BPSD Dr Alison Haddow

BPSD Types Types Assessment Assessment ABCD of Management ABCD of Management Case Discussion Case Discussion

Behavioural Symptoms Agitation Agitation Aggression Aggression Inappropriate vocalisation Inappropriate vocalisation Culturally inappropriate behaviour Culturally inappropriate behaviour Sexual disinhibition Sexual disinhibition Hoarding Hoarding Shadowing Shadowing Etc etc Etc etc

Psychological Symptoms Anxiety Anxiety Depression Depression Hallucinations Hallucinations Delusions Delusions Paranoid thinking Paranoid thinking Suicidal Ideation Suicidal Ideation

Causes of BPSD Environment Change in environment stimulating No signage Lighting - dim/glare Restrictive area Temperature Communication Physical Delirium Pain Medication Constipation Impaired hearing/vision Fatique

Treatment of BPSD Environment Modify Relaxation Tx Communication ‘Key’ Physical Treat Medication Anxiolytic Antipsychotic Antidepressant

A = Activating Event B = Behaviour C = Consequence D = Debrief; Decide ABC-D of Management of BPSD

Preventing & Managing Aggression A = Activating Event To prevent aggression, follow the Top Tips. If aggression occurs establish the activating event, or trigger. There is always an A. B = Behaviour What happened as a result of A? Describe the actual behaviour, ie; verbal/physical aggression; weapon used (urinal, walking stick etc) STOP! Decision point! Back off or continue? C = Consequence What was the consequence of B? Assess why the person was aggressive - are they unwell, in pain? D=Decide & Debrief What changes do you need to make - environmental, staffing. How can you change A to better manage B? Brainstorm! D = De-escalate Allow time for recovery Behaviour will escalate if it's not well managed. Immediate management strategies:  Remove other people from danger  Remove potential weapons  Give the person space (stand back)  Communicate in a calm, non- confronting way - avoid asking 'What' or 'Why' - (remember communication is 55% body language, 38% tone of voice & only 7% words)  Encourage the person to talk about how they are feeling  Empathise, ie: I can see you are very angry, frightened etc………….  Allow the person time to talk through their issues & establish what the problem is (try to put yourself in their shoes).

When to stop Antipsychotics Low dose Low dose High dose High dose Cochrane review: 9 trials withdrawal/cont. Most no problems Relapse rate higher esp. Severe BPSD