BPSD Flashcards
Standardized tools to objectively assess BPSD
- NPI-Q (neuropsychiatric inventory)
- MBI-C (mild behavioural impairment checklist)
Behaviours NOT responsive to antipsychotic therapy
- Wandering
- Exit seeking
- Pacing
- Excessive talking/calling out/verbalization
- Repetitive questions
- Hoarding
- Social/sexual disinhibition
Non-pharm strategies for shadowing/restlessness/anxiety when caregiver gone
- Address any unmet needs (hunger, thirst, pain, bodily functions)
- Physical activity - go for regular walk
- Keep a routine
- Offer activities that match patients abilities
- Respite care/sitter
- Music therapy
- Art therapy
Pharmacologic treatment for restlessness
SSRI
Behaviours RESPONSIVE to pharmacotherapy
- Depression
- Anxiety
- Apathy??
- Physical aggression
- Verbal aggression
- Hallucinations
- Delusions
- Sexual inappropriateness
- Sleep
- Mania/manic like
When to reassess antipsychotics
Cochrane review 2018
Low quality evidence to successfully discontinue after min 3 months, may have little or no impact on BPSD symptoms
*symptoms often don’t persist for longer than 3 months
Non-pharm strategies to manage BPSD (general)
- Multidisclipinary care
- Massage/touch therapy
- Reminiscence therapy
- Animal therapy
- Musictherapy
- Exercise
- Social interaction
- Cognitive stimulation
- Occupational therapy
- Environmental modification
- Psychotherapy
List ALL types of BPSD/NPS
- Anxiety
- Depression
- Apathy
- Euphoria
- Sleep disturbances/night time behaviours
- Hoarding
- Sexual disinhibition
- Physical aggression
- Verbal aggression
- Mania
- Hallucinations
- Delusions
What is the PIECES model?
A way to understand the meaning behind behaviours
P = Physical (5 D’s = Drugs, delirium, disease, discomfort, disability)
I = Intellectual (7 A’s = agnosia, apraxia, aphasia, amnesia, apathy, anosognosia, altered perception)
E = Emotional (frustration, grief, loneliness, depression, anxiety)
C = Capabilities (ADL’s, IADLs, language skills)
E = Environmental (temperature, clutter, lighting, sound)
S = Social (social network, life story, heritage)
BPSD treatment in LTC
- Music
- Snoezelen room
- Aromatherapy
Three components of behavioural analysis
ABC
Antecedent - time and activity
Behaviour - description of
Consequences - interventions by staff and outcome
3 indications for use of antipsychotics
- Patient harm to self
- Patient harm to others
- Patient very distressed
10 BPSD symptoms NOT affective/psychotic
- Exit seeking
- Wandering
- Hoarding
- Pacing
- Night time wakening
- Sexual disinhibition
- Physical aggression
- Verbal aggression
- Calling out
- Repeating questions
Tools to assess pain in dementia patients
- PAIN AD tool
- PACSLAC
- DOLOPLUS
- MOBID
3 strategies (non pharm) to care resistance
- Introduce self before performing care
- Explain each step before it happens and throughout
- Consistent routine/care plan
- Involve patient as they are able
4 factors that predispose to hoarding
PTSD
1. Psychiatric illness
2. Traumatic events
3. Social isolation
4. Executive dysfunction
6 non-cognitive features in MCI
- Depression
- Anxiety
- Apathy
- Irritability
- Agitation
- Sleep changes
8 communication strategies for agitated patient with dementia
- Introduce self
- Ensure they can hear you
- Sit at their level but not too close
- Speak slowly and clearly
- Ask if they need repetition/assess understanding throughout
- Avoid negative words and tone
- Avoid negative posture
- Allow sufficient time for them to respond
- Shift focus away from trigger
How to help caregivers for BPSD
- Psychoeducation
- Psychotherapy
- Respite care/day program
- Train to ID triggers and how to manage
10 ways to manage wandering
- Child proof locks
- Dead bolt high up
- GPS Tracking
- Wandering registry
- Medical ID bracelet
- Conceal door handle
- Conceal door to look like something else
- Alarm when door opens
- Cameras
- Put away items that may trigger person to leave like coat or shoes
Factors to consider when assessing NPS (Watt article)
Protective - familiar carer, familiar environment, carer knowledge of dementia, glasses and hearing aids
Predisposing - over/under stimulating environment, vision/hearing impairment, psychiatric disease, worsening dementia, caregiver burden
Precipitating - pain, hunger, thirst, med changes, temperature, sleep disturbed
Perpetuating - poor communication strategies, inadequate iD and tx of precipitating factors, not implementing care plan, lack of support for carers
