Pimavanserin (Nuplazid) is an atypical antipsychotic used to treat hallucinations and delusions, which prevents the patient from having a relapse. It does not affect motor symptoms. At the time of the podcast, it was only approved for Parkinson’s disease psychosis, but they are working towards DRP FDA approval.
Another medication frequently used is quetiapine (Seroquel). It is not as efficacious as Nuplazid but is safer with less impact on EPS disorders. The anticholinergic effects can cause constipation and are also sedating.
For non-pharmacological treatments, it is important to have a structured daily hygiene routine, including exercise, diet, awake and sleep times, and activity. Predictability is important for these patients.
Caretakers should also consider sundowners and prevent situations where shadows can be misinterpreted. Arranging more light inside the residence from 4 pm until 1 hour before bed can help to minimize shadows and increase stimulation (NEI, 2020).
Identify at least two strategies to suggest to family or staff for a client who is experiencing dementia-related psychotic behavior at home and in the long-term care environment.
Don’t suffer in silence. If you see something, say something. Earlier treatment of psychotic behavior is better than waiting until it is too late. Do not challenge the patient’s delusions or hallucinations. Holidays can exacerbate dynamics as families are sequestered together. Also, placement won’t cure the delusions or hallucinations, and placement can make the situation more complicated.
Bring symptoms to light early to your provider. Symptoms could be related to dehydration, infection, polypharmacy, structural lesion/subdural hematoma. The patient may need to be evaluated. Don’t wait until it is too late. Don’t take accusations personally. Don’t lock horns with your family members regarding their reports of psychotic symptoms. Avoid oppositional conversations with the client, instead, distract and redirect them (NEI, 2020).
Caregivers should seek out support groups for caregivers as grasping this new potential diagnosis can be confusing and isolating, and finding comfort in others who may be experiencing the same or similar feelings is important to help work through it.
References:
Neuroscience Education Institute. (2020). E95 - (CME) What’s real? Practical management of dementia-related psychosis. NEI Podcast. https://neiglobal.libsyn.com/e95-cme-whats-real-practical-management-of-dementia-related-psychosis
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