lOMoARcPSD|1709022
MoARcPSD|1709022
Week 6: Collaboration Café
1. How does dementia-related psychosis differ from other types of
psychosis?
Many types of dementia can cause psychosis. Unlike schizophrenia, which
is characterized by more auditory than visual hallucinations, it is
characterized by more visual hallucinations. There can be delusions. In
cases with severe dementia, psychosis is evident. The types of dementia
determine the intensity of psychosis.
2. Differentiate the clinical presentations of psychosis in
clients with the four different types of dementia.
Dementia caused by Parkinson's disease, Alzheimer's disease, Lewy body
dementia, frontotemporal dementia, and vascular dementia can all exhibit
psychosis. Each type of dementia presents unique clinical features of
psychosis. For instance, hallucinations affect 20–30% of people with
Alzheimer's disease dementia, while delusions affect 30–40% of patients.
Psychotic traits may coexist with physical aggressiveness. Dementia with
psychosis affects almost 50% of Parkinson's disease patients. If a patient
experiences dementia and Parkinsonian symptoms within a year of each
other, it is likely Lewy body dementia; otherwise, it is Parkinson's disease
dementia. One-half of those with Lewy body dementia will experience
psychosis of some type. Both Lewy body dementia and Parkinson's
disease dementia frequently cause visual hallucinations. 15% of individuals
with vascular dementia exhibit psychotic symptoms, while 5–10% of
patients with frontotemporal dementia exhibit both delusions and
hallucinations. A common feature of vascular dementia is delusions.
3. Discuss a minimum of two possible approaches to treatment for
dementia-related psychosis and select a minimum of one
pharmacological and one nonpharmacological approach.
Prior to initiating treatment, a thorough history taking and diagnostic testing
should be performed to rule out any additional medical or mental causes of
psychosis.
Nonpharmacological approaches, such as maintaining good daily
cleanliness, regular sleep, food regimen, and exercise, can significantly
improve cognition in the elderly. The shadow observed in the evening could
be mistaken for a visual hallucination, a typical symptom of psychosis
associated with dementia. Better nighttime lighting may aid in resolving
the issue of mistaking a shadow for a visual hallucination. Reducing
stimulant environments and identifying triggers can help alleviate
symptoms.
, lOMoARcPSD|1709022
Antipsychotics of the first and second generations are used as
pharmacological therapies. Antipsychotic use is severely restricted due to its
potential to exacerbate the motor symptoms associated with Lewy body
and Parkinson's disease dementia. Because of its low side effect profile and
minimal impact on motor function, pimavanserin has been licensed for
treatment in patients with Parkinson's disease dementia who exhibit
psychotic symptoms, such as delusions and hallucinations.
Three hundred fifty-one individuals with various forms of dementia
participated in a 12-week pimavanserin treatment trial, which revealed a
75.2% decrease in delusions and hallucinations (Friedman, 2021).
Headache, urinary tract infection, anxiety, lightheadedness, asthenia,
constipation, hypertension, and asymptomatic lengthening of QT interval
were observed as side effects; however, Friedman (2021) reported no EPS
symptoms. Although clozapine has demonstrated effectiveness in treating
psychosis associated with dementia, its significant side effect profile
discourages widespread use.
Tablet of Pimavanserin 34 mg Once daily, take one tablet orally (Stahl,
2020).
Patient education:
It might take up to four weeks to start noticing its effect.
Taken with or without meals
It is important to report any side effects that you have, including headache,
dysuria, anxiety, dizziness, constipation, asthenia, peripheral edema,
disorientation, and hypertension. This will help in managing the treatment
effectively and ensuring the patient's comfort.
Identify at least two strategies to suggest to family or staff for a client who
is experiencing dementia-related psychotic behavior at home and in the
long-term care environment.
Early diagnosis and intervention play a crucial role in managing dementia-
related psychotic behavior. I would advise the patient's family member or
caregiver to report any signs of psychosis to the provider or to see a
psychiatrist as soon as feasible. To prevent a patient's conduct from getting
worse, I would teach caregivers to divert their attention from upsetting
situations rather than confronting the patient. Reducing stimulant
environments and identifying triggers can help alleviate symptoms.
Reference
Boland, R., & Verduin, M.L. (2022) Kaplan and Sadock's synopsis of
MoARcPSD|1709022
Week 6: Collaboration Café
1. How does dementia-related psychosis differ from other types of
psychosis?
Many types of dementia can cause psychosis. Unlike schizophrenia, which
is characterized by more auditory than visual hallucinations, it is
characterized by more visual hallucinations. There can be delusions. In
cases with severe dementia, psychosis is evident. The types of dementia
determine the intensity of psychosis.
2. Differentiate the clinical presentations of psychosis in
clients with the four different types of dementia.
Dementia caused by Parkinson's disease, Alzheimer's disease, Lewy body
dementia, frontotemporal dementia, and vascular dementia can all exhibit
psychosis. Each type of dementia presents unique clinical features of
psychosis. For instance, hallucinations affect 20–30% of people with
Alzheimer's disease dementia, while delusions affect 30–40% of patients.
Psychotic traits may coexist with physical aggressiveness. Dementia with
psychosis affects almost 50% of Parkinson's disease patients. If a patient
experiences dementia and Parkinsonian symptoms within a year of each
other, it is likely Lewy body dementia; otherwise, it is Parkinson's disease
dementia. One-half of those with Lewy body dementia will experience
psychosis of some type. Both Lewy body dementia and Parkinson's
disease dementia frequently cause visual hallucinations. 15% of individuals
with vascular dementia exhibit psychotic symptoms, while 5–10% of
patients with frontotemporal dementia exhibit both delusions and
hallucinations. A common feature of vascular dementia is delusions.
3. Discuss a minimum of two possible approaches to treatment for
dementia-related psychosis and select a minimum of one
pharmacological and one nonpharmacological approach.
Prior to initiating treatment, a thorough history taking and diagnostic testing
should be performed to rule out any additional medical or mental causes of
psychosis.
Nonpharmacological approaches, such as maintaining good daily
cleanliness, regular sleep, food regimen, and exercise, can significantly
improve cognition in the elderly. The shadow observed in the evening could
be mistaken for a visual hallucination, a typical symptom of psychosis
associated with dementia. Better nighttime lighting may aid in resolving
the issue of mistaking a shadow for a visual hallucination. Reducing
stimulant environments and identifying triggers can help alleviate
symptoms.
, lOMoARcPSD|1709022
Antipsychotics of the first and second generations are used as
pharmacological therapies. Antipsychotic use is severely restricted due to its
potential to exacerbate the motor symptoms associated with Lewy body
and Parkinson's disease dementia. Because of its low side effect profile and
minimal impact on motor function, pimavanserin has been licensed for
treatment in patients with Parkinson's disease dementia who exhibit
psychotic symptoms, such as delusions and hallucinations.
Three hundred fifty-one individuals with various forms of dementia
participated in a 12-week pimavanserin treatment trial, which revealed a
75.2% decrease in delusions and hallucinations (Friedman, 2021).
Headache, urinary tract infection, anxiety, lightheadedness, asthenia,
constipation, hypertension, and asymptomatic lengthening of QT interval
were observed as side effects; however, Friedman (2021) reported no EPS
symptoms. Although clozapine has demonstrated effectiveness in treating
psychosis associated with dementia, its significant side effect profile
discourages widespread use.
Tablet of Pimavanserin 34 mg Once daily, take one tablet orally (Stahl,
2020).
Patient education:
It might take up to four weeks to start noticing its effect.
Taken with or without meals
It is important to report any side effects that you have, including headache,
dysuria, anxiety, dizziness, constipation, asthenia, peripheral edema,
disorientation, and hypertension. This will help in managing the treatment
effectively and ensuring the patient's comfort.
Identify at least two strategies to suggest to family or staff for a client who
is experiencing dementia-related psychotic behavior at home and in the
long-term care environment.
Early diagnosis and intervention play a crucial role in managing dementia-
related psychotic behavior. I would advise the patient's family member or
caregiver to report any signs of psychosis to the provider or to see a
psychiatrist as soon as feasible. To prevent a patient's conduct from getting
worse, I would teach caregivers to divert their attention from upsetting
situations rather than confronting the patient. Reducing stimulant
environments and identifying triggers can help alleviate symptoms.
Reference
Boland, R., & Verduin, M.L. (2022) Kaplan and Sadock's synopsis of
