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BPSD Hierarchy and Dialogue

BPSD Hierarchy and Dialogue. David J Findlay Stirling 12-10-09. Assumptions. The higher up this hierarchy any therapeutic intervention can be made the more likely it is to be successful More than one strategy can be pursued simultaneously

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BPSD Hierarchy and Dialogue

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  1. BPSD Hierarchyand Dialogue David J Findlay Stirling 12-10-09

  2. Assumptions • The higher up this hierarchy any therapeutic intervention can be made the more likely it is to be successful • More than one strategy can be pursued simultaneously • Dialogue more effective than checklist

  3. Underlying Illness I : Context • Is there a clear diagnosis of dementia, including suggested sub-type ? • Has the problem symptom or behaviour been clearly identified and defined ? • For whose benefit is treatment being sought and is (in)capacity an issue ?

  4. Underlying Illness II : Physical • Has delirium been excluded by appropriate consideration of recent changes in mental and physical state ? • Have pain and constipation been assessed for or empirically treated ? • Has drug toxicity been considered ?

  5. Underlying Illness III : Psychiatric • Has there been evidence of seemingly delusional ideation and/or response to possibly hallucinatory phenomena ? • Has the presence of depression and / or anxiety been considered ? • Are there unexplained phenomena ?

  6. Hidden Meaning I : Carers • What do carers currently understand by the reported symptom or behaviour ? • What is their background level of knowledge about dementia or “BPSD” ? • What are their training and support arrangements ?

  7. Hidden Meaning II : Environment • Are there already-known problems with the physical surroundings in which the patient’s management takes place ? • Is the overall level of stimulation (too) low or high ? • Has appropriate advice been sought ?

  8. Hidden Meaning III : Personality • Is there anything in this person with dementia’s background which might “explain” the present behaviour ? • Is this an exacerbation of previous traits or a significant change ? • Has there been discussion with relatives ?

  9. Pragmatic Input I : Psychological • Have Antecedents, Behaviour and Consequences charts been completed ? • What is the availability of psychological therapies provision or support ? • What are shift handover arrangements ?

  10. Pragmatic Input II : Pharmacological • What are review arrangements for (stopping) psychotropic medication ? • Is there a local protocol for (drug) treatment of “BPSD” ? • What (antipsychotic) side effects might be helpful for this particular individual ?

  11. Pragmatic Input III : Adjunctive • What is the scope for recreational / diversionary “failure-free” activities ? • What is known about the individual’s likes and dislikes e.g. music ? • What “alternative therapies” have staff so much as heard of ?

  12. Summary / Conclusions • A hierarchy of possible interventions • Dialogical methodology • Issues with antipsychotics • Equality and psychological therapies

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