Historically, BPSD was treated with a range of medicines, including benzodiazepines, antipsychotics and antidepressants. Currently, the antipsychotic drug risperidone is only licensed for short-term use (up to six weeks) for persistent aggression in patients with moderate to severe Alzheimer's disease (AD) that is unresponsive to non-pharmacological approaches in patients with a risk of harm to themselves or others. Only specialists should prescribe risperidone, once they have considered the risks and put a process in place for a review.

Other antipsychotics are not licensed for BPSD. In March 2004, the MHRA advised against using risperidone and olanzapine in people with dementia due to the increased risk of cardiovascular and cerebrovascular (stroke) events. In 2009, the MHRA issued further guidance stating that there is a clear increased risk of stroke and a small increased risk of death associated with antipsychotics in elderly people with dementia.

In 2008, the Government commissioned a report to examine the use of antipsychotics in people with dementia in response to safety concerns. The report concluded that the risks outweigh the benefits in most cases and antipsychotics are too often used as a first-line response to difficult behaviour in dementia, rather than a considered second-line treatment when other nonpharmacological approaches have failed. The report recommended that people with dementia should only receive antipsychotics when absolutely necessary and that reducing their use in this group should be an NHS priority.

Suggestions to achieve this included:

• Training carers and medical staff to use alternatives
• Providing psychological therapies for patients and carers
• Carrying out further research into alternative treatments
• Conducting audits.

A 52 per cent reduction in antipsychotic prescriptions for people with dementia was achieved between 2008 and 2011. The evidence for the use of acetylcholinesterase inhibitor medicines in BPSD treatment is weak. However, the NICE-SCIE Clinical guideline CG42 advises that patients with dementia with Lewy bodies are offered acetylcholinesterase inhibitors in preference to antipsychotics for BPSD.

Patients with AD should be offered acetylcholinesterase inhibitors when €non-drug treatments or antipsychotics are inappropriate or ineffective€.