Background: People with behavioral and psychological symptoms of dementia (BPSD) are often prescribed psychotropic medications. There is little evidence that one class of medication is more effective and safer than another and so expert opinion plays an important role in shaping local practice. In an earlier U.S. survey of psychiatrists and neurologists, limited consensus emerged regarding the pharmacological management of BPSD. We repeated this study to check consensus levels in Australia and New Zealand, following the introduction of newer atypical neuroleptics, antidepressants and cholinesterase inhibitors, and to identify areas where drug trials will be of greatest benefit.

Methods: A brief structured survey, similar to one used in the U.S.A., was posted to a random sample of members of the Australian and New Zealand Faculty of Psychiatry of Old Age.

Results: We received 106 replies (71% response). Respondents, who had 14 years' experience on average, rated atypical neuroleptics as their treatment of choice for dementia complicated by psychosis, verbal aggression, physical aggression, sundowning and persistent yelling. Opinions varied widely regarding the management of other symptoms and the role of second-line treatments.

Conclusion: Atypical neuroleptics were preferred by most respondents for treatment of most BPSD. These views, while based on considerable clinical experience, have only limited backing from published reports, and head-to-head studies of available treatments are required to ensure that clinical practice has scientific support.