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Semin Neurol 2022; 42(02): 225-236
DOI: 10.1055/s-0041-1742144
Review Article

Medication Management of Neuropsychiatric Symptoms in Neurological Conditions: A Dimensional Transdiagnostic Approach

Jordan R. Anderson 
1   Department of Psychiatry and Neurology, Oregon Health and Science University, Unity Center for Behavioral Health, VA Portland Healthcare System, Portland, Oregon
,
Michael Schrift
2   Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, Seattle, Washington
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Abstract

Neuropsychiatric symptoms are prevalent in neurologic practice, but their complexity makes them challenging to manage. Many cognitive, affective, behavioral, and perceptual symptoms span multiple neurologic diagnoses—and there is prominent variability in neuropsychiatric symptom burden for a given condition. There is also a relative lack of robust controlled clinical trial evidence and expert consensus recommendations for a range of neuropsychiatric symptom presentations. Thus, the categorical approach (e.g., a discrete diagnosis equals a specific set of medication interventions) used in many other medical conditions can sometimes have limited utility in commonly encountered neuropsychiatric clinical scenarios. In this review, we explore medication management for a range of neuropsychiatric symptoms using a dimensional transdiagnostic approach applied to the neurological patient. This approach allows the clinician to think beyond the boundaries of a discrete diagnosis and treat specific symptom domains (e.g., apathy, impulsivity). Pharmacologic considerations, including mechanisms of action and their application to various neurotransmitter systems and brain networks, are discussed, as well as general recommendations to optimize medication adherence and rapport with the patient. The dimensional, transdiagnostic approach to pharmacological management of patients with neurological conditions will help the clinician treat neuropsychiatric symptoms safely, effectively, and confidently.

Keywords

neuropsychiatry - transdiagnostic - dimensional - pharmacology - medication


Publication History

Article published online:
09 February 2022

© 2022. Thieme. All rights reserved.

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