Dementia: challenging behaviour and the use of antipsychotic drugs

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Dementia challenging behaviour and the use of
antipsychotic drugs

• A guide for care home staff

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Dementia challenging behaviour and the use of
antipsychotic drugsWhy are we looking at it
and what are we going to cover?

• What is dementia?
• Who gets dementia?
• What is challenging behaviour?
• What are antipsychotics and why are they used for
  challenging behaviour?
• What is the problem with giving antipsychotics to
  people with dementia?
• What national guidelines are there?
• What can be tried instead?
• What if a person with dementia is given
  antipsychotics?

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What is dementia?

• Dementia is a disorder that affects how the brain
  works
• Symptoms of dementia vary from person to person,
  but can include
• loss of memory
• difficulty thinking things through and
  understanding
• problems with reading and writing
• And also importantly
• confusion and agitation
• hallucinations and delusions
• difficulty controlling movements of the body

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What is dementia?

• What are hallucinations?Hallucinations are when
  someone sees, hears, smells, tastes or feels
  something that is not there
• What are delusions?
• Delusions are false beliefs that the person
  strongly believes are true e.g. that they are
  being followed or spied on

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What is dementia?

• Symptoms of dementia usually get worse over time
• It can become difficult for the person to do many
  daily activities or to care for themselves
• The most common cause of dementia is Alzheimer's
  disease. About 60 of people with dementia have
  Alzheimer's disease
• Other types of dementia include vascular dementia
  and dementia with Lewy bodies

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What is dementia?

• In Alzheimer's disease, small clumps of protein
  known as plaques develop around brain cells. This
  upsets the normal workings of the brain
• Vascular dementia is a type of dementia caused by
  problems in the supply of blood to the brain
• Dementia with Lewy bodies is where abnormal
  structures, which are known as Lewy bodies,
  develop inside the brain

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Who gets dementia?

• Dementia is more likely to affect older people,
  but younger people can also develop it
• about two-thirds of people with dementia are over
  80
• about one-sixth of people with dementia are over
  90

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What is challenging behaviour?

• Sometimes people with dementia can develop
  distressing symptoms and/or challenging behaviour
  that isnt to do with memory or understanding-
• Challenging symptoms include hallucinations,
  delusions, anxiety, and severe agitation
• Challenging behaviour includes aggression,
  agitation, wandering, hoarding, sexual
  disinhibition, lack of interest in things, and
  disruptive vocal activity (such as shouting)
• These symptoms are also sometimes called
  non-cognitive symptoms

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What are antipsychotics and why are they used for
challenging behaviour in dementia?

• Antipsychotics are drugs that were first
  developed to treat people with schizophrenia
• They work by blocking the effects of chemical on
  the brain
• Examples of antipsychotics are risperidone,
  quetiapine, olanzapine and haloperidol
• They are sometimes used to treat the distressing
  symptoms or challenging behaviour in people with
  dementia
• Antipsychotics can help reduce feelings of
  anxiety or aggression within a few hours, but may
  take several days or weeks to reduce
  hallucinations or delusional thoughts

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What is the problem with giving antipsychotics to
people with dementia?

• Antipsychotics may not actually work for
  distressing symptoms/challenging behaviour in
  people with dementia
• If antipsychotics are used in people with
  dementia, they may increase the chance that the
  person has a stroke
• Antipsychotics can also cause other problems,
  such as odd movements, problems with blood
  pressure, dizziness and unsteadiness
• Antipsychotics can cause very serious problems in
  people with a certain type of dementia called
  dementia with Lewy bodies

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National guidelines

• There are national guidelines for the treatment
  of people with dementia
• These guidelines have been written by the
  National Institute for Health and Clinical
  Excellence (NICE)
• The guidelines say that antipsychotics should not
  be used for mild to moderate non-cognitive
  symptoms in people with dementia.
• The guidelines say medication should only be
  used if there is severe distress or an immediate
  risk of harm to the person with dementia or
  others
• There is a website where you can see NICE
  guidelines www.nice.org.uk
• Your local health authority may also have
  guidelines or advice for you to follow

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What else can be tried before antipsychotics?

• You might want to think about
• Is there something physically wrong with them
  e.g. do they have an infection? The doctor should
  physically examine the patient
• Is the patient angry about something or someone?
  Can anything be done about this?
• Is it very noisy or hectic in the home at the
  moment? Could anything else be causing problems?
• Other issues that could be causing a problem
  include
• Overcrowding
• Lack of privacy
• Lack of activities
• Anyone involved in looking after people with
  dementia should have training in managing people
  with dementia

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What else can be tried instead of antipsychotics?

• NICE recommends a number of non-drug options that
  could be tried. For example-
• aromatherapy
• multisensory stimulation
• therapeutic use of music and/or dancing
• animal assisted therapy
• massage
• Patient centered care is important-
• Develop individual patient tailored care plans
• Write in the patients notes
• Review regularly

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What if a person with dementia is given an
antipsychotic?

• Sometimes the doctor will decide that a person
  with dementia should be prescribed an
  antipsychotic
• If the doctor decides to do this, they should do
  some checks on the patient first
• It should be explained to the person with
  dementia (if possible) and their carers why an
  antipsychotic is being used. It should be
  explained how the antipsychotic may help, but
  also what the risks are. This should be written
  in the patients records

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What if a person with dementia is given an
antipsychotic?

• The antipsychotic should be given for as short a
  time as possible
• It should be reviewed regularly by the doctor
• It is important that the symptoms the
  antipsychotic should be improving (the target
  symptoms) are documented and written in the
  patient records
• Care home staff should regularly document the
  persons symptoms and behaviour e.g. using
  behaviour charts. The doctor can then use this
  information to check if the antipsychotic is
  helping or even working

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So what have you learnt?

• Do you know the answers to these questions?
• What is dementia?
• Who does it normally affect?
• What is challenging behaviour or non-cognitive
  symptoms?
• What are antipsychotics?
• What are the problems with using antipsychotics
  in people with dementia?
• What else can be tried instead of antipsychotics?