Post by Neo on Jan 19, 2005 21:22:02 GMT -5
Attributed to Norbert
FAQ1 - Hallucinations and Antipsychotics 02/18/04 07:03 AM
PSYCHOSIS SEEN IN DEMENTIA-
SUSPICION - unfounded belief that the spouse is cheating with the neighbor.
DELUSION - firmly held false belief - that people are living in the attic or that a neighbor is stealing the TV signals.
HALLUNINATIONS - The person sees or hears things that are not there. Sees people or animals that are not there. May actually wave or talk to the non-existent person. The person "sees" these things because of things that are happening in their brain.
Misperceptions - the person misinterprets shadows as a person or animal - combat this with adequate lighting to reduce shadows.
DEALING WITH HALLUCINATIONS ---
In some cases, a person is aware that they are having hallucinations; and reassurance - telling them that you will keep them safe is helpful. They may only need you to tell them that it is just on of their visions (when visual hallucinations). But - this is not the norm in hallucinations.
In most cases, the hallucinations are part of the person's reality (they really do see these things- internally) and being told that it is not real, will provoke anger. It is best to comfort, distract, or redirect the person. You can play along - telling the monster in the closet to leave.
One other thing, if the hallucinations do not cause problems or distress to the person, there may be no reason to treat them. Or it may be appropriate to treat so that they are reduced but not completely eliminated (to minimize sided effects from aggressive treatment)
ANTIPSYCHOTIC MEDICINES---
Antipsychotics are used in dementia to control psychosis that is harmful to the patient. Psychosis behaviors are hallucinations, delusions or extreme suspiciousness.
Someone once wrote here,
" I am not against drugs per se but think that antipsychotic ones meant for schizophrenia should not be prescribed for elderly AD dementia patients."
Psychosis in schizophrenia is caused by the overproduction of the neurotransmitter dopamine. This neurotransmitter is responsible for emotions and the result is hearing voices, seeing things that are not there, etc. All this is the result of imbalance between dopamine and acetycholine which produces logical thought to balance the emotions.
In Dementia, the same imbalance often develops, because of reduced acetycholine and preservation of dopamine. This can produce a medically defined condition "Psychosis of dementia". That's why these drugs are used but at a much lower level than for schizophrenia - because the same imbalance exists.
The first generation antipsychotic haloperidol (Haldol) has some really bad side effects and is not recommended for long term use for dementia patients. It is sometimes used in the hospital for one time use for agitation or to calm the patient for a medical procedure.
Lorazepam (Ativan)is an anxiety medication used for single episode events of agitation. It has similar effects on reduced cognition and is inappropriate for routine daily dosing to dementia patients.
The newer antipsychotics (called "atypical antipsychotics") have other side effects but fewer of the really bad ones of Haldol.
risperidone (Risperdal) is the strongest of the atypicals and is somewhat intermediate because it still has dose level related effect of producing Parkinsonian symptoms and slowing of movements.
olanzapine (Zyprexa)and quetiapine (Seroquel)are atypicals (with few of the side effects of seen with haldol) with Zyprexa being the stronger of the two.
Seroquel is the mildest of the second generation anti-psychotics and is most appropriate when a stronger drug is not required. It is the best tolerated antipsychotic by persons with Lewy Body or Parkinsons.
Another mild antipsychotic that is very new is Abilify. It is novel because it is more selective in the effect it has. It is also rather expensive. Few studies have been done on its use in dementia. Some doctors prefer to use it rather than resort to the stronger meds (risperdal or zyprexa.)
All atypicals have verying degree of side effects of orthostasis (lowered blood pressure when standing), sedation, and weight gain.
Some patients- those with lewy body- have a sensitivity to antipsychotics, called Neuroleptic Sensitivity Syndrome. They do better with the milder Seroquel, or if necessary Abilify.
Because of the neurotransmitter imbalance, use of Aricept will often reduce the psychotic symptoms or allow the use of a lower dose of the antipsychotic meds.
Agitation and Aggression-----
The other major use of antipsychotics in dementia, is treating agitation and aggression.
Antipsychotics take the edge off aggression. Once again, minor issues are treated with Seroquel, major aggression is treated with Risperdal or Zyprexa. Additionally, Depakote is usually added as a mood stabilizer. It raises the threshold needed to cause an emotional reaction in the person.
I hope this helps.
Norbert
FAQ1 - Hallucinations and Antipsychotics 02/18/04 07:03 AM
PSYCHOSIS SEEN IN DEMENTIA-
SUSPICION - unfounded belief that the spouse is cheating with the neighbor.
DELUSION - firmly held false belief - that people are living in the attic or that a neighbor is stealing the TV signals.
HALLUNINATIONS - The person sees or hears things that are not there. Sees people or animals that are not there. May actually wave or talk to the non-existent person. The person "sees" these things because of things that are happening in their brain.
Misperceptions - the person misinterprets shadows as a person or animal - combat this with adequate lighting to reduce shadows.
DEALING WITH HALLUCINATIONS ---
In some cases, a person is aware that they are having hallucinations; and reassurance - telling them that you will keep them safe is helpful. They may only need you to tell them that it is just on of their visions (when visual hallucinations). But - this is not the norm in hallucinations.
In most cases, the hallucinations are part of the person's reality (they really do see these things- internally) and being told that it is not real, will provoke anger. It is best to comfort, distract, or redirect the person. You can play along - telling the monster in the closet to leave.
One other thing, if the hallucinations do not cause problems or distress to the person, there may be no reason to treat them. Or it may be appropriate to treat so that they are reduced but not completely eliminated (to minimize sided effects from aggressive treatment)
ANTIPSYCHOTIC MEDICINES---
Antipsychotics are used in dementia to control psychosis that is harmful to the patient. Psychosis behaviors are hallucinations, delusions or extreme suspiciousness.
Someone once wrote here,
" I am not against drugs per se but think that antipsychotic ones meant for schizophrenia should not be prescribed for elderly AD dementia patients."
Psychosis in schizophrenia is caused by the overproduction of the neurotransmitter dopamine. This neurotransmitter is responsible for emotions and the result is hearing voices, seeing things that are not there, etc. All this is the result of imbalance between dopamine and acetycholine which produces logical thought to balance the emotions.
In Dementia, the same imbalance often develops, because of reduced acetycholine and preservation of dopamine. This can produce a medically defined condition "Psychosis of dementia". That's why these drugs are used but at a much lower level than for schizophrenia - because the same imbalance exists.
The first generation antipsychotic haloperidol (Haldol) has some really bad side effects and is not recommended for long term use for dementia patients. It is sometimes used in the hospital for one time use for agitation or to calm the patient for a medical procedure.
Lorazepam (Ativan)is an anxiety medication used for single episode events of agitation. It has similar effects on reduced cognition and is inappropriate for routine daily dosing to dementia patients.
The newer antipsychotics (called "atypical antipsychotics") have other side effects but fewer of the really bad ones of Haldol.
risperidone (Risperdal) is the strongest of the atypicals and is somewhat intermediate because it still has dose level related effect of producing Parkinsonian symptoms and slowing of movements.
olanzapine (Zyprexa)and quetiapine (Seroquel)are atypicals (with few of the side effects of seen with haldol) with Zyprexa being the stronger of the two.
Seroquel is the mildest of the second generation anti-psychotics and is most appropriate when a stronger drug is not required. It is the best tolerated antipsychotic by persons with Lewy Body or Parkinsons.
Another mild antipsychotic that is very new is Abilify. It is novel because it is more selective in the effect it has. It is also rather expensive. Few studies have been done on its use in dementia. Some doctors prefer to use it rather than resort to the stronger meds (risperdal or zyprexa.)
All atypicals have verying degree of side effects of orthostasis (lowered blood pressure when standing), sedation, and weight gain.
Some patients- those with lewy body- have a sensitivity to antipsychotics, called Neuroleptic Sensitivity Syndrome. They do better with the milder Seroquel, or if necessary Abilify.
Because of the neurotransmitter imbalance, use of Aricept will often reduce the psychotic symptoms or allow the use of a lower dose of the antipsychotic meds.
Agitation and Aggression-----
The other major use of antipsychotics in dementia, is treating agitation and aggression.
Antipsychotics take the edge off aggression. Once again, minor issues are treated with Seroquel, major aggression is treated with Risperdal or Zyprexa. Additionally, Depakote is usually added as a mood stabilizer. It raises the threshold needed to cause an emotional reaction in the person.
I hope this helps.
Norbert
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : )