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Management Checklist for Behavioural Symptoms of Dementia Name……………………………. D.O.B……………………………….. Date of Assessment………………….. Management should focus around early recognition and prevention of behavoural symptoms of dementia, using assessment and non drug management. Antipsychotics should only be prescribed as a last resort and for a defined length of time. The need for ongoing antipsychotic treatment should be assessed by specialist services. Medical Review Dehydration: assess fluid intake, constipation Pain: Assess for any possible causes of pain. Infection: especially UTI, chest infection Medication Review Medication: avoid polypharmacy, codeine, anticholinergics including tricyclic antidepressants, oxybutinin, long acting SSRIs. Be aware of possible serotonergic syndrome, drug induced delirium. Clinical Review Delirium & confusion : treat according to guidance. Known Neuropsychiatric symptoms Depression: 4GDS >2 – treat appropriately-see local depression guidelines Person centred care Environmental factors Assess severity of symptoms Address factors that may influence behaviour MILD TO MODERATE SYMPTOMS SEVERE SYMPTOMS Refer any patient refusing to eat/drink or needing restraint WATCHFUL WAITING / NON DRUG TREATMENTS ASSESS & document baseline: Document symptom / incident, triggers and tried intervention in individual care plan and review regularly with carers/ staff . BADCHAVS tool. o CVA risk Cognition o Target symptoms o Co morbid conditions Notes : Interventions should be tailored to the individual and may include: CBT /psychosocial therapy, diversion, reorientation, multisensory stimulation & other simple interventions (e.g. if hungry, in pain etc.) o Carer consent Review progress regularly - If symptoms worsen, unsuccessful then consider specific interventions including psychosocial interventions / drug therapies. EXTREME RISK OR DISTRESS Severe distress / Risk of harm to self or others RISK - BENEFIT documented & TARGET SYMPTOMS identified If antipsychotics contra indicated, (e.g. stroke, Lewy Body dementia) or ineffective, contact Older Persons Mental Health team for advice. Severe agitation or psychosis (with aggression): Start with a low dose antipsychotic & titrate up according to response: 1st choice: Risperidone 250 microgram bd to max 1mg bd 2nd choice : Olanzapine 2.5mg od to bd PSYCHOSOCIAL interventions: tailor activities to individual needs & document in care plan. PHARMACOLOGICAL therapies Review at 6 weeks and / or every 12 weeks: 1. Assess response: improvement in severity of symptoms. 2. Monitor side effects: cognitive decline, target behaviour, weight gain, BP drop / dizziness, glucose levels, EPSE, sedation, constipation, fluid intake, signs of (chest) infection. 3. Reduce dose: If patient symptoms have improved and stable for 3 to 6 months reduce the dose by 50% every 2 weeks with continued monitoring and then stop. 4. Unless there is severe risk or extreme distress, the recommended default management is to discontinue the antipsychotic and continue to monitor/assess. 5. Where continued antipsychotic treatment is clinically necessary, referral to specialist services is advised. Set next review date with ongoing management plan. Analgesia: Paracetamol 1g up to qds Mild to moderate agitation: Lorazepam 0.5mg to 1 mg up to qds (short term) Trazodone 50 to 300mg daily Depression: Sertraline 50 to 100mg daily Citalopram 10 to 20 mg OD Sleep Disturbance: Zopiclone 3.75 to 7.5mg nocte Temazepam 10mg nocte Mood stabiliser: Carbamazepine 50 to 300mg daily 6. Any other Comments: Alzheimer’s SOCIETY. Optimising treatment and care for people with behavioural and psychological symptoms of dementia