Behavioral Disturbances of Dementia: Interventions to Reduce the Use of Psychotropic Medications

Live webinar held March 28, 2013


  • Staff from many levels, disciplines and settings (both acute care and long term care).
  • Behavioral health staff, nurse practitioners, nurses, CNAs, Nursing Home Administrators, Social Workers and Case Manages from both Acute and Long term care.


At the end of this one-hour presentation, participants have learned:

1. To more clearly describe problematic behaviors and possible triggers;
2. Strategies for preventing/reducing problem behaviors; and
3. Appropriate use of anti-psychotic medications.


Michele L. Thomas, BS, PharmD, BCPP

Michele L. Thomas, BS, PharmD, BCPP


Michele L. Thomas, BS, PharmD, BCPP, is a Board Certified licensed clinical pharmacist and Pharmacy Services Manager for the Department of Behavioral Health and Developmental Services (DBHDS) located in Richmond, Virginia. As Pharmacy Services Manager, Dr. Thomas serves as an information resource and provides consultation and guidance to DBHDS / Community Services Board staff and others, on psychopharmacology / pharmacy / clinical related issues as well as pharmacy informatics and technology developments affecting pharmacy practice in the DBHDS health system. Her position also provides advice and counsel on various other issues that contribute to the success of Pharmacy Services in DBHDS including, administrative related issues on policy, compliance, contracting and third party billing.

Dr. Thomas is a member of several local and national organizations related to pharmacy practice, psychopharmacology, mental health and geriatrics and, is responsible for the development and coordination of pharmacy performance improvement and programs to ensure that optimum pharmaceutical care and services are provided to clients.

Andrew L. Heck, PsyD, ABPP

Andrew L. Heck, PsyD, ABPP


Andrew L. Heck, PsyD, ABPP,is a licensed clinical psychologist and Clinical Director at Piedmont Geriatric Hospital in Burkeville, Virginia. As Clinical Director, he is responsible for the Social Work, Psychology, and Rehabilitation departments, as well as the overall clinical operations of the hospital. Dr. Heck has dedicated his career to the care and understanding of elderly individuals with moderate to severe mental illness, and is board-certified in Clinical Psychology by the American Board of Professional Psychology, and is a Fellow of the American Academy of Clinical Psychology.

He holds clinical faculty appointments in the Departments of Gerontology, Pharmacy, and Psychiatry departments at Virginia Commonwealth University, and holds leadership positions in several local and national organizations related to mental health and older adults. His particular areas of interest include dementia evaluation, decision-making competency and capacity, behavioral treatment, and ethics in working with the elderly.

E. Ayn Welleford, MSG, PhD, AGHEF

E. Ayn Welleford, MSG, PhD, AGHEF


E. Ayn Welleford, MSG, PhD, AGHEF, received her BA in Management/Psychology from Averett College, MS in Gerontology and PhD in Developmental Psychology from Virginia Commonwealth University. She has taught extensively in the areas of Lifespan Development, and Adult Development and Aging, Geropsychology, and Aging & Human Values.

As an educator, researcher, and previously as a practitioner she has worked with a broad spectrum of individuals across the caregiving and long term care continuum. As Associate Professor and Chair of VCU’s Department of Gerontology, she currently works to “Improve Elder Care through Education” through her Teaching, scholarship, and Community Engagement. Outside of the classroom, Dr. Welleford provides community education and serves on several boards and committees. She is the Immediate Past Chair of the Governor’s Commonwealth of Virginia Alzheimer’s and Related Disorders Commission. Dr. Welleford is the proud recipient of the 2008 AGHE Distinguished Teacher Award.



Q: What can you tell us about gradual dose reductions on antidepressants?
A: [Thomas, Michele]: This really depends…The AGS recommends for Acute depression in the geriatric individual, goals are to reverse the current episode and continue to prevent a relapse, for at least 6 months.
To prevent recurrence – if in a maintenance period, goals are to continue for 12–18 months or indefinitely if hospitalization was required in the past or suicidality or psychosis was present. When one does wish to taper however, I try to stick to the 10% rule, e.g., 10% dose reduction every 4-6 weeks – and may adjust that based on individual factors, comorbidities, etc.

Q: What was the answer to the first poll question? Is it appropriate to medicate for physically aggressive behaviors, ever?
A: [Heck, Andrew (DBHDS)] Once everyone’s safety has been accounted for, it is only justifiable to medicate for aggressive behavior if (a) the aggression is directly related to a mental disorder that the FDA has approved as a target for the drug (e.g., antipsychotics are approved to use for individuals with a formal diagnosis of psychosis), or (b) a facility can document that virtually all other contributing factors (e.g., using the HEAR method) have been explored and ruled out. Medicating with an antipsychotic medication for individuals with dementia is an absolute last resort intervention, and must be documented as such.

A: [Thomas, Michele]: For the poll, A, B, C = are appropriate antipsychotic treatment targets and, I agree with Dr. Heck’s statements above.

Q: Why do you caution against bright light exposure for clients with bipolar disorder?
A: [Heck, Andrew (DBHDS)] Research indicates that bright light therapy can induce a manic episode for individuals with a history of Bipolar Disorder. Regular exposure to sunlight does not do this, only concentrated amounts of bright light from light therapy equipment. The exact frequency at which this happens and the mechanism that causes it is not precisely known.

Q: Why is bright light adversive for Those with Bipolar Disorder? is this for all those with Bipolar do or just cognitively impaired people?
A:[Heck, Andrew (DBHDS)] This pertains to any individuals with a history of Bipolar Disorder, not just older adults and not just for individuals with cognitive impairment.