Objective The overall purpose of this study is to further develop the hermeneutic approach utilized in our multidisciplinary work with BPSD patients by conducting a literature review.
Design This study, which is based on a hermeneutic approach, evaluates clinical treatment of BPSD patients performed over an extended period of time. The analysis includes aspects of nursing care and pharmacological treatment as well as questions of an existential nature. An attempt at encompassing the complexity of an overall perspective is being made. In addition to evaluating and analyzing treatment, we also conduct a literature review to find out whether similar thoughts and experiences can be found elsewhere. The results of the literature review are integrated with our personal experiences.
Material and Methods Data collection strategies included searches of Medline. Key words used were dementia, behaviour, BPSD, multidisciplinary, integrated, treatment. The study can almost be categorized as an interdisciplinary one, since it includes evaluation of nursing care and pharmacological treatment and also aims at creating an existential understanding of the symptoms and different treatment alternatives.
Results Several studies have shown that structured non-pharmacological intervention (e.g. activity programs, caregiver training, music therapy and care environment alterations) has a beneficial effect on BPSD patients (Opie et al. 1999).
Pharmacological treatment should include newer neuroleptics, such as risperidone (De Deyn et al. 2000). Anticonvulsants, such as topiramate, have often demonstrated a positive effect on aggressive behavior in dementia (Fhager et al. 2001). Cholinesterase inhibitors can be used to treat apathy in patients with Alzheimerís disease and can reduce psychotic symptoms, in particular hallucinations, in Alzheimerís disease and Dementia with Lewy bodies (Cummings 2000, McKeith et al. 2000).
Treatment should be tailored individually to each patient (Hinchcliffe et al. 1995). It is our experience that each patient presenting with BPSD needs individually adjusted medication. Such medication may include the above-mentioned drugs but also, depending on the patientís symptoms, antidepressants and anxiolytics. Effort must be put into trying to understand the patientís previous personality in order to be able to understand the BPSD symptomatology (Sutor et al. 2001). Structured BPSD treatment requires multidisciplinary teams with particular interest in this kind of treatment (Lawlor 2002).
Quality of treatment is dependent on well-structured intervention with a nursing staff that has worked together for a long time and been able to work out a common practice. Successful treatment is characterized by an open communication and an interplay between medical competence and nursing skills (Fhager et al. 2002).
Conclusion Optimal treatment of BPSD patients requires an experienced nursing staff that is able to work in multidisciplinary teams. It also requires flexibility, knowledge and an ability to translate complex information into practical measures. Applying an interdisciplinary methodology by combining scientific analysis with a hermeneutic approach is essential for this kind of treatment. Understanding the patientís previous life history and personality is of vital importance for an existential perspective.
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