Psychosis and the Agitation in Clients with Dementia

Please all reference needs to be 5 years or less. Thank you
Differentiate the clinical presentations of psychosis and agitation in clients with dementia.
Dementia, defined as abilities acquired neurological syndromes and characterized by a decline in cognitive abilities and autonomy, include frequent behavioral and psychological disorders.
The presence of delusions or hallucinations indicates psychosis. Delusions and hallucinations must be distinguished from disorientation, fear, and misinterpretation, which are common in those with dementia. Delusions of paranoid type, misidentification and somatic are identified. The main hallucinations described are visual and auditory, although they can also be olfactory. It is a real challenge to differentiate between psychosis and confusion per se of dementia. Psychosis and agitation are often considered together since they often occur together. For example, a patient who is experiencing those hallucinations or delusions may be agitated or restless resistant to care, aggressive in some way, disrupted sleep; those are the kind of common manifestations of what we call agitation. Therefore, it’s so important to know how to differentiate psychosis and agitation in dementia because they used to be present together. There are three neurobiological theories that explain the psychosis which are the dopamine, glutamatergic and serotonin theories (Ismail et al, 2022).
Agitation occurs in 50% of patients with dementia, half of whom become frankly aggressive. The term agitation describes inappropriate motor, vocal, or verbal activity that has no causal explanation. Agitated behavior is not in itself helpful to the patient and adversely affects relief efforts. Some of these behaviors are inappropriate in themselves, while others may be due to their intensity, frequency, or the context in which they are exhibited. Agitation means that the person with dementia is restless or worried. He can't seem to be at peace. Agitated people pace incessantly from one place to another, cannot sleep or act aggressively towards others. They may verbally attack, try to hit, or hurt someone. There are two neurobiological theories that explain the agitation in these patients are the imbalance of dopamine and GABA (Ismail et al, 2022).
Discuss two possible approaches to treatment for agitation.
Due to the polypharmacy and possible side effect-medications interactions in elderly patient, non-pharmacological treatment is considered the first therapeutic option in the management of agitation in patients with dementia.
According to Caraci et al, in 2020; Brexpiprazole has showed positive effect and improvement in the pharmacological treatment of agitation in patient with diagnosis of dementia. It’s an atypical antipsychotic partial dopamine agonist or dopamine stabilizer medication. Compared with other antipsychotic medications that the main way was blocking dopamine Rexulti, stabilized the dopamine level. Rexulti (brexpiprazole) is an atypical antipsychotic that was approved by the FDA (United States Food and Drug Administration) in July 2015 for the treatment of schizophrenia and as adjunctive therapy to antidepressants in patients with major depressive disorder. The mechanism of action is unknown, however, its efficacy is measured by the combination of its partial agonist activity at serotonin 5-hydroxytryptamine (HT) 1A and dopamine D2 receptors, as well as its serotonin 5 antagonist activity. -HT2A. It also has some affinity for dopamine D3 receptors and activity antagonist of norepinephrine α1A, histamine H1 and muscarinic M1 receptors (Caraci et al, 2020).
Escitalopram is another pharmacological option that has been shown to be effective in treating agitation in patients with dementia. It is an antidepressant agent, which acts by selectively inhibiting the reuptake of serotonin in the interneuronal synaptic cleft, increasing the synaptic concentration of serotonin and, consequently, the activation of neural serotonergic pathways. It's in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Identify at least two strategies to suggest to a caregiver for a client who is experiencing agitation in the home environment (Marcinkowska et al, 2020).
3. Identify at least two strategies to suggest to a caregiver for a client who is experiencing agitation in the home environment.
Communication can be difficult for people with Alzheimer's and related dementias, as they have trouble remembering things. They can also become anxious, agitated, or even angry. In some types of dementia, language skills are affected, so they may have difficulty finding the right word or speaking. You may feel frustrated or impatient, but it is important to understand that the illness is causing this change in communication skills. We can mention strategies that allow us in a certain way to prevent episodes of agitation by creating a familiar environment for the patient, providing family photos, a quiet environment free of noise. If the patient is agitated and/or aggressive, it is important to stay calm, try to de-escalate the situation. Doing nothing can make things worse. You should try to find out the causes of the behavior, if the causes are resolved, the problem behavior can stop (Alzheimer's Association, 2022).
4. Identify at least two strategies to suggest to staff for a client who is experiencing aggressive behavior in the long-term care environment.
Management not only of aggressive patients with a diagnosis of dementia but of any patient is key to holistic and patient-centered management. That said, in the management of these patients, verbal de-escalation is important, helping the patient to recover their own self-control, clearly establishing the limits of behavior, guaranteeing the safety of both the patient and the professionals and the rest of the people who around them, decrease hostility and prevent episodes of aggression (Medea, Roberts, Dunn, & James, 2020).
Thank you,
References,
Alzheimer's Association. (2022). Anxiety and Agitation. https://www(dot)alz(dot)org/help-support/caregiving/stages-behaviors/anxiety-agitation?lang=en-USLinks to an external site.
Caraci, F., Santagati, M., Caruso, G., Cannavò, D., Leggio, G. M., Salomone, S., & Drago, F. (2020). New antipsychotic drugs for the treatment of agitation and psychosis in Alzheimer's disease: focus on brexpiprazole and pimavanserin. F1000Research, 9, F1000 Faculty Rev-686. https://doi(dot)org/10.12688/f1000research.22662.1Links to an external site.
Ismail, Z., Creese, B., Aarsland, D., Kales, H. C., Lyketsos, C. G., Sweet, R. A., & Ballard, C. (2022). Psychosis in Alzheimer disease—Mechanisms, genetics and therapeutic opportunities. Nature Reviews Neurology, 18(3), 131-144.
Marcinkowska, M., Śniecikowska, J., Fajkis, N., Paśko, P., Franczyk, W., & Kołaczkowski, M. (2020). Management of Dementia-Related Psychosis, Agitation and Aggression: A Review of the Pharmacology and Clinical Effects of Potential Drug Candidates. CNS drugs, 34(3), 243–268. https://doi(dot)org/10.1007/s40263-020-00707-7Links to an external site.
Medea, B., Roberts, M., Dunn, R., & James, I. A. (2020). The Role of Models and Formulations in the Management of Behaviors that Challenge in Dementia. Open Access Journal of Gerontology & Geriatric Medicine, 5(5).