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
