Relieving Caregiver Burden Through Evidence-Based Treatment for Dementia-Related Psychosis
Dementia-related psychosis (DRP) occurs in all forms of dementia and at all stages. What tactics should be used when talking with patients and their care partners about DRP? How is it best treated?
Dementia-related psychosis (DRP), which includes delusions and hallucinations, contributes to patient and caregiver burden of dementia. Delusions and hallucinations occur in all forms of dementia and at all stages. Certain tactics should be used when talking with patients and their care partners, and some evidence can be shared that may relieve some of the distress of DRP. When treating symptoms of DRP, clinicians should follow guidelines recommendations, such as using medication only if the patient or others are in severe distress or danger and starting with low doses. Long-term treatment is not recommended. Novel antipsychotics or alternative agents may offer superior efficacy and safety compared with standard atypical antipsychotics, but more evidence-based treatment options are needed.
From the Series: Dementia-Related Psychosis: Recognition and Treatment
To cite: Ballard C, Aarsland D. Relieving caregiver burden through evidence-based treatment for dementia-related psychosis. J Clin Psychiatry. 2021;82(4):AD19038AH5C.
To share: https://doi.org/10.4088/JCP.AD19038AH5C
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Neurologists, Geriatric Psychiatrists, and Nurse Practitioners and Physician Assistants who specialize in Neurology and Psychiatry
Provide evidence-based therapies to manage psychosis in patients with dementia
Supported by an educational grant from ACADIA Pharmaceuticals Inc.
After completing this educational activity, you should be able to:
- Provide evidence-based therapies to manage psychosis in patients with dementia
Release, Review, and Expiration Dates
This brief report activity was published in June 2021 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2023. The latest review of this material was May 2021.
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.
Disclosure of Off-Label Usage
Dr Ballard has determined that, to the best of his knowledge, no therapies are approved by the US Food and Drug Administration for the treatment of dementia-related psychosis.
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.
This Academic Highlights section of The Journal of Clinical Psychiatry presents the highlights of the teleconference series “Dementia-Related Psychosis: Recognition and Treatment,” which was held in May and June 2020. This report was prepared and independently developed by the CME Institute of Physicians Postgraduate Press, Inc., and was 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.
Clive Ballard, MBChB, MMedSci, MRCPsych
University of Exeter College of Medicine and Health, UK
Dag Aarsland, MD, PhD
National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation and Institute of Psychiatry, Psychology & Neuroscience at King’s College London
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, Exevia, 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. Dr Aarsland has received research support and/or honoraria from AstraZeneca, Lundbeck, Novartis, Biogen, and GE Health and has served as a paid consultant for Lundbeck, Eisai, Heptares, and Mentis Cura.
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