Antipsychotic Therapy

Today, the treatment of dementia is based on psychotropic medications, which come with many side effects and adverse reactions. Medication can be beneficial in many cases, but too often with dementia patients it is used to treat a symptom. In this type of situation it is important to balance the old symptoms with the new symptoms and risks of the medication being used, and decide for whose benefit the medication is being administered. There is a wide-range of non-pharmacologic interventions that have been considered for treatment of dementia. The most effective intervention has been environment modification, which has shown to enhance functional abilities of the patient (Sung, Lee, Chang & Smith, 2011). In long-term facilities this includes incorporating familiar items from home to familiarize a new environment, in order to reduce anxiety, and promote relaxation. One of the most frequently researched interventions is the use of music as an environmental modifier, and it has shown management of behavioral problems (Sung, Lee, Chang & Smith, 2011). It is a very significant finding, considering the fact that music has no known side effects (Wall and Duffy, 2010).

We carried out an extensive review of the literature on non-pharmacological treatments for dementia using Medline and other related searches, but this is not intended to be a formal systematic review.

Phillips states that individuals with dementia often display resistance to care, confusion, disruptive or aggressive behaviors: For these reasons, many seniors who are not actually suffering from psychosis are given antipsychotic medications. The goal of the pan-Canadian Reducing Antipsychotic Medication in Long Term Care program was to encourage long-term care facilities and nursing homes to discontinue the use of unnecessary antipsychotic medications to experiment with alternative therapies.

Psychotropic medications are approved by the US Food and Drug Administration (FDA) primarily for the treatment of psychosis and mood disturbances associated with schizophrenia or bipolar disorders (Grunier, 2008). Despite FDA black box warnings related to the “off-label” use of these medications in the dementia population, a survey conducted by the Office of Inspector General in 2011 found that 86% to 95% of nursing home residents received these medications for other indications, such as managing behavioral disturbances associated with dementia (Chiu, 2015). It is the overuse and misuse of psychotropic medications, in particular as a strategy to subdue residents, that has designated these drugs to be labeled

Dementia is an extremely common disease among the elderly, with 4 million Americans currently suffering from the Alzheimer’s type alone. Figures show that 3% of people between the ages of 65-74 suffer from the disease, rapidly increasing to 19% for the 75-84 age bracket, and as high as 47% for the over 85s. Therefore, it is easy to see why Dementia is such a large part of many people’s lives, whether they are suffering from the condition themselves, or have an elderly relative who requires full time care just to undertake simple day to day tasks. The disease can be extremely traumatic for the patient and their families, as the person, who may have been extremely lively and bright throughout their

A research study was conducted by Dr. Helen Kales and others as to whether or not antipsychotic drugs increased mortality rate in elderly dementia patients. In her article in The American Journal of Psychiatry, Kales concluded, “Antipsychotic medications taken by patients with dementia were associated with higher mortality rates than were most other medications used for neuropsychiatric symptoms.” According to Dr. Lyketos, who did a presentation about dementia patients, “A few neuropsychiatric symptoms in dementia patients include: depression, sundowning, anxiety, repetitious questioning, and sleep disturbance” (Lyketos). Sundowning is one of the most common symptoms and occurs when the patient suffers “increased confusion and agitation at cyclic

It has been reported that by the year 2030, the number of dementia patients will increase to 75.6 million cases worldwide (Qiu-Yue Wang, Dong Mei Li, 2016). Alzheimer’s is the most common type of dementia characterized by major brain tissue degeneration. The widespread network of damage that accumulates with age often manifests as anger, depression, anxiety, and other behavioral and psychological symptoms that are difficult to treat through medication (Qiu-Yue Wang, Dong Mei Li, 2016). Art therapy serves as a channel of communication to patients diagnosed with Alzheimer’s who have lost their ability to speak or think clearly. Several benefits have been observed through art therapy interventions in patients with a degenerative brain disease such as Alzheimer’s. A study conducted in 2004 showed that patients with severe dementia could effectively improve their visual-spatial abilities as well as delay the progression of the disease through painting and drawing (Qiu-Yue Wang, Dong Mei Li, 2016). Furthermore, it has been reported that the use of antipsychotics could increase mortality and cerebrovascular events among older patients with dementia (Rue-Chuan Chen et al., 2014). Non-pharmacological treatments should not be underestimated when alleviating the burdens of Alzheimer’s on patients. The brain is a infinite network of circuits and connections that change

The National Institute of Neurological Disorders and Stroke defines dementia as:“ word for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there. (Health, 2014).This essay is going to discuss and explore what dementia is and the four main types of dementia which includes Alzheimer’s Disease, Vascular Dementia, Frontotemporal Dementia and Lewy Body Dementia. Then it explores the physiology changes in different types and the signs and symptoms of dementia. This effect can change the life of people having dementia to suffer in physical issues, social isolation and mental illness. Next, it discusses how environmental changes and music therapy strategies work in dementia. Lastly, the supports that Alzheimer’s Australia and Emmy Monash Aged Care can provide.

As we have seen, treatment of schizophrenia with antipsychotic drugs can have impressive results in terms of decreasing active symptoms, although it does nothing to alleviate negative symptoms or to improve cognitive functioning. Unfortunately, this kind of treatment has the drawback of extremely serious and even fatal side-effects. Newer generation atypical antipsychotics offer more hope, as they can treat both active and negative symptoms, and also improve cognitive functioning. Moreover, they have fewer side-effects. However, treatment is complicated by the fact that results are unpredictable; and in addition the side-effects that they do have can be very serious, such as diabetes, which in itself is life-threatening. However, as the potential side-effects are known, the physician has leeway to choose a drug which is a good match for the patient’s clinical profile. Then, once the patient’s symptoms have been much alleviated with an appropriate newer generation atypical antipsychotic, the patient should be able to also benefit from a range of psychotherapeutic interventions. It is argued that this is the best treatment regime to choose, as it is likely to result in the greatest improvement in quality of life, coupled with the lowest risk of potentially devastating side-effects, or of death. This is likely to be better than utilizing cognitive behavioral therapy, the results of which are not reliably known – although research has certainly shown that it is less efficacious

Purpose: It has been well established that use of Antipsychotics (APs) and Benzodiazepines (BZDs) in the elderly population is associated with increased incidence of adverse effects including sedation, falls, and cognitive impairment. The Veterans Health Administration (VHA) introduced the Psychotropic Drug Safety Initiative (PDSI) to improve evidence-based psychotropic drug prescribing for Veterans with mental illness. This initiative aims to address possible issues with pharmacotherapy such as overprescribing, clinical management, and inappropriate indications.1 The purpose of this project is to assess the impact of recommendations made by a pharmacist on the utilization of APs and BZDs in patients with dementia.

Schizophrenia is a chronic brain disorder that affects more than one percent of the population. When schizophrenia is active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation. However, when these symptoms are treated properly, a large portion of those diagnosed will greatly improve over time.

For this study 68 residents were chosen and were divided into two groups; 33 residents whom completed the yoga training and the control group of 35 residents. Before the start of the study, data was collected to create a baseline and was collected again afterwards for comparison between the two groups. The researchers were able to collect the data needed through questionnaires and physical measurements, such as measurements of body composition, muscle strength and endurance, depression and problem behaviours. At the end of the 12 week study, significant differences were found between the control group and the yoga group. Some of the differences found included changes in all physical health measurements, expect boy fat, and mental health had improved for the yoga group, while the control group experienced physical health deterioration and no improvement in mental health. The research question intents to find interventions that would provide positive behavioural changes for those with dementia. Therefore, the mental improvements found by this study provides evidence to support the research question. Furthermore, the data collected about the mental health improvements, such as the decreased wandering, sleeplessness, and the increased sociability, adds

PICO framework (Patient / Population, Intervention, Comparison & Outcome) was used to formulate the report question. The PICO components help in identifying relevant information to guide investigations to produce the evidence required in a research (Polgar, 2013). An initial browse was carried out in order to get information on current evidence available and how it relates to clinical practice. Google Scholar and Google search was used in the initial browse using keywords from the PICO question, these words include dementia, music therapy, agitation in dementia, older adults. These provided information around the question area from articles, government policies and charity organisations for dementia. Evidence of this initial browse is provided

Alzheimer’s disease is an insidious illness which leads to cognitive and functional impairment, and is becoming more commonplace than ever before. There is no known cure, treatment, or prevention for this disease; in case of point, researchers have yet to discover a way to slow the progression of the illness. As the treatment of the physical manifestation of this disease is difficult to pinpoint, many researchers have dedicated their resources to finding ways to improve the quality of life of those who are diagnosed. Many patients with Alzheimer’s experience depression, anxiety, aggression, and social isolation as a result of their disease; these emotional responses can be treated. Social, music, and exposure therapy in a combined approach will significantly decrease depression scores on the Geriatric Depression Scale (GDS) and reduce agitation scores on the Cohen-Mansfield Agitation Inventory (CMAI). Participants exposed to our therapy program will show less physical and verbal aggression, demonstrate positive body language as observed by a third rater, increased brain stimulation reflected in fMRI scans and decelerated brain atrophy from the

During my first clinical rotation as a nursing student, I was assigned to care for several older adults suffering from dementia. Although all of my patients ranged in severity from mild to severe progression of dementia, they all experienced moments of agitation, anxiety, or disturbed behaviors related to their disease. It occurred to me after careful review of several patient charts that despite often being prescribed pharmaceutical regimes for other comorbidities, these patients were rarely prescribed medications, besides those to control anxiety, specifically targeted at treating their progressing dementia. Through some research I discovered that the significant number of individuals affected with dementia is a growing public health concern in part due to the current limited ability of pharmaceutical treatments to treat the disease (Samson, Clement, Narme, Schiaratura, & Ehrle, 2015). This revelation began my interest in current nonpharmacological treatments being implemented in controlling adverse behaviors and feelings in patients diagnosed with dementia.