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Case 9 - “Those Terrible Men Have Left”

Agitation in MNCD

Published online by Cambridge University Press:  31 October 2024

Matthew Gibfried  and
George T. Grossberg
Matthew Gibfried
Affiliation:
Saint Louis University School of Medicine, Missouri
George T. Grossberg
Affiliation:
Saint Louis University School of Medicine, Missouri
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Summary

Biopsychosocial-spiritual distress, also known as agitation, can be experienced by anyone with unmet biological needs, safety needs, need for love and belonging, and need for self-actualization. Signs of potential biopsychosocial-spiritual distress can include: restlessness, aggression, agitation, sundowning, wandering, exit seeking, social withdrawal, repetitive behaviors, and increased anxiety. Common unmet biopsychosocial needs in long-term care can include loneliness, boredom, pain, hunger, toileting issues, difficulty communicating needs, medical interventions, changes in routine, interpersonal conflicts, staff issues, and issues with other residents. Potential signs of psychosis in those with major neurocognitive disorders can include screaming out, picking at the skin, extreme agitation with personal care, talking to oneself, signs of compulsive behaviors, and the presence of paranoia. The presence of psychosis in major neurocognitive disorder may warrant the use of antispsychotic angents.

Keywords

agitationmajor neurocognitive disordersAlzheimer’s diseaseaggressionbiopsychosocial distresspsychosis
Type
Chapter
Information
Clinical Case Studies in Long-Term Care Psychiatry
Navigating Common Mental Health Challenges in Geriatric Care
 , pp. 39 - 45
Publisher: Cambridge University Press
Print publication year: 2024

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References

References

Aigbogun, M. S., Cloutier, M., Gauthier-Loiselle, M., Guerin, A., Ladouceur, M., Baker, R. A., Grundman, M., Duffy, R. A., Hartry, A., Gwin, K., & Fillit, H. (2019). Real-world treatment patterns and characteristics among patients with agitation and dementia in the United States: Findings from a large, observational, retrospective chart review. Journal of Alzheimer’s Disease, 77 (3), 1181–1194. https://doi.org/10.3233/JAD-200127CrossRefGoogle Scholar

Further Reading

Ballard, C., Corbett, A., Orrell, M., Williams, G., Moniz-Cook, E., Romeo, R., Woods, B., Garrod, L., Testad, I., Woodward-Carlton, B., Wenborn, J., Knapp, M., & Fossey, J. (2018). Impact of person-centered care training and person-centered activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomized controlled trial. PLoS Medicine, 15 (2). https://doi.org/10.1371/journal.pmed.1002500CrossRefGoogle Scholar
Carrarini, C., Russo, M., Dono, F., Barbone, F., Rispoli, M. G., Ferri, L., Di Pietro, M., Digiovanni, A., Ajdinaj, P., Speranza, R., Granzotto, A., Frazzini, V., Thomas, A., Pilotto, A., Padovani, A., Onofrj, M., Sensi, S. L., & Bonanni, L. (2021). Agitation and dementia: Prevention and treatment strategies in acute and chronic conditions. Frontiers in Neurology, 12, 644317. Published 2021 Apr 16. doi:10.3389/fneur.2021.644317CrossRefGoogle ScholarPubMed
Grossberg, G. T., Kohegyi, E., Mergel, V., Josiassen, M. K., Meulien, D., Hobart, M., Slomkowski, M., Baker, R. A., McQuade, R. D., & Cummings, J. L. (2020). Efficacy and safety of brexpiprazole for the treatment of agitation in Alzheimer’s dementia: Two 12-week, randomized, double-blind, placebo-controlled trials. The American Journal of Geriatric Psychiatry, 28 (4), 383–400. https://doi.org/10.1016/j.jagp.2019.09.009CrossRefGoogle ScholarPubMed
Ijaopo, E. O. (2017). Dementia-related agitation: A review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy. Translational Psychiatry, 7 (10), e1250. https://doi.org/10.1038/tp.2017.199CrossRefGoogle ScholarPubMed
Marcinkowska, M., Śniecikowska, J., Fajkis, N., Paśko, P., Franczyk, W., & Kołaczkowski, M. (2020). Management of dementia-related psychosis, agitation and aggression: A review of the pharmacology and clinical effects of potential drug candidates. CNS drugs, 34 (3), 243–268. https://doi.org/10.1007/s40263-020-00707-7CrossRefGoogle ScholarPubMed
Watt, J. A., Goodarzi, Z., Veroniki, A. A., Nincic, V., Khan, P. A., Ghassemi, M., Lai, Y., Treister, V., Thompson, Y., Schneider, R., Tricco, A. C., & Straus, S. E. (2020). Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: Systematic review and network meta-analysis. The BMJ, 372. https://doi.org/10.1136/bmj.n532Google Scholar

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