Management of Behavioral and Psychological Symptoms of Dementia （BPSD）--no easy solution

Management of the behavioral and psychological symptoms of dementia (BPSD) is a hot topic because these commonly seen symptoms in persons with dementia are quite difficult to manage.As highlighted in the comments by Xiao[1],the administration of antipsychotics is controversial because the use of antipsychotic medications in persons with dementia is associated with increased mortality,increased risk of stroke and worsened cognitive function[2,3].Xiao recommends that more long-term follow-up studies on the management of the BPSD be conducted to give clinicians better guidance on the treatment of this complex condition.This recommendation is particularly pertinent for Chinese populations.Two studies from Hong Kong showed that patients with the BPSD who were treated with antipsychotic medications did not have an increased risk of cerebrovascular accidents[4]or mortality[5].Clearly,more studies should be conducted in populations of different ethnicity to confirm or disprove the presumed risks of antipsychotic medications in patients with dementia.     

Behavioral and Psychological Signs and Symptoms of Dementia (BPSD) in antipsychotic-naïve Alzheimer's Disease patients

BACKGROUND/OBJECTIVE: There were few studies identifying the natural unfolding of behavioural and psychological symptoms of dementia (BPSD) in the course of Alzheimer's disease (AD) progression in antipsychotic-naive AD patients. This study aims to examine the specific nature of the association between BPSD in AD and the global severity of illness measured by Global Deterioration Scale(GDS) in antipsychotic-naive AD patients in Korea. METHODS: A total of 562 antipsychotics-naive AD patients were recruited from four different groups [a geriatric mental hospital (n = 145), a semi-hospitalized dementia institution (n = 120), a dementia clinic (n = 114) and community-dwelling dementia patients (n = 183)]. BPSD exhibited by AD patients were measured using the 25-item Korean version of the BEHAVE-AD. RESULTS: Ninety-two percent (n = 517) of AD patients had at least one BPSD, while 56% (n=315) had 4 or more BPSD. Specific kinds of behavioral disturbance peak at the stages of moderate AD (GDS stage 5) or moderately severe AD (GDS stage 6). AD patients left at home without any treatment had higher frequency of BPSD than did other groups seeking treatment, although all of them were antipsychotic-naive. CONCLUSION: BPSD potentially remediable to treatment were highly frequent in Korean AD patients. Health policies to meet the unmet needs of elderly Koreans are urgently needed, especially for AD patients at home without treatment.     

Mothers’ Early Depressive Symptoms and Preschoolers’ Behavioral Problems: The Moderating Role of Genetic Influences

As a stressful environment in families, mothers’ depressive symptoms might increase children’s risks of developing behavioral problems by exacerbating genetic influences. Using data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort data of approximately 750 pairs of twins, we examined whether genetic influences on preschoolers’ behavioral problems depended upon mothers’ depressive symptoms. Results indicated that the genetic etiology for both internalizing and externalizing behaviors varied with maternal depressive symptoms at 9-months child age. Genetic effects on externalizing behaviors increased as mothers’ depressive symptoms increased; however, genetics effects on internalizing behaviors increased when depressive symptoms either increased or decreased from the median level. These different patterns of interactive effects suggest potentially different mechanisms for the etiology of children’s externalizing and internalizing behaviors.     

The Relationship Between Perceived Family Support and Depressive Symptoms in Adolescence: What is the Moderating Role of Coping Strategies and Gender?

This study examined the moderating role of gender and coping strategies in the relationship between perceived family support, self-esteem and depressive symptoms. Data were used from the My World Survey Second Level (MWS-SL), a national survey of mental health among 6062 young people aged 12–19 years. Conditional process analyses indicated that planned coping moderated the relationship between perceived family support and depressive symptoms for those engaging in low-moderate levels but not high levels of planned coping, and this moderating role was stronger for females than males. Avoidance coping was a moderator for those engaging in moderate-high but not low levels of avoidance coping, and gender also moderated this relationship. Support-focused coping only moderated the perceived family support/depressive symptoms relationship for females. Findings suggest that the strength of the relationship between perceived family support and depressive symptoms depends on level of engagement with a particular coping strategy, and this engagement is a consistently stronger moderator for females.     

The Impact of Dementia on Family Caregivers: What Is Research Teaching Us?

Dementia family caregiving has been the focus of research for decades. Much has been learned about the negative impact of caregiving as well as characteristics that may be protective. This paper explores themes in caregiving pertinent to clinicians and researchers working with dementia family caregivers: the psychological, subjective, and physical outcomes of caregiving, ways in which dementia alters relationships between the patient and caregiver, and strategies for improving outcomes for caregivers. Suggestions for next steps in research and clinical care are made.     

Differences between Current and Past Self-Injurers: How and Why Do People Stop?

This research sought to clarify how some self-injurers cease the behavior, maintaining this for at least 1 year. Using the Experiential Avoidance Model (EAM), we examined whether characteristics of self-injurers remain in people who have successfully ceased self-injury and what, by implication, might be targeted to improve therapeutic efficacy. The study was conducted using an online cross-sectional survey of 215 first-year university students. Past self-injurers (34) scored significantly better on subscales of the General Health Questionnaire, as well as Distress Tolerance, Experiential Avoidance, and Self-blame compared to Current self-injurers (29). The Experiential Avoidance Model is a useful basis for understanding self-injury, and informing therapeutic approaches. Reducing Anxiety, and developing Tolerance and Positive Emotional Intensity may be keys to ceasing self-injury.     

The Effectiveness of Parent–Child Interaction Therapy with Depressive Mothers: The Changing Relationship as the Agent of Individual Change

This study uses a multi-method approach to investigate the effectiveness of Parent–Child Interaction Therapy (PCIT) in reducing children’s behavior problems when parents report clinical levels of depressive symptoms. Participants were 132 children, 2–7 years of age, and their biological mothers, who either reported low (N = 78) or clinical levels of depressive symptoms (N = 54). Results showed that depressive mothers were likely to report more severe child behavior problems than non-depressive mothers at the pre-treatment assessment, but that depressive mothers reported greater reductions in child behavior problems than non-depressive mothers from pre- to post-treatment. The two groups showed similar levels of observed interaction quality at the pre-treatment assessment (i.e., parent and child emotional availability and parent verbalization patterns) and similar improvements in interaction quality from pre- to post-treatment. The implications of the findings for clinical practice were discussed.     

Evaluation of Community-Based Cessation Programs: How Do Smokers with Behavioral Health Conditions Fare?

Though persons with behavioral health conditions experience large disparities in tobacco use, questions about the efficacy of evidence-based tobacco use treatment remain understudied in community health settings. This evaluation examined outcomes from eight community-based tobacco cessation programs for participants with and without behavioral health conditions (n?=?974 participants). The majority (64.8%) of participants reported one or more current behavioral health conditions, including mental illness and/or substance abuse. Participants who used cessation medication during the program and who attended more counseling sessions had an increased likelihood of being quit at 4-month follow-up. Quit rates were between 9.8% (intent-to-treat rate) and 30.6% (responder rate); behavioral health status did not negatively affect reported quit rates. Findings add to the growing literature evaluating community-based interventions within the behavioral health population.     

Do Antenatal and Postnatal Parental Psychological Distress, and Recognized Need of Help Predict Preadolescent’s Psychiatric Symptoms? The Finnish Family Competence Cohort Study

In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child’s first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents’ well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers’ postnatal distress predicted subsequent internalizing problems. Furthermore, mother’s depressed mood in the first trimester best predicted the child’s externalizing problems at age 12. Nurses’s ratings of mother’s antenatal and perinatal need for support, perinatal distress, and family’s need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring’s externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.     

Concern for the aphasic person's sense of self: Why,who and how?

Abstract

Shelagh Brumfitt appropriately reminds us that the management of the aphasic adult is broader than language intervention. Indeed, that treatment of disordered language must be set within a context of recognition of the impact of aphasia and the adjustment involved. Brumfitt's conviction is that the aphasic person needs to develop an alternative and positive sense of self in order to adapt to the forced changes brought about by the aphasic condition. Assisting the patient with this adaptation may be as important as targeting treatment for the language disorder, and should be implicit in the concept of rehabilitation.     

Subarachnoid Techniques for Cancer Pain Therapy: When, Why, and How?

For cancer patients who obtain inadequate pain relief with conservative treatment, there is a growing list of effective options for subarachnoid therapy. Morphine and bupivacaine have been the most frequently used drugs for intrathecal infusion, and their use has consistently yielded good results. Despite their effectiveness, however, a therapeutic deficit remains, primarily in the treatment of neuropathic cancer pain. Because of this limitation, more recent research has focused on novel compounds for intrathecal therapy such as clonidine, midazolam, ketamine, and SNX-111. In addition to new drug options, there are various catheter delivery systems from which to choose. In reviewing the literature and experience to date with these various medications and delivery systems, we hope to better aid the clinician in tailoring the best treatment for each patient.