BPSD Prescribing — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryBPSD PrescribingMRCPsych Paper B

A 75-year-old woman with moderate to severe Alzheimer's dementia has persistent aggression despite appropriate non-pharmacological interventions, and there is a risk of harm to others. Risperidone is prescribed within its UK marketing authorisation. What is the maximum licensed duration of treatment for this indication?

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Correct answer: E — 6 weeks

The correct answer is E: 6 weeks. The UK marketing authorisation permits risperidone for short-term treatment of persistent aggression in moderate to severe Alzheimer's dementia when non-pharmacological approaches have been unsuccessful and there is a risk of harm. The SmPC states that it should not be used for more than 6 weeks for this indication, with frequent reassessment of the need for treatment. Two weeks is not the licensed maximum. Treatment for 3 months, 6 months or indefinitely would exceed the licensed duration and would require a separate, carefully justified off-label decision. Antipsychotic exposure should be kept as short as possible because people with dementia have increased risks including cerebrovascular adverse events and mortality.

Reference: Electronic Medicines Compendium, Risperidone 2 mg Tablets: Summary of Product Characteristics, sections 4.1, 4.2 and 4.4, updated 17 January 2024. https://www.medicines.org.uk/emc/product/11872/smpc