Alzheimer's Disease
Psychiatric Care
Most families don't reach a psychiatrist because of memory loss. They come because of agitation, suspicion, night-time distress, or a depression that arrived alongside the diagnosis. Those symptoms are treatable — and in older adults, they demand more caution about medication, not less.
Psychiatric symptoms in Alzheimer's disease
Alzheimer's disease is a progressive neurodegenerative condition, and its cognitive and disease-modifying treatment sits with neurology and primary care. What brings families to a psychiatrist is the other half of the illness: the behavioral and psychological symptoms of dementia, often shortened to BPSD. Agitation, aggression, depression, anxiety, delusions, hallucinations, apathy, and disrupted sleep affect most people with dementia at some point, and they are frequently harder on the household than the memory loss itself.
The first question is never which medication. It's what changed. A sudden shift in behavior in an older adult is a medical event until proven otherwise — pain that can't be reported, a urinary tract infection, constipation, dehydration, a new drug, poor hearing or vision, or delirium layered on top of the dementia. Prescribing a sedating medication over an untreated infection is a familiar and avoidable error.
When a medical cause is excluded, non-pharmacologic approaches come first: identifying triggers, adjusting routine and environment, and coaching caregivers on specific responses. Both the American Psychiatric Association and the Alzheimer's Association put these ahead of medication, and they work often enough to be worth real effort.
Medication has a place when symptoms are severe, dangerous, or causing significant distress — used deliberately, at the lowest effective dose, and revisited rather than left running indefinitely. Antipsychotics carry an FDA boxed warning for increased risk of death in older adults with dementia-related psychosis, which makes the decision to start one a genuine conversation rather than a default. Dr. Farkas's MD/PhD background and her practice of proactive deprescribing are built for exactly this kind of judgment.
Symptoms treated
This page is educational and is not a diagnostic tool. Cognitive and disease-modifying treatment is directed by neurology or primary care.
How Dr. Farkas approaches behavioral symptoms
Cautious, guideline-concordant, and built around the fact that older adults tolerate medication differently. The plan follows the specific symptom — not a protocol template.
What to expect from your first appointment
A new patient evaluation with Dr. Farkas runs 30–60 minutes. It covers what the behavior looks like and when it happens, what was tried already, the complete medication list including anything prescribed elsewhere, and recent medical history. Families are encouraged to bring specifics — what time of day, what preceded it, what helped — because that detail is what separates a treatable trigger from a symptom of the disease.
Caregivers are welcome to attend with appropriate consent, and telehealth often works well when getting an older adult to an office is difficult. Available throughout South Carolina and New York, with in-person appointments at the Hilton Head Island, SC office.
Related Conditions
Call or text 988 (Suicide & Crisis Lifeline). Text HOME to 741741 for the Crisis Text Line. Call 911 or go to your nearest emergency room if you or someone you care for is in immediate danger. The Alzheimer's Association helpline is available around the clock at 1-800-272-3900.
Medical disclaimer: This page is for educational purposes and does not constitute medical advice. No doctor–patient relationship is established through website use. Individual results vary; no specific outcome is guaranteed. Telehealth visits are conducted on a HIPAA-compliant platform. Gabriella I. Farkas, MD PhD, is a board-certified psychiatrist licensed in South Carolina and New York.
Ready for help with
the behavioral symptoms?
30–60 minutes. Causes investigated before medication is reached for. Caregivers included in the plan.
Psychiatric management of Alzheimer's focuses on behavioral and psychological symptoms of dementia (BPSD): agitation, depression, psychosis, sleep disturbance. Non-pharmacologic interventions come first; pharmacotherapy is used with caution, avoiding anticholinergic burden and following FDA and APA guidance on antipsychotics in older adults with dementia (black-box warning).
Key Takeaways
- Psychiatric care in Alzheimer's focuses on behavioral and psychological symptoms such as agitation, depression, psychosis, and poor sleep.
- Non-drug approaches come first.
- Antipsychotics carry an FDA black-box warning in dementia and are reserved for severe symptoms at the lowest dose for the shortest time.
- Cognitive medications such as donepezil and memantine are coordinated with neurology.
Frequently Asked Questions
Can psychiatric medications help with dementia?
Selectively. SSRIs may reduce depression and agitation. Antipsychotics carry an FDA black-box warning for increased mortality in dementia and are reserved for severe agitation or psychosis after safer options fail — at the lowest effective dose for the shortest necessary duration.
What is BPSD?
Behavioral and Psychological Symptoms of Dementia — agitation, aggression, depression, apathy, anxiety, delusions, hallucinations, sleep disruption. BPSD affects most patients with Alzheimer's at some point and drives caregiver burden and nursing-home placement.
Do you prescribe cholinesterase inhibitors or memantine?
Dr. Farkas coordinates with neurology on cognitive-specific medications (donepezil, rivastigmine, galantamine, memantine) and focuses her prescribing on psychiatric symptoms and polypharmacy review.