{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:40:09Z","timestamp":1756309209891,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,8,21]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:p>A 76-year-old man presented with complaints of increased confusion, visual hallucinations and decline in memory. He was admitted to the hospital and started on quetiapine 50\u2009mg daily for symptom management. Shortly after, he was diagnosed with Lewy body dementia and started on rivastigmine, a cholinesterase inhibitor (ChEI), at 1.5\u2009mg two times per day. The patient\u2019s symptoms continued to worsen and antipsychotics increased for aggressive behaviour. After he became physically aggressive, an extensive medication management review was conducted, prompting an alternative treatment strategy. The quetiapine dose was reduced from 150\u2009mg daily to 12.5\u2009mg daily, his rivastigmine was increased to 3\u2009mg two times per day and all other antipsychotics were discontinued. The up-titration of his rivastigmine after 10 days of therapy was well tolerated with no adverse effects. He demonstrated a clear clinical response to optimised ChEI therapy and low dose quetiapine, showing improvements in alertness and functioning.<\/jats:p>","DOI":"10.1136\/bcr-2019-230193","type":"journal-article","created":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T08:04:04Z","timestamp":1567670644000},"page":"e230193","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Acute treatment of psychotic symptoms in a newly diagnosed Lewy body dementia patient with an accelerated titration schedule of rivastigmine and de-escalation of antipsychotics"],"prefix":"10.1136","volume":"12","author":[{"given":"Rebecca Nicole","family":"Burgett","sequence":"first","affiliation":[{"name":"Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-7718","authenticated-orcid":false,"given":"Thomas Michael","family":"Farley","sequence":"additional","affiliation":[{"name":"Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA"},{"name":"Pharmacy, Mercy Hospital Iowa City, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori Ann","family":"Beireis","sequence":"additional","affiliation":[{"name":"Internal Medicine, Mercy Hospital Iowa City, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,9,4]]},"reference":[{"key":"2025082708231745000_12.9.e230193.1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s40266-018-00636-7","article-title":"Pharmacological management of dementia with lewy bodies","volume":"36","author":"Hershey","year":"2019","journal-title":"Drugs Aging"},{"key":"2025082708231745000_12.9.e230193.2","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1212\/WNL.0000000000004058","article-title":"Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium","volume":"89","author":"McKeith","year":"2017","journal-title":"Neurology"},{"key":"2025082708231745000_12.9.e230193.3","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1080\/14656566.2018.1519548","article-title":"Advances in the pharmacotherapeutic management of dementia with Lewy bodies","volume":"19","author":"Palermo","year":"2018","journal-title":"Expert Opin Pharmacother"},{"key":"2025082708231745000_12.9.e230193.4","unstructured":"\u00a0Lewy Body Dementia Association. Treatment of Lewy Body Dementia. 2015. https:\/\/www.lbda.org\/sites\/default\/files\/treatment.pdf (cited 2 Apr 2019)."},{"key":"2025082708231745000_12.9.e230193.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03399-7"},{"key":"2025082708231745000_12.9.e230193.6","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000260060.60870.89"},{"key":"2025082708231745000_12.9.e230193.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5846(03)00040-X"},{"issue":"Suppl 13","key":"2025082708231745000_12.9.e230193.8","first-page":"21","article-title":"Use of quetiapine in elderly patients","volume":"63","author":"Tariot","year":"2002","journal-title":"J Clin Psychiatry"},{"key":"2025082708231745000_12.9.e230193.9","unstructured":"\u00a0UpToDate. Prognosis and treatment of dementia with Lewy bodies. 2019. www.uptodate.com"},{"key":"2025082708231745000_12.9.e230193.10","unstructured":"\u00a0Lexicomp. Quetiapine: Drug Information. 2019. https:\/\/online.lexi.com"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230193","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:23:22Z","timestamp":1756308202000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":10,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9,4]]},"published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1136\/bcr-2019-230193"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230193","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}