Risperidone for Dementia Aggression — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareRisperidone for Dementia AggressionSCE Palliative Medicine

An 82-year-old care-home resident with dementia was started on risperidone six weeks ago for aggression that created immediate risk. Pain, infection and environmental triggers were treated. She is now settled. What is the best next step?

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Correct answer: C — Review and attempt supervised withdrawal

Antipsychotics in dementia are reserved for severe distress or risk of harm after reversible causes and non-drug measures have been addressed. They should be used at the lowest effective dose for the shortest possible time, with explicit reassessment. Once the crisis has resolved, a planned dose reduction or withdrawal should be attempted if clinically safe. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: NICE NG97: Dementia—managing non-cognitive symptoms. https://www.nice.org.uk/guidance/ng97/chapter/recommendations