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Royal College 2023 > BPSD > Flashcards

BPSD Flashcards

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1
Q

Standardized tools to objectively assess BPSD

A
  1. NPI-Q (neuropsychiatric inventory)
  2. MBI-C (mild behavioural impairment checklist)
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2
Q

Behaviours NOT responsive to antipsychotic therapy

A
  1. Wandering
  2. Exit seeking
  3. Pacing
  4. Excessive talking/calling out/verbalization
  5. Repetitive questions
  6. Hoarding
  7. Social/sexual disinhibition
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3
Q

Non-pharm strategies for shadowing/restlessness/anxiety when caregiver gone

A
  1. Address any unmet needs (hunger, thirst, pain, bodily functions)
  2. Physical activity - go for regular walk
  3. Keep a routine
  4. Offer activities that match patients abilities
  5. Respite care/sitter
  6. Music therapy
  7. Art therapy
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4
Q

Pharmacologic treatment for restlessness

A

SSRI

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5
Q

Behaviours RESPONSIVE to pharmacotherapy

A
  1. Depression
  2. Anxiety
  3. Apathy??
  4. Physical aggression
  5. Verbal aggression
  6. Hallucinations
  7. Delusions
  8. Sexual inappropriateness
  9. Sleep
  10. Mania/manic like
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6
Q

When to reassess antipsychotics

A

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

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7
Q

Non-pharm strategies to manage BPSD (general)

A
  1. Multidisclipinary care
  2. Massage/touch therapy
  3. Reminiscence therapy
  4. Animal therapy
  5. Musictherapy
  6. Exercise
  7. Social interaction
  8. Cognitive stimulation
  9. Occupational therapy
  10. Environmental modification
  11. Psychotherapy
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8
Q

List ALL types of BPSD/NPS

A
  1. Anxiety
  2. Depression
  3. Apathy
  4. Euphoria
  5. Sleep disturbances/night time behaviours
  6. Hoarding
  7. Sexual disinhibition
  8. Physical aggression
  9. Verbal aggression
  10. Mania
  11. Hallucinations
  12. Delusions
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9
Q

What is the PIECES model?

A

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)

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10
Q

BPSD treatment in LTC

A
  1. Music
  2. Snoezelen room
  3. Aromatherapy
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11
Q

Three components of behavioural analysis

A

ABC
Antecedent - time and activity
Behaviour - description of
Consequences - interventions by staff and outcome

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12
Q

3 indications for use of antipsychotics

A
  1. Patient harm to self
  2. Patient harm to others
  3. Patient very distressed
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13
Q

10 BPSD symptoms NOT affective/psychotic

A
  1. Exit seeking
  2. Wandering
  3. Hoarding
  4. Pacing
  5. Night time wakening
  6. Sexual disinhibition
  7. Physical aggression
  8. Verbal aggression
  9. Calling out
  10. Repeating questions
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14
Q

Tools to assess pain in dementia patients

A
  1. PAIN AD tool
  2. PACSLAC
  3. DOLOPLUS
  4. MOBID
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14
Q

3 strategies (non pharm) to care resistance

A
  1. Introduce self before performing care
  2. Explain each step before it happens and throughout
  3. Consistent routine/care plan
  4. Involve patient as they are able
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15
Q

4 factors that predispose to hoarding

A

PTSD
1. Psychiatric illness
2. Traumatic events
3. Social isolation
4. Executive dysfunction

16
Q

6 non-cognitive features in MCI

A
  1. Depression
  2. Anxiety
  3. Apathy
  4. Irritability
  5. Agitation
  6. Sleep changes
17
Q

8 communication strategies for agitated patient with dementia

A
  1. Introduce self
  2. Ensure they can hear you
  3. Sit at their level but not too close
  4. Speak slowly and clearly
  5. Ask if they need repetition/assess understanding throughout
  6. Avoid negative words and tone
  7. Avoid negative posture
  8. Allow sufficient time for them to respond
  9. Shift focus away from trigger
18
Q

How to help caregivers for BPSD

A
  1. Psychoeducation
  2. Psychotherapy
  3. Respite care/day program
  4. Train to ID triggers and how to manage
19
Q

10 ways to manage wandering

A
  1. Child proof locks
  2. Dead bolt high up
  3. GPS Tracking
  4. Wandering registry
  5. Medical ID bracelet
  6. Conceal door handle
  7. Conceal door to look like something else
  8. Alarm when door opens
  9. Cameras
  10. Put away items that may trigger person to leave like coat or shoes
20
Q

Factors to consider when assessing NPS (Watt article)

A

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

Royal College 2023 (79 decks)

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