skip to main content

BPSD Management — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardGeriatric MedicineBPSD ManagementRACP Adult Medicine

A 75-year-old with Alzheimer disease has frightening delusions and repeated physical aggression creating immediate risk to his spouse. Pain, urinary retention, constipation, infection, medication toxicity and delirium have been assessed; tailored environmental and behavioural measures have failed. If medication is now required, which plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Begin low-dose risperidone, document target behaviours and harms, then schedule response and deprescribing reviews

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

E is correct. Antipsychotics have a narrow role only after causes and person-centred measures are addressed and symptoms are severe, distressing or dangerous. E low-dose risperidone trial can be considered with substitute decision-maker involvement where relevant, explicit target symptoms, discussion of stroke and mortality risk and an early deprescribing review. A increases falls, sedation and delirium. B converts a short therapeutic trial into indefinite exposure. C uses chemical sedation without a defined indication or monitoring plan. D lacks evidence for routine aggression control and adds substantial toxicity. If there is no meaningful benefit, treatment should stop; if it helps, the need should still be reassessed and tapering attempted.

Reference: RACGP Silver Book: Behavioural and psychological symptoms of dementia: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/behavioural-and-psychological-symptoms-of-dementia