If, within a reasonable period of time, a treatment has not been effective in improving target symptoms, if it is accompanied by significant or proportional adverse effects, or if it has led to a deterioration in the resident's level of functioning, then it should be modified or discontinued. When evaluating outcomes, it is important to monitor the resident's social interactions, participation in activities, and self care, as well as the frequency and intensity of behavioral symptoms. When an antipsychotic medication is used for the treatment of agitation and related behavioral disturbances, the process of dose adjustment, rather than the final dose, is a rational measure of the quality of treatment. Residents with agitation secondary to dementia, in general, respond to doses that are low relative to those used in younger adults for the treatment of schizophrenia, but there is significant interindividual variability in the rates of drug metabolism and sensitivity to drug effects. Treatments for all residents should start at low doses, with dose increments made as needed after careful observation of the resident for both therapeutic response and adverse effects.
PRN medications can have an important role during the upward or downward titration of dosage.
They also can be of benefit when prodromal symptoms are observed in residents with infrequent recurrent episodic disturbances. Neither the natural history of behavioral disturbances in residents with dementia nor the long-term effects of psychotherapeutic medications have been adequately studied. Therefore, the appropriate duration of such treatment must be established on an individual basis. When residents have been stabilized on medications that appear to be effective, trials of dose reduction or discontinuation are desirable to determine the necessity for continuing maintenance treatment. Functional psychiatric disorders such as depression are common in nursing home residents and require treatment.