APPROACH TO AGITATION AND OTHER PSYCHIATRIC SYNDROMES/BEHAVIOURS

Abstract

We will highlight the commission's approach to agitation and other psychiatric syndromes, behaviours. The goals are to recognize psychiatric symptoms, manage, protect, and individualise care over the long-term. Psychiatric symptoms in dementia are common, generally increasing with stage of dementia and affecting nearly everyone with dementia at some point. Many different symptoms co-occur and may cluster into affective, psychosis, apathy, and hyperactivity, highlighting the need for careful assessment and a management strategy, for example, the DICE approach. We will outline interventions with the best evidence for the assessment and management of agitation, including pleasant events and maximising communication as prevention strategies, and providing good quality care. We will discuss management principles for agitation and their overlap with other symptoms (such as hallucinations, delusions, depression and apathy) which may co-occur. Indications for drug interventions including antipsychotics and antidepressants, harmful effects, and withdrawal will be outlined. Assessing and managing agitation might start with asking the person what is wrong and involve improving communication and person-centred care, consideration and management of physical causes (pain, infection, discomfort etc) pleasant activities, social engagement, occupational interventions, caregiver interventions; before considering pharmacological treatments. For management of depressive symptoms it is important to consider risk for self-harm, self-neglect, underlying delirium, pain, and the need for tailored treatment to patient's needs and wishes. Substantial improvement in quality of life can be gained with considerate and personalized interventions for psychiatric symptoms including agitation.