Background Agitation is a common challenging behaviour in dementia with a negative influence on patient’s quality of life and a high caregiver burden. Treatment is often difficult. Current guidelines recommend restrictive use of psychotropic drug treatment, but guideline recommendations do not always suffice. Objective To explore how physicians decide on psychotropic drug treatment for agitated behaviour in dementia when the guideline prescribing recommendations are not sufficient. Methods We conducted five online focus groups with a total of 22 elderly care physicians, five geriatricians and four old-age psychiatrists, in The Netherlands. The focus groups were thematically analysed. Results We identified five main themes. Transcending these themes, in each of the focus groups physicians stated that there is ‘not one size that fits all’. The five themes reflect physicians’ considerations when deciding on psychotropic drug treatment outside the guideline prescribing recommendations for agitated behaviour in dementia: (1) ‘reanalysis of problem and cause’, (2) ‘hypothesis of underlying cause and treatment goal’, (3) ‘considerations regarding drug choice’, (4) ‘trial and error’ and (5) ‘last resort: sedation’. Conclusion When guideline prescribing recommendations do not suffice, physicians start with reanalysing potential underlying causes. They try to substantiate and justify medication choices as best as they can with a hypothesis of underlying causes or treatment goal, using other guidelines, and applying personalised psychotropic drug treatment.

中文翻译：

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痴呆症激越行为的精神药物治疗：如果指南处方建议不充分怎么办？定性研究

背景 激越是痴呆症中常见的挑战性行为，对患者的生活质量有负面影响，并且给护理人员带来沉重的负担。治疗通常很困难。目前的指南建议限制使用精神药物治疗，但指南建议并不总是足够的。目的 探讨当指南处方推荐不充分时，医生如何决定对痴呆症激越行为进行精神药物治疗。方法 我们在荷兰开展了五个在线焦点小组，共有 22 名老年护理医师、五名老年病学家和四名老年精神科医生参加。对焦点小组进行了专题分析。结果 我们确定了五个主题。超越这些主题，在每个焦点小组中，医生都表示“没有一种适合所有人的尺寸”。这五个主题反映了医生在决定针对痴呆症激越行为的指南之外的精神药物治疗时的考虑：（1）“问题和原因的重新分析”，（2）“潜在原因和治疗目标的假设”，（3 ）“关于药物选择的考虑”，（4）“反复试验”和（5）“最后的手段：镇静”。结论 当指南处方建议不够时，医生会开始重新分析潜在的根本原因。他们试图通过潜在原因或治疗目标的假设，使用其他指南，并应用个性化的精神药物治疗，尽可能地证实和证明药物选择的合理性。