Among the most frustrating challenges for any health care
professional are treating and alleviating the distress of an
agitated patient with dementia -- especially compelling in the
midst of today's unprecedented population explosion among adults
over age 65. For the first time ever, people age 85 and older
represent the fastest-growing segment of our population.
As we find ways to meet this challenge, we are also transforming
how we think about aging. Instead of the pejorative term
"senility," which implies that simply to be old is to be infirm, we
refer to the ABCs of geriatric psychiatry: disturbances in
(A)ffect, (B)ehavior, and (C)ognition, which are not normal at any
age.
This remarkable monograph offers practical direction on
assessing and managing agitation in patients with dementia.
Furthermore, this encouraging work shows that successful outcomes
-- with response rates as high as 70% -- can be achieved with a
systemic approach, involving both patient and caregiver, that
includes cognitive, behavioral, psychodynamic, and reminiscence
therapies. This concise book identifies and diagnoses the multiple
types of agitation in dementia patients. It also explains how to
look for and treat the underlying medical etiologies, and
recommends treatment and management techniques, including: -
Definitional and theoretical conceptualizations of agitation in the
elderly; the epidemiology (i.e., the possible relationships
involving agitation and dementia, and the dynamic between symptoms
and the care setting) and neurochemistry (i.e., the neurobiological
changes of behavior involve biochemical and structural causes, not
structural causes alone) of agitation- Behavior assessment scales
as evaluation tools; differential diagnoses (distinguishing
delirium, depression, psychosis, and anxiety from the many
precipitating and maintaining factors underlying agitation);
clinical assessment and management of agitation in residential and
other settings (extremely difficult and frustrating, often leading
to staff and caregiver burnout)- Nonpharmacological interventions,
such as a systemic approach to psychotherapy for both patient and
caregiver (with some response rates as high as 70%), bright light
therapy (promising but unproven), electroconvulsive therapy
(effective -- with minimal and temporary side effects -- for
severe, treatment-intolerant, or treatment-resistant illness), and
hormone replacement therapies- The pathophysiology, pharmacology,
and clinical data of serotonergic agents, mood stabilizers,
neuroleptics, beta blockers, benzodiazepines, and other
miscellaneous agents- The legal and ethical issues in treating
agitation in patients with dementia -- finding the balance between
autonomy and beneficence in the treatment of an agitated patient
with dementia is difficult at best, with the challenge being to
allow the patient's participation as long and as fully as
possible
This book will appeal to a wide audience of geriatric
psychiatrists, primary care physicians and internists, general
practitioners, nurses, social workers, psychologists, pharmacists,
and mental health care workers and practitioners.
General
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