BPSD — structured clinical viva

This is chronic antipsychotic exposure for BPSD without clear ongoing severe risk, now with sedation and falls risk. Re-describe the original target symptom and current behaviour with ABC/DICE; exclude pain, constipation, infection and environmental triggers for residual shower resistance; screen for EPS, orthostasis and oversedation. Nine months without structured review is already a red flag. ^[1]

Evidence framing for family. Schneider meta-analysis: atypical antipsychotics increase death risk versus placebo in dementia RCTs. CATIE-AD: limited effectiveness and frequent discontinuation. DART-AD long-term: continued neuroleptics associated with higher mortality — the tablet is not a harmless "calm forever" medicine. Devanand: among responders, stopping risperidone can increase relapse — so taper carefully with monitoring rather than abrupt cessation if prior severe psychosis/aggression. ^[2][3][4][5]

Plan. Optimise non-drug personal-care strategies and pain management (Husebo). Gradual dose reduction (e.g. reduce by 25–50% every 1–2 weeks) toward stop if stable, with staff education on relapse signs and criteria to restart a low dose. Document risk–benefit discussion with substitute decision-maker. ^[1][6]