Mental Health Month: Caregivers Guide to Drugs Used for Agitation and Psychosis
This month is Mental Health Month so I thought it would be good to look at drugs used to treat agitation and psychosis, what you should expect from this type of medication and when you need to get more help. Agitation
is seen in about 60 to 80 percent of people with Alzheimer's disease and psychoses around 35 to 50 percent. Medications are often used to treat behavioral disturbances associated with agitation and paranoia seen in the moderate stage of Alzheimer's disease.
Finding the Correct Drug and Dosage
Caregiver information is central to monitor drug effectiveness.
When a doctor prescribes drugs he should have already:
- made a thorough assessment of the patient.
- have treated or be treating any reversible medical problems they have and that may be contributing to their psychiatric condition, and
- implemented any behavioural programes and considered environmental issues contributing to the situation.
The doctor needs to prescribe the appropriate drug, find the correct dosage and prevent or minimize any drug interactions or side effects from it.
The role of the caregiver is pivotal to getting the best results. The doctor cannot be with his patient 24/7 so the caregiver needs to report back to the doctor the positive and negative effects the drug/drugs they are taking.
Medications for Agitation, Psychosis and Alzheimer's
There are many different forms of medication available that can be used to treat agitation but only antipsychotic agents are used to treat psychosis. Potential agents include:
Anxiolytics; Examples are Lorazepam (Ativan), Alprazolam (Xanax), Oxazepam (Serax).
Drugs used to treat Alzheimer's disease can also help with agitation. They include Donepezil (Aricept), Rivastigmine (Exelon), Tagrine (Cognex), Reminyl.
Mood stabilizers-Examples include Carbamazipine (Tegretol), Divalproex (Depakote)
Antipsychotics- Examples are Haloperidol (Haldol) and atypical types of medication such as Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (seoquel)
Age Affects How Drugs Work
There are a number of reasons why drugs work differently and make older people more prone to adverse reactions to them.
Elders experience more adverse drug reactions for a number of reasons. Older people get more diseases and often have multiple diseases. Receiving all sorts of different drugs for different illnesses at one time makes it more likely that they will suffer adverse drug interactions.
Body changes of advancing age affect drug distribution and metabolism. This can lead to drug toxicity at doses that are therapeutic for younger people. Elders often have smaller body sizes so that common prescription doses can be more toxic to them. Total body water decreases with age by as much as 15 percent making a difference to blood concentrations. A number of studies have shown that reduced absorption of nutrients can affect drug absorption although no clinically significant decreases in drug absorption resulting from normal aging have been recognized.
Older bodies become less efficient. Liver size decreases in mass resulting in changes of function and the ability to metabolise drugs. Kidneys become less efficient at reabsorbing and getting rid of body waste and toxins. The ageing central nervous system shows increased susceptibility to many commonly used drugs
Certain Drugs Can Cause More Problems
Some drugs can cause more problems than others. Benzodiazepines, opiates and warfarin are typical. The benzodiazepines producing increased sedation, opiates may result in increased analgesia and respiratory suppression, and warfarin, an increased anticoagulant effect.
How Long Should You Tolerate Symptoms for Before Seeking Help?
If the drugs do not seem to be helping after a week or two and/or behavior problems do not stabilize, or continue to worsen, go back to the doctor.
How Long Should You Tolerate Drug Side Effects before Getting Help?
It is always important to contact the doctor urgently and get help for medication side effects. Some side effects are life threatening and it is important to get the patient assessed. Sometimes the doctor may reduce the dose and other times he may stop the drug altogether and commence a new one that target the symptoms she/he is experiencing.