Diagnosing Dementia-Related Psychosis: Using Tools and Communicating With Patients and Caregivers

What diagnostic criteria and assessment tools would you use for dementia-related psychosis? What strategies may help when discussing psychosis with patients’ family members? Dr Ballard considers these topics in this brief CME activity.

Abstract

Psychosis is common in patients with dementia; therefore, clinicians should carefully evaluate psychotic symptoms reported by patients or their caregivers. A variety of tools exist for the diagnosis of DRP, such as the Neuropsychiatric Inventory and new diagnostic criteria. It is important to talk with patients and caregivers about the impact of DRP on well-being, their level of distress (and patients’ insight), the potential risks of medication to treat DRP, and the potential course of DRP because, then, it is possible for people to contribute knowledgably to discussions of the best treatment options. Certain techniques can help clinicians communicate with patients and carers about DRP symptomology and appropriate care strategies. 

From the Series: Dementia-Related Psychosis: Recognition and Treatment

To cite: Ballard C. Diagnosing Dementia-Related Psychosis: Using Tools and Communicating With Patients and Caregivers. J Clin Psychiatry. 2021;82(1):AD19038BR3C.

To share: https://doi.org/10.4088/JCP.AD19038BR3C

© Copyright 2020 Physicians Postgraduate Press, Inc.

Target Audience

  • Primary: Neurologists, Geriatric Psychiatrists, and NPs and PAs who specialize in Neurology and Psychiatry.
  • Secondary: Primary Care Clinicians and Psychiatrists

Learning Objectives

  • Use tools for identification of psychotic symptoms in patients with dementia
Activity summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation
Activity opens: 
11/25/2020
Activity expires: 
11/30/2022
Cost:
$0.00
Rating: 
0

Support Statement

Supported by an educational grant from ACADIA Pharmaceuticals Inc.

Learning Objective

After completing this educational activity, you should be able to:

  • Use tools for identification of psychotic symptoms in patients with dementia

Release, Review, and Expiration Dates

This brief report activity was published in November 2020 and is eligible for AMA PRA Category 1 Credit™ through November 30, 2022. The latest review of this material was October 2020.

Statement of Need and Purpose

Hallucinations and delusions are key behaviors contributing to behavioral crises in patients with dementia, and a lack of consistency in assessment of behaviors has been found. Clinicians may lack awareness of the incidence of psychotic symptoms in different forms of dementia, as dementia pathology has been incorrectly diagnosed on the basis of the presence or absence of psychosis. Some patients may not be able to describe their psychotic symptoms, requiring caregiver input to aid clinicians in recognition. Rating scales can be implemented to aid identification. Clinicians need education about assessing patients with dementia for hallucinations and delusions and about the incidence of psychotic symptoms in different forms of dementia. In addition, many patients with dementia-related psychosis (DRP) receive antipsychotics and are on treatment for over a year, although guidelines recommend tapering after 4 months. Clinicians need education to implement guideline-concordant care that is tailored to the individual patient, incorporating current information on the risks and benefits of nonpharmacologic and pharmacologic interventions for DRP. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on DRP.

Disclosure of Off-Label Usage

Dr Ballard has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this activity.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

Acknowledgment

This activity is derived from the teleconference series “Dementia-Related Psychosis: Recognition and Treatment,” which were held in May and June 2020 and supported by an educational grant from ACADIA Pharmaceuticals Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

Faculty Affiliation

    Clive Ballard, MBChB, MMedSci, MRCPsych, MD
    University of Exeter College of Medicine and Health, UK

 

Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:

Dr Ballard is a consultant for and has received honoraria from Acadia, Roche, Lundbeck, Excevia, AARP, Synexus, and Novo Nordisk; has received grant/research support from Synexus and Novo Nordisk; and is a member of the speakers/advisory boards for Acadia, Roche, AARP, Synexus, and Novo Nordisk.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

 

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

MOC APPROVAL STATEMENT

Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification DirectoryDiagnosing Dementia-Related Psychosis: Using Tools and Communicating With Patients and Caregivers has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

MOC PART II CME ACTIVITY

Psychiatry and Neurology

Available Credit

  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation

Price

Cost:
$0.00
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