

    更新日期:2013-12-15 00:00:00

  • Need for closure and cognitive flexibility in individuals with autism spectrum disorder: A preliminary study.

    abstract::The need for closure (NFC), a desire for a firm answer and less ambiguity, has a key role in cognitive flexibility in typical development (TD) populations. This study investigated this motivational construct and its relation to cognitive inflexibility in autism spectrum disorder (ASD). Compared with individuals with T...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Fujino J,Tei S,Itahashi T,Aoki Y,Ohta H,Kubota M,Isobe M,Hashimoto RI,Nakamura M,Kato N,Takahashi H

    更新日期:2019-01-01 00:00:00

  • Psychotic and nonpsychotic depressions: II. Platelet MAO activity, plasma catecholamines, cortisol, and specific symptoms.

    abstract::Preliminary data are presented on levels of plasma cortisol, dopamine (DA), epinephrine (EPI), and norepinephrine (NE) before and after dexamethasone in 22 depressed patients (of whom 4 were psychotic). Platelet monoamine oxidase (MAO) activity, determined in 19 of the depressed patients, was significantly higher in t...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Schatzberg AF,Rothschild AJ,Langlais PJ,Lerbinger JE,Schildkraut JJ,Cole JO

    更新日期:1987-02-01 00:00:00

  • Cognitive impairment and depression symptoms are independently associated with suicidal ideation in US Veterans.

    abstract::Depression is associated with cognitive impairment and suicidality. The independent association between cognitive impairment and suicidality is less clear. We examined the relationship between suicidal ideation and cognitive impairment in a sample of 50 veterans with depressive disorder diagnoses. Using zero-inflated ...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Ryan AT,Phalen P,Jahn DR,Wastler H,Bennett M,Ghahramanlou-Holloway M,Schwartz B

    更新日期:2020-01-30 00:00:00

  • Autonomic effects of dextroamphetamine in normal men: implications for hyperactivity and schizophrenia.

    abstract::This study test the effects on autonomic nervous system (ANS) activity of two doses (0.25 mg/kg and 0.50 mg/kg) of dextroamphetamine in normal men. Skin conductance and heart rate were recorded during rest, tone presentation, and a reaction time task. Compared to placebo, dextroamphetamine increased both skin conducta...

    journal_title:Psychiatry research

    pub_type: 临床试验,杂志文章


    authors: Zahn TP,Rapoport JL,Thompson CL

    更新日期:1981-02-01 00:00:00

  • Association of adoptive child's thought disorders and schizophrenia spectrum disorders with their genetic liability for schizophrenia spectrum disorders, season of birth and parental Communication Deviance.

    abstract::Joint effects of genotype and the environment have turned out to be significant in the development of psychotic disorders. The purpose of the present study was to assess the association of an adoptive child׳s thought and schizophrenia spectrum disorders with genetic and environmental risk indicators and their interact...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Roisko R,Wahlberg KE,Hakko H,Tienari P

    更新日期:2015-04-30 00:00:00

  • Perceived coercion in voluntary hospital admission.

    abstract::The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to thos...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: O'Donoghue B,Roche E,Shannon S,Lyne J,Madigan K,Feeney L

    更新日期:2014-01-30 00:00:00

  • Circulating miRNA associated with posttraumatic stress disorder in a cohort of military combat veterans.

    abstract::Posttraumatic stress disorder (PTSD) affects many returning combat veterans, but underlying biological mechanisms remain unclear. In order to compare circulating micro RNA (miRNA) of combat veterans with and without PTSD, peripheral blood from 24 subjects was collected following deployment, and isolated miRNA was sequ...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Martin CG,Kim H,Yun S,Livingston W,Fetta J,Mysliwiec V,Baxter T,Gill JM

    更新日期:2017-05-01 00:00:00

  • Is a gin and tonic more like gin or tonic? A comparison of comorbid and non-comorbid anxiety disorder diagnostic pairs.

    abstract::Despite findings indicating that anxiety disorders are more likely to co-occur with each other than occur in isolation, little research has explored precise areas of overlap and differentiation among comorbid pairs of anxiety disorders. Furthermore, many studies comparing phenomena across anxiety disorders define comp...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Norton PJ,Chase TE

    更新日期:2015-01-30 00:00:00

  • Depression type and depression severity in relation to risk of violent suicide attempt.

    abstract::Low levels of cerebrospinal fluid 5-hydroxyindoleacetic acid and a blunted thyroid-stimulating hormone response to thyrotropin-releasing hormone have been reported in depressed patients--in particular in those who have made violent suicide attempts. There are at least two conceivable explanations for these findings: T...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: van Praag HM,Plutchik R

    更新日期:1984-08-01 00:00:00

  • Influences of parenting on normal personality traits.

    abstract::There is a considerable literature linking aspects of experienced parenting to later personality disorders. Because dimensionally measured personality disorders are associated with variations in normal personality traits, it is important to understand the contribution of parenting experienced in childhood to later nor...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Reti IM,Samuels JF,Eaton WW,Bienvenu OJ 3rd,Costa PT Jr,Nestadt G

    更新日期:2002-08-05 00:00:00

  • Cortical atrophy in young adults with a history of hyperactivity in childhood.

    abstract::A computed tomographic (CT) brain scan study was conducted in 24 young males treated and followed up for hyperactivity since childhood. Compared to 27 matched controls, adults with a history of hyperactivity had a significantly greater frequency of cerebral atrophy. No differences in cerebellar atrophy frequency or in...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Nasrallah HA,Loney J,Olson SC,McCalley-Whitters M,Kramer J,Jacoby CG

    更新日期:1986-03-01 00:00:00

  • Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK.

    abstract::The absence of assessment tools incorporating different cultural models of mental illness is a major barrier to recruiting ethnic minorities into clinical trials, reducing generalisability of findings and potentially increasing disparities in access to evidence-based care. This study aimed to develop and validate a ne...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Degnan A,Berry K,James S,Edge D

    更新日期:2018-05-01 00:00:00

  • Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy.

    abstract::Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizo...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Michaels TM,Horan WP,Ginger EJ,Martinovich Z,Pinkham AE,Smith MJ

    更新日期:2014-09-04 00:00:00

  • Motor mechanisms in schizophrenic patients with tardive dyskinesia.

    abstract::A specific aspect of the motor output of patients with tardive dyskinesia was investigated with an experimental procedure referenced in force control function (i.e., the maintenance of sustained force output). We hypothesized that response output (button press) at a given level would be significantly altered when prec...

    journal_title:Psychiatry research

    pub_type: 杂志文章


    authors: Vrtunski PB,Alphs LD,Meltzer HY

    更新日期:1994-10-01 00:00:00