BPSD - Devon Partnership NHS Trust

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Pharmacological Management of Severe Behavioural & Psychological Symptoms of Dementia (BPSD) The aim of these guidelines is to promote evidence based, cost effective prescribing and support adherence to: o NICE Clinical Guideline CG42: Dementia (Nov 2006) o The use of antipsychotic medication for people with dementia: Time for action. (Banerjee 2009: Department of Health) o NICE Quality Standard QS01: Dementia (June 2010) o Alzheimer’s Society (2011): Optimising treatment and care for people with behavioural and psychological symptoms of dementia- A best practice guide for health and social care professionals The guidelines are NOT intended to replace prescribing information contained in the BNF or Summary of Product Characteristics. Treatment choice and duration Behavioural and psychological symptoms occur in about 90% of individuals with dementia, (frequency increases with severity of dementia), causing considerable distress and/or risk of harm to the individual, increasing distress to the family/carer and potentially interfering with/preventing the provision of required care. The presenting neuropsychiatric symptoms include psychosis, agitation, aggression, mood disorder and wandering and are collectively referred to as ‘behavioural and psychological symptoms of dementia’ (BPSD). For people with a diagnosis of dementia, behaviours that challenge are best ‘managed’ by good nursing care, the correct environment and use of ‘ABC’ (antecedents, behaviours and consequences) to try and identify causes and possible triggers for the presenting behaviour (e.g. hunger, pain). Non-pharmacological approaches must always be considered first (but are beyond the scope of, and not covered in, this guideline) Pharmacological treatment is not a substitute for non-pharmacological approaches and these techniques must always be used concurrently. Where non-pharmacological interventions have failed or are inappropriate, other possible causes (i.e. physical illness) should be eliminated prior to considering an individual trial of medication for the management of BPSD using the Pharmacological Treatment Algorithm below. PG 14 – Pharmacological Management of BPSD Approved by Drug and Therapeutics Committee: September 2013 Review date: September 2015 Page 2 of 10
No further intervention needed at this time. Continue to provide care for individual in accordance with current care-plan Individual presents with behaviours that challenge (e.g. agitation, wandering, aggression, tearfulness, sexual disinhibition shouting, hallucinations, delirium) Identify and document target symptoms, severity and level of distress caused to individual (Use suitable assessment tool i.e. Cohen–Mansfield Scale or Neuropsychiatric Inventory ) Could presenting symptoms be a result of underlying physical cause (including pain) YES Assess, diagnose and provide appropriate treatment Symptoms resolved NO YES NO Could presenting symptoms be sideeffects of concurrently prescribed medication YES Complete a medication review and rationalise treatment Symptoms resolved YES NO NO Could presenting symptoms be caused by underlying depressive illness and/ or anxiety disorder YES Assess, diagnose and provide appropriate treatment (refer to local prescribing guidelines) Symptoms resolved YES NO NO Consider and implement appropriate nonpharmacological interventions (e.g. environmental changes, psychological therapies, multisensory stimulation, massage, aromatherapy) Symptoms resolved YES Consider, discuss and provide appropriate pharmacotherapy in accordance with this prescribing guidance (PG14) NO Symptoms resolved NO YES Review prescribed medication regularly. After a period of 3 months, aim to reduce and stop medication when presenting behaviour has settled. Advise GP of plan to reduce and stop medication if still prescribed medication (after a trial of reduction) on discharge from in-patient unit or community team Where a medication has been ineffective, always stop it before introducing a subsequent treatment PG 14 – Pharmacological Management of BPSD Approved by Drug and Therapeutics Committee: September 2013 Review date: September 2015 Page 3 of 10
Page 1: Prescribing Guideline Pharmacologic
Page 5 and 6: Initiation of medication (by, or on
Page 7 and 8: Appendix 1 Decision aid for special
Page 9 and 10: BENZODIAZEPINES Intervention Ration

BPSD - Devon Partnership NHS Trust

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