Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.