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Behavioural and psychological symptoms of dementia: a new framework for holistic understanding and non-pharmacological management

Published online by Cambridge University Press:  01 March 2021

Ian Andrew James
Affiliation:
BSc, MSc, PhD, is a consultant clinical psychologist in community and in-patient services and an Honorary Professor at the University of Bradford, working for Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust at the Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
Kristina Gray
Affiliation:
BSc, is an activity coordinator in adult mental health services, working for Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust at the Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
Esme Moniz-Cook
Affiliation:
BSc, DClinPsych, PhD, is an honorary consultant clinical psychologist and Professor of Clinical Psychology of Ageing and Dementia Care Research in the Faculty of Health Sciences, University of Hull, UK.
Katy Lee
Affiliation:
BSc, DClinPsych, is a clinical psychologist, clinical lead for the intensive support team and principal clinical psychologist in the Intensive Support Service for Older People, Surrey and Borders Partnership NHS Foundation Trust, Frimley, UK.
Katharina Reichelt
Affiliation:
MSc, DClinPsych, is a consultant clinical psychologist in memory services working for Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust at the Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
Jonathan Richardson
Affiliation:
MRPsych, is a consultant old age psychiatrist and Associate Medical Director of Quality Improvement, working for Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust at the Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
Corresponding

Summary

The National Institute for Health and Care Excellence (NICE) informs us that the first-line treatments for behavioural and psychological symptoms of dementia (BPSD) are non-pharmacological. Although psychotropics used to be the main strategy in the management of behaviours that challenge, there has been an increase in the use of biopsychosocial formulations since 2010, and there are now over a dozen to choose from. However, many are overly focused on obtaining information about the agitation, and less specific about providing details of the actions required to manage the behaviours. The NICE guidelines too fail to provide specific guidance on which non-pharmacological approaches to use. This article argues for giving equal weight to both the collection of meaningful information and the development of ‘informed actions’, because it is the actions that lead to change. The article outlines a management programme providing a framework for the assessment, formulation and treatment of agitation in dementia. The work draws on theory, evidence-based practice and practice-based evidence to provide a model with sufficient structure and flexibility to be useful for clinicians across a range of settings and professional groups.

Type
Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of The Royal College of Psychiatrists.

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References

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