Bulletin of Integrative Psychiatry  New Series June 2020  Year XXVI No. 2 (85)/119 BP I Bulletin of Integrative Psychiatry Buletin de Psihiatrie Integrativa Paradoxical side effect in treatment with antipsychotics for aggression/agitation and psychosis in dementia: case-series Tudor Florea, Matei Palimariciuc, Vasile Chiriță, Roxana Chiriță Tudor Florea - M.D., PhD. Student, assistant professor Grigore T. Popa University of Medicine and Pharmacy, Iași, Psychiatrist, “Sf. Sava” Hospital, Iași, Romania Matei Palimariciuc - M.D., PhD Student, assistant professor Grigore T. Popa University of Medicine and Pharmacy, Iași; junior psychiatrist, Socola Institute of Psychiatry, Iași Vasile Chiriță - M.D., PhD, Professor of Psychiatry, Honorary Member of the Romanian Academy of Medical Science Roxana Chiriță - M.D., PhD, Professor of Psychiatry Grigore T Popa University of Medicine and Pharmacy, Iași, Senior psychiatrist ABSTRACT Antipsychotic treatment is widely used for treating aggression/agitation and psychosis in the elderly population. The doses used are lower, administering medication is done over a prolonged time period, tests done and clinical observation is more frequent compared to the non-geriatric population. The objective of this case-series was to present a particularity encountered in the use of antipsychotics. Three patients suffered from increased aggression and agitation during treatment with antipsychotics. After medication administration was ceased the symptomatology remitted. Tests used for this study included Mini-Mental State Exam (MMSE), Neuropsychiatric Inventory Nursing Home Version (NPI-NH). We found that the elevation of the NPI-NH score was significant with increased dosage, thus after reaching the maximum allowed doses for patients with dementia, the decision was made to stop the antipsychotic and change to another agent (antipsychotic or anticonvulsant). These results suggest that more studies should focus on fast management of the antipsychotics’ side effects, and the dynamics between symptom development and treatment decisions. The delay between the start of medication and the decision to switch could have a negative impact for the patients. Future treatment algorithms should take into consideration the possibility of worsening the symptoms and more in-depth studies should be conducted to widen the picture of antipsychotic treatment in the geriatric population, especially for patients with severe dementia.