Problem Behaviours In People Research Articles

Psychological determinants for behavioral problems in people with multiple sclerosis: a patient control pilot study

Psychological determinants for behavioral problems in people with multiple sclerosis: a patient control pilot study

Effectiveness of a health education program for people with dementia and their family caregivers: An intervention by nurse practitioners

PurposeThis study assesses the effectiveness of a health education program on caregiving outcomes for people with dementia and their families. MethodsThis quasi-experimental study involved 250 people with dementia and their family caregivers. Behavioral problems in people with dementia were assessed using the Chinese version of the Cohen-Mansfield Agitation Inventory-community form. Family caregiver outcomes were measured using the Agitation Management Self-Efficacy Scale, Caregiver Preparedness Scale, Competence Scale, and Community Resource Awareness and Utilization Assessment. ResultsFollowing the intervention, the experimental group demonstrated significant improvements in terms of self-efficacy, preparedness, competence, and awareness and utilization of community resources among family caregivers. Additionally, the experimental group exhibited lower levels of behavioral problems among people with dementia. ConclusionsThis study helped improve caregiving outcomes for people with dementia and their family caregivers. Therefore, outpatient healthcare providers can utilize these findings to enhance care for this population.

Children with Congenital Heart Disease Show Increased Behavioral Problems Compared to Healthy Peers: A Systematic Review and Meta-Analysis.

Millions of children and adults are living with congenital heart disease (CHD). Their risk for behavioral problems has not been the subject of a meta-analysis. We performed a systematic review and meta-analysis of measures of behavioral problems in people born with CHD compared to peers without CHD. We searched Pubmed, CINAHL, Embase, PsycInfo, and the Cochrane Library from January 1, 1986 to November 15, 2021. We included studies that reported a measure of behavioral problems in patients with CHD in children and adults older than 3years of age. We screened 26,343 search results, and 24 studies met inclusion criteria. The quality of evidence was generally low. Subjects with CHD had a small increase in internalizing problems [standardized mean difference (SMD): 0.198, p = 0.02] and total behavior problems (SMD: 0.287, p = 0.013), but no difference in externalizing behavioral problems. There was significant heterogeneity in all three domains of behavior problems analyzed, and it could not be explained by variables such as age, severity, assessor, or assessment tool. There are small increases in parent- and self-reported overall behavioral problems and internalizing problems in patients with CHD compared to healthy controls. Wide confidence intervals in the meta-analyses leave open the possibility that certain factors may increase the risk of behavioral problems in this group, and future studies with important attention paid to potential confounders may help identify risk factors.

Management of behavioural problems in people with dementia

Behavioural and psychological symptoms of dementia (BPSD) encompass the wide range of non-cognitive symptoms that affect over 90% of those with dementia. These symptoms include aggression, agitation, psychosis and social disinhibition, and can represent unmet needs in patients that may otherwise be unable to express themselves. Each person with dementia can have any combination of these symptoms – to varying severity – and they can fluctuate throughout the disease course. This article focuses on BPSD, including its common causes, patient assessment within primary care and key aspects of management.

The Role of Caregivers’ Sleep Problems in the Association between Behavioral Symptoms of Dementia and Caregiving Depression and Anxiety

ABSTRACT Objectives Behavioral problems in people with dementia are a source of depression and anxiety for caregivers, who experience high levels of sleep problems. The present study aims to explore the role of sleep problems on the relationship between behavioral problems associated with dementias – considering its different dimensions – and family caregivers’ depressive and anxious symptoms. Method 264 family caregivers participated in the study. Through face-to-face interviews, sociodemographic and health variables, caregivers’ depressive and anxious symptoms were measured, as well as their sleep problems. Data related to people with dementia symptoms and their level of independence in daily life activities were also collected. Data analysis consisted of simple mediational models using the PROCESS method for SPSS. Results the test for the indirect effect of disruptive behaviors on depression through sleep problems was statistically significant, as it was for disruptive behaviors on anxiety through sleep problems. The effect of sleep problems in the association between depressive and memory problems in the person with dementia, and caregivers’ depression and anxiety were not statistically significant. Conclusions Sleep problems are significantly and positively associated with care-recipients’ disruptive behaviors, but not with depressive and memory problems. The indirect effect of disruptive behaviors on caregivers’ mood through sleep problems suggests that disruptive behaviors seem to play an important role for understanding caregivers’ sleep problems.

Teorija uma i problemi u ponašanju kod osoba s intelektualnom ometenošću

Introduction. Behavioral problems are more common in people with intellectual disability than in typical population and present an obstacle to their adaptive functioning and social inclusion. Since adjusted social behavior requires, among other things, an adequate understanding and interpretation of thoughts and behavior of others, theory of mind could be one of the factors of adjusted behavior and behavioral problems in people with intellectual disability. Objective. The aim of this paper is to single out the research in which the issue of the relationship between the ability of theory of mind and behavioral problems of people with intellectual disabilities has been addressed, through a literature review. Methods. Insight into the available literature was performed by searching the electronic databases that are available through the services of the Serbian Library Consortium for Coordinated Acquisition - KOBSON, as well as through Google Scholar and Research Gate. Results. Based on the analyzed research results, it can be concluded that there is a negative correlation between theory of mind and behavioral problems, both in children and in adolescents and adults with intellectual disabilities. While some studies have found a direct link between theory of mind and behavioral problems, others have found that this link is indirect, whereby the role of intermediaries tend to have executive functions, social acceptance, quality of parental interaction and resilience. Conclusion. Since the results of several studies suggest that more advanced theory of mind enables more successful social interactions and more adjusted behavior, it is necessary to enrich the education of people with intellectual disability with contents related to understanding thoughts, emotions, desires and intentions, as one of the elements of approach to treatment, in order to prevent problematic behaviors.

Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review.

What is the effect of physical exercise on cognitive decline and behavioural problems in people with mild cognitive impairment (MCI) or dementia? What is the effect of physical exercise on particular domains of cognitive function? How do training protocols and patients' characteristics influence the outcomes? Systematic review and meta-analysis of randomised trials. People with MCI or dementia as their primary diagnosis. Physical exercise. Cognitive function including global cognition, memory, executive function, reasoning, attention, language, and behavioural problems. Forty-six trials involving 5099 participants were included in this review. Meta-analysis of the data estimated that aerobic exercise reduced the decline in global cognition, with a standardised mean difference (SMD) of 0.44, 95% CI 0.27 to 0.61, I2= 69%. For individual cognitive functions, meta-analysis estimated that exercise lessened working memory decline (SMD 0.28, 95% CI 0.04 to 0.52, I2= 40%). The estimated mean effect on reducing the decline in language function was favourable (SMD 0.17), but this estimate had substantial uncertainty (95% CI -0.03 to 0.36, I2= 67%). The effects of exercise on other cognitive functions were unclear. Exercise also reduced behavioural problems (SMD 0.36, 95% CI 0.07 to 0.64, I2= 81%). Physical exercise can reduce global cognitive decline and lessen behavioural problems in people with MCI or dementia. Its benefits on cognitive function can be primarily attributed to its effects on working memory. Aerobic exercise at moderate intensity or above and a total training duration of > 24 hours can lead to a more pronounced effect on global cognition.

Dealing with behavioral and psychological symptoms of dementia: a general overview.

Dealing with the behavioral and psychological symptoms of dementia (BPSD) is often complex. Given the controversy with regard to antipsychotics for behavioral problems in people with dementia, there has been a renewed emphasis on nonpharmacological interventions, with progress in the design of the relevant studies. Potential nonpharmacological interventions for BPSD are: cognitive training/stimulation, rehabilitative care, activities of daily living, music therapy, massage/touch, physical activity, education/training of professionals, and education and psychosocial support of informal caregivers. Use of antipsychotics in the management of BPSD is controversial due to limited efficacy and the risk of serious adverse effects, but credible alternatives remain scarce. The problem of chronic use of antipsychotics in nursing homes should be tackled. Discontinuation of antipsychotic medication in older individuals with BPSD appears to be feasible. Discontinuation efforts are needed to differentiate between patients for whom antipsychotics have no added value and patients for whom the benefits outweigh the risks.

Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.

Psychometric properties of a Dutch version of the Behavior Problems Inventory-01 (BPI-01)

There are only a limited number of Dutch validated measurement instruments for measuring behavioral problems in people with a moderate to profound intellectual disability. In this study, the psychometric properties of a Dutch version of the behavior Problems Inventory-01 (BPI-01; Rojahn et al., 2001) have been investigated among 195 people with a moderate to profound intellectual disability who live in a residential facility. The BPI-01 was completed by 42 informants (staff members) of 23 care units. The inter-rater reliability, intra-rater reliability and internal consistency turned out to be good. Factor analysis confirmed two of the three a priori factors and the third factor was a mix of self-injurious (SIB) behavior and stereotypic behavior. The BPI-01 was compared to the Aberrant Behavior Checklist (Aman et al., 1985a) and showed a good convergent validity. This study shows that a Dutch version of the BPI-01 has good psychometric properties for measuring behavior problems in individuals with moderate to profound intellectual disability.

The effectiveness of aripiprazole in the management of problem behaviour in people with intellectual disabilities, developmental disabilities and/or autistic spectrum disorder – A systematic review

The management of problem behaviours (PB) in individuals with intellectual disabilities (ID), developmental disabilities (DD) and/or autistic spectrum disorders (ASD) can be challenging. Antipsychotic medications are commonly prescribed where other strategies have failed. A systematic review (SR) was conducted to establish the research evidence for the efficacy of aripiprazole in the management of PB in adults and children with ID, DD and/or ASD. Although included studies supported the efficacy of aripiprazole for this indication, the overall quality of studies was poor. Of the 20 studies included in this systematic review there were only two randomised controlled trials (RCTs) on children with ASD and/or ID/DD, both of which were conducted by the pharmaceutical company that manufactures aripiprazole, and it is not clear whether a number of same participants were included in both RCTs. One of the RCTs was extended into an open label long term follow up, which showed that aripiprazole's efficacy lasted over 52 weeks and the adverse effects were tolerable. Four studies were open label prospective studies, 11 were retrospective case reports which included four single case reports, and two were prospective case series. Most studies reported adverse effects from aripiprazole in the form of weight gain, increased appetite, sedation, tiredness, drooling and tremor. However, aripiprazole improved serum prolactin level in some participants and overall did not show any adverse effect on QTc interval. There is a need for more carefully designed RCTs into the use of aripiprazole in the management of PB in people with ID/DD and/or ASD, which should be carried out independent of pharmaceutical companies.

Procena maladaptivnog ponašanja kod osoba sa težim oblicima intelektualne ometenosti

The most common forms of maladaptive behaviors in persons with intellectual disability are aggressive, destructive and auto aggressive behavior. The aim of this paper is to review the available literature indicate various possibilities of behavioral assessment in people with severe intellectual disability. By researching of electronic databases Serbian Library Consortium for Coordinated Acquisition - KOBSON were collected and analyzed papers that processed topic of behavioral problems in people with severe forms of intellectual disability. By analyzing of available papers was observed that many authors emphasize the importance of behavioral approaches to assessment and treatment of behavioral problems in people with severe intellectual disability. Besides the commonly used indirect, researchers point to the importance of the descriptive and experimental methods to assess. The paper describes seven instruments for assessing behavioral problems.

Efficacy of beta blockers in the management of problem behaviours in people with intellectual disabilities: A systematic review

Both medication and non-medication based strategies are used in the management of problem behaviours in individuals with intellectual disabilities. Beta-adrenoceptor blocking medications are one group of drugs used for this purpose. However, despite its regular use, the evidence for the efficacy of these drugs for in this context is lacking. A systematic review was conducted to establish the research evidence for the efficacy of beta blockers in problem behaviours in adults and children with intellectual disabilities. Although the research identified supported the efficacy of beta blockers for this indication the overall quality of studies identified was poor and no randomised controlled trials were identified. There is a need for more robust research into the use of beta blockers for people with intellectual disabilities who show problem behaviours.

A literature review of spaced-retrieval interventions: a direct memory intervention for people with dementia

With the increasing prevalence of dementia, there is a pressing need to identify effective interventions that prolong independent functioning. As pharmacological interventions aimed at slowing cognitive decline have been found to have a number of limitations, research has now moved toward studying complementary non-pharmacological cognitive training interventions. This review describes the use of spaced-retrieval as a method to teach new information and reduce behavioral problems in people with dementia. We searched the databases PsychINFO, MEDLINE, and Scopus as well as reference lists of relevant papers to identify articles describing the use of spaced-retrieval with people with dementia. Only primary, peer-reviewed research published in English was included in this review. In total, 34 studies were identified, three of which were randomized controlled trials. We found that across studies, there was wide variability with regard to design, methodology, and outcome measures used. Nonetheless, the existing research demonstrates that spaced-retrieval training can be successfully used to teach people with dementia new and previously known face- and object-name associations, as well as cue-behavior associations aimed at alleviating problem behaviors and improving functional skills. The method can also assist with the recollection of past events. Current evidence indicates that spaced-retrieval training is effective in enabling people with dementia to learn new information and behavioral strategies. Future research should attempt to address the limitations outlined in this review and focus on utilizing this technique to achieve more functional and clinically relevant outcomes. Recommendations are also made with regard to investigating potential secondary benefits of spaced-retrieval and strengthening study design.

Behavioral problems in people with intellectual disability: Basic facts, incidence and risk factors

In people with intellectual disabilities, behavioral problems result from the interaction of multiple risk factors of different origin, which undoubtedly indicates the importance of knowing their individual characteristics and life circumstances. Incidence, specific forms and topography of behavioral problems depend on different factors, both socio-demographic and inherent ones. Behavioral problems significantly impede acquiring new adaptive skills and have a negative influence on the interaction with the environment. Emotional and behavioral problems are a significant source of stress in children with intellectual disability, as well as their parents and professional staff. These difficulties, especially aggression and disruptiveness, have a big influence on the selection of education model, i.e. on how much the child will be involved in the educational process and the decision whether or not a person will be institutionalized. Better understanding of behavioral problems in people with intellectual disability is the basis of eliminating or reducing risk factors, as well as creating a comprehensive treatment model.

Psychological treatments in intellectual disability: the challenges of building a good evidence base

Psychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

Exploring the effect of foot massage on agitated behaviours in older people with dementia: A pilot study

To explore the effects of foot massage on agitated behaviours in older people with dementia living in long-term care. Seventeen men and 5 women (mean age 84.7 years), with a diagnosis of dementia and a history of clinically significant agitation, received a 10-minute foot massage each day for 14 days. The short form of the Cohen-Mansfield Agitation Inventory (CMAI-SF) and the Revised Memory and Behavior Problems Checklist (RMBPC) were completed at baseline, post-test and 2-weeks follow up. CMAI-SF and RMBPC scores were significantly reduced at post-test and remained significantly lower than baseline at follow up. This study provides preliminary evidence suggesting that limited short-duration foot massage reduces agitation and related behavioural problems in people with dementia, and that these behaviour changes are maintained after the massage ceases. A randomised controlled trial is required to confirm these findings.

Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services

Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards. Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug. The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20-29) and 27% an affective illness (ICD-10 F30-39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous. In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated.

Assessment of mental health problems in people with Down syndrome: key considerations

Accessible summary People with Down syndrome can have problems with the way they think, feel, and act. Those who help people understand these difficulties need to have information about the factors that can contribute to such problems. This knowledge is important so difficulties can be found early, and help given. SummaryThe dual disability literature is marked by a lack of reviews with respect to assessment of specific aetiological groups. The current review summarises the wide body of literature relevant to the assessment of psychiatric and behavioural problems in people with Down syndrome. Adequate assessment within this population requires knowledge, not only of epidemiological findings with respect to psychiatric and behavioural problems, but also an understanding of other important areas including psychometrics, neurocognitive functioning, dementia and other medical issues. These areas are reviewed, and directions for future research are proposed.

Management of Behavioural Problems in People with Dementia

There are currently 700 000 people with dementia in the UK, and this is projected to rise to over a million by 2025. Dementia can occur at any age, but is most common in older people, affecting one in six people over the age of 80 years. The most common form of dementia is Alzheimer's disease, other forms include vascular dementia and dementia with Lewy bodies. Behavioural and psychological symptoms in dementia are common. As well as causing distress to the person with dementia, they are a significant cause of distress to carers and are a common factor leading up to institutionalization of the person with dementia.