Pharmacological Interventions Behavioural and Depression: 42% - - PowerPoint PPT Presentation

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Pharmacological Interventions Behavioural and Depression: 42% - - PowerPoint PPT Presentation

Dec 06, 2023 529 likes •831 views

Pharmacological Interventions Behavioural and Depression: 42% Psychological Agitation: 35% Anxiety: 35% Irritability: 30% Delusions: 22% Symptoms of Aberrant motor behaviour: 25% Sleep Disturbance: 14% Disinhibition: 12% Hallucinations:

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Pharmacological Interventions

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Behavioural and Psychological Symptoms of Dementia – 90%

Depression: 42% Anxiety: 35% Delusions: 22% Sleep Disturbance: 14% Hallucinations: 8.5% Agitation: 35% Irritability: 30% Aberrant motor behaviour: 25% Disinhibition: 12%

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50% of people living with dementia

PAIN

Higher prevalence than in cancer at end of life

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SLIDE 5

THINK DELIRIUM

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Cognitive symptoms of dementia: 100%

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Golden rules

  • 1. Speak to family.
  • 2. What does the patient with dementia want?
  • 3. Advanced decisions.
  • 4. Advanced statements.
  • 5. Legal framework for drug administration.
  • 6. Low and slow.
  • 7. Titrate to effect.
  • 8. Consider all side effects / contraindications.
  • 9. Speak to family.
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SLIDE 11
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Nociceptive pain

  • Regular paracetamol.
  • Remove stimulus – Think constipation,

GORD, wind.

  • NSAIDS + PPI.
  • Opiates.
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Neuropathic pain

  • SNRI
  • Amitriptyline
  • Pregabalin
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Golden rules

1. Speak to family. 2. What does the patient with dementia want? 3. Advanced decisions. 4. Advanced statements. 5. Legal framework for drug administration.

  • 6. Low and slow.
  • 7. Titrate to effect.
  • 8. Consider all side effects / contraindications.

9.Speak to family.

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SLIDE 15
  • SSRI – Sertraline, Fluoxetine, Citalopram.
  • Mirtazapine – positive side effect profile.
  • Trazadone – agitation, hypnotic.
  • Venlafaxine / Duloxetine.
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Pregabalin* Mirtazapine Selective serotonin reuptake inhibitor

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Antipsychotics

  • When and what to prescribe…..
  • Treat the symptom not the

behviour

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Antipsychotics

  • Risperidone - ? The safe (er) option?
  • Olanzapine – The all rounder.
  • Aripiprazole – Cardiologists friend
  • Amisulpride – Diabetologists friend
  • Haloperidol – The junior doctors friend
  • Quetiapine – Neurologists friend
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IM antipsychotics

  • Convenience vs drug
  • Rule 2
  • Legal framework
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Golden rules

1. Speak to family. 2. What does the patient with dementia want? 3. Advanced decisions. 4. Advanced statements.

  • 5. Legal framework for drug administration.

6. Low and slow. 7. Titrate to effect.

  • 8. Consider all side effects / contraindications.
  • 9. Speak to family.
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  • Can dopaminergic medication be reduced?
  • Rivastigmine
  • Quetiapine
  • ?Clozapine?

Psychotic symptoms in Parkinson’s disease

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Sleep / wake reversal

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Sleep wake cycle

  • Melatonin 10mg– mixed evidence,

cochrane, no effect and low side effects.

  • Trazadone 50mg-100mg – improved time to

sleep and time asleep

  • Ramelteon 8mg – no effects and poor

evidence base.

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SLIDE 26
  • Acetylcholinesterase

inhibitors*

  • Memantine*
  • Trazadone
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georgecrowther@nhs.net