Behavioural Problems and Patterns of Psychopharmacological Treatment given in Elderly Patients with Dementia

Abstract

Behavioural and psychological symptoms are very common in dementia patients. Alterations in multiple neurotransmitter systems are involved in the pathogenesis of behavioural and psychological symptoms of dementia (BPSD). These symptoms complicate the therapy and outcome. Because of multi morbidity and poly pharmacy the therapy of BPSD is difficult and needs continuous clinical observation of the patients. It is a case series review of the patients attending the clinic for elderly at the Department of psychiatry and the purpose is to assess the behavioural and psychological problems associated with dementia and patterns of psychopharmacological interventions given to these patients, also to assess outcome of these patients on OPD basis. Inclusion Criteria consisted of patients with dementia presenting to psychiatry OPD and willing to participate in the study after informed consent. Patients with severe medical problems or severe psychiatric illness rendering them uncooperative for interview were excluded. Case files were used to collect cases and respective treatment given were used for the study. Behavioural Pathology in AD Rating Scale (BEHAVE-AD scale) was used to assess the severity of BPSD symptoms based on care givers objective data. A total of 50 cases meeting the criteria with predominant behavioural problems were taken for the study who were willing to participate and had given informed consent. Agitation, aberrant motor behaviour, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes were most frequent complaints in our study sample. Care giver psychoeducation, cognitive enhancers (Donepezil and Memantine), Haloperidol and Escitalopram were commonly employed in management of our patients with favourable outcome. BPSD was found to be present in 37.5% of our subjects and is in line with the findings of international patients having dementia with behavioural and psychological problems.