I’m disturbed by unanimous condemnation of prefrontal lobotomy. I don’t think it’s fair. I’d guess that nearly everyone who has written in has never dealt with wildly psychotic manic or delirious persons. In the days that psychosurgery was performed there were no effective alternative treatments, no means of controlling dangerous injurious behaviors except restraints and torture such as immersion and these worked only temporarily and required prolonged hospital confinement. Many lobotomized persons were able to be discharged home. “Desperate Cures” is an apt description and Moniz and Freeman were not Joseph Mengeles. Freeman was certainly guilty of self aggrandizement and performing his procedures sloppily and too widely. The American media helped to popularize a procedure that reduced most to a state of docility and inertia. Lobotomies may have had limited efficacy at one time but are now simply outmoded. Medicine marches on.
An assessment for an underlying cause of behavior is needed before prescribing antipsychotic medication for symptoms of dementia .  Antipsychotics in old age dementia showed a modest benefit compared to placebo in managing aggression or psychosis, but this is combined with a fairly large increase in serious adverse events. Thus, antipsychotics should not be used routinely to treat dementia with aggression or psychosis, but may be an option in a few cases where there is severe distress or risk of physical harm to others.  Psychosocial interventions may reduce the need for antipsychotics.