GuidelinesOther guideline
Summary points
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
- Treatment with antidementia medication combined with non-pharmacological measures provides the most benefits in patients with dementia.
- Medication must be individualised taking into account the constellation of symptoms, the stage of the disease, the side-effect profile, and caregiver availability.
- Titrate medication from a low starting dose.
- Target daily doses of first-line antidementia medication are as follows: donezepil 10 mg, rivastigmine 12 mg, galantamine 24 mg, and memantine 20 mg. This should, however, be guided by response and tolerability. These medications are effective in the symptomatic treatment of AD, VaD, DLB dementia, dementia in Parkinson’s disease and certain frontotemporal dementias.
- Patients should be closely monitored for the first month after commencing treatment.
- The most promising approach to VaD is secondary prevention of CvD by addressing its risk factors.
- Rule out underlying or coexisting medical conditions and psychosocial environmental factors in patients with behavioural, mood or anxiety symptoms.
- In patients with depression, consider antidepressants that have more sedative effects, such as citalopram, sertraline, mirtazapine, and agomelatine. In view of the potential for QT prolongation, citalopram should not be used in doses greater than 20 mg per day in adults older than 60 years.
- For hyperactivity or agitation, a low-dose first- or second-generation antipsychotic medication may be used for a short period of time.