Comments and Controversies
Dr. Henry A. Nasrallah is on target in his editorial, “Combination therapies are here to stay” (From the Editor, Current Psychiatry, May 2010). Psychosis in the context of dementia is another area of interest. We have been thoroughly steeped in the “black-box” warning about antipsychotic use in dementia. The most common discussion point among psychiatrists in consideration of the managing complex dementia with psychotic disturbances is which medications to use and how to use antipsychotics when there is no other choice. The warning is certainly judicious; however, the fact is that almost every day this clinical situation could arise, placing us in a difficult position of weighing a complex risk vs safety analysis with no viable guidance and no real option other than to make decisions and involve family members in complicated informed consent discussions. Evidence also suggests that functional capacity in dementia may be enhanced by combining donepezil and memantine, which also is of consequence in dementia polypharmacy.
John Hendrick, MD
Assistant professor of psychiatry
East Tennessee State University
Johnson City, TN