title: Managing severe aggression in frontotemporal dementia.
abstract: OBJECTIVE
  The aim of this paper is to present a case and discussion illustrating the limitations in the evidence base to guide practice in relationship to managing severe aggression in people with dementia. It also calls attention to the association between haloperidol use and increased mortality in dementia.
  
  
  METHODS
  Case report and review of the literature.
  
  
  RESULTS
  A 60-year-old man with rapidly progressive frontotemporal dementia complicated by severe aggression was managed in specialised psychogeriatric services and high-dose haloperidol was used. This treatment decision was made following literature review, consultation with experts and a detailed risk-benefit analysis. Unfortunately, his physical condition deteriorated swiftly and he died soon after.
  
  
  CONCLUSIONS
  Haloperidol is associated with increased mortality in patients with dementia. This case exposes the difficulties in managing severe aggression in dementia, with few safe and effective treatment options and a lack of consensus guidance in the area of very severe aggression in dementia.
authors.affiliation: Psychiatry RMO, Older Persons Mental Health Services, Northern Adelaide Local Health Network, Adelaide, SA, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Powell
authors.forename: Patrick
authors.initials: P
authors.lastname: Flynn
authors.forename: Sally
authors.initials: S
authors.lastname: Rischbieth
authors.forename: Duncan
authors.initials: D
authors.lastname: McKellar
mesh_terms: D000374:Aggression / Q000523:psychology*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000139:chemically induced / Q000523:psychology; D003072:Cognition Disorders / Q000150:complications; D003643:Death; D017809:Fatal Outcome; D057180:Frontotemporal Dementia / Q000188:drug therapy* / Q000523:psychology*; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D012640:Seizures / Q000150:complications
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol
keywords: aggression; behavioural and psychological symptoms of dementia (BPSD); extra-pyramidal side effects (EPSE); frontotemporal dementia; haloperidol