A 65-year-old patient with severe behavioral and psychological symptoms of dementia (BPSD) has been readmitted to a geropsychiatry unit due to recurrent aggressive behaviors that have caused injuries and resulted in discharge from long term care facilities. In addition to non-pharmacological interventions and pain management, he has not benefited from either citalopram or sertraline, nor have his symptoms responded to risperidone or olanzapine. Trials of prazosin and dextromethorphan-quinidine have also been unsuccessful. The clinician is concerned that the patient may be running out of placement options and wonder if there are any other evidence-based strategies that can be tried. Which of the following is the next best step in managing this patient’s severe, refractory BPSD? A. Quetiapine B. Electroconvulsive therapy C. Dronabinol D. Fish oil
