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Objectives The objective of this study was to report the effectiveness of trazodone for treatment of bruxism in dementia. Methods A single case study of a 66-year-old man with severe vascular dementia and awake bruxism was performed. Results The patient's bruxism responded robustly to titration of trazodone. He tolerated the medication with no untoward sedation or other adverse effects. Conclusions Bruxism is occasionally encountered in patients with advanced dementia and raises concerns about nutritional compromise and about potential need for poorly tolerated dental treatment. Trazodone may potentially be effective for bruxism in some patients.

Objectives To examine the effectiveness of low-dose lithium carbonate for managing carbamazepine-induced hyponatremia. Methods Single case study in an 88 year old man with bipolar illness and vascular dementia who had failed to respond to other mood stabilizers. Results The patient had developed hyponatremia on two separate occasions when treated with carbamazepine. Introduction of low-dose lithium resulted in prompt normalization of serum sodium levels, which was maintained for the subsequent 8 weeks. Conclusions Carbamazepine may sometimes be the best or only viable treatment option for patients with bipolar illness or other conditions. When its use is complicated by syndrome of inappropriate ADH, dose reduction and fluid restriction are the simplest options but, if ineffective, addition of lithium may be a feasible, albeit somewhat complicated, alternative.

Musical hallucinations (MHs) are relatively uncommon phenomena sometimes encountered in older patients, especially older women. They usually involve popular, overlearned music, either entire songs or repetitive snippets. While MHs are most commonly associated with hearing loss, they may occur in a variety of psychiatric, neurologic, and iatrogenic conditions. We report a 91-year-old man whose MHs were causally related to the antidepressant mirtazapine. Although mirtazapine is generally well tolerated, it may rarely cause MHs or other psychotic symptoms.

Behavioral problems are seen in most patients with dementia and are often poorly characterized in the literature. We present a 70-year-old man with advanced Alzheimer disease and problematic disinhibited behaviors, including intrusiveness and Witzelsucht (disinhibited humor). These symptoms responded robustly to carbamazepine. Carbamazepine may be a useful adjunct in managing problematic behaviors in dementia, especially when those problems can be framed as behavioral disinhibition.

Catatonia is an episodic syndrome characterized by specific affective, behavioral, and motor symptoms and thought to result from regional abnormalities in neurotransmitter function. Although generally thought to represent a manifestation of schizophrenia or depression, there is strong evidence that it may represent a distinct entity, caused by a number of psychogenic, infectious, iatrogenic, and neurological conditions. The morbidity associated with catatonia is significant, and, in some cases, the condition may be life threatening.