| Popis: |
I (D.S.) work part-time as a psychiatrist on a palliative care team at the local Veterans Affairs hospital. In that capacity, I work alongside 3 internists who address the medical needs of our veteran population, while I focus on the psychological (emotional) side. Some patients present problems that engage both the internist and the psychiatrist. Among them, one of the most difficult patients to treat is the individual with agitated dementia. There is no clear clinical strategy for treating dementia. There are many pharmacologic approaches offered to treat agitation. Agitation sometimes takes the form of behavioral “acting out” (violence), which can create a situation on an inpatient unit that affects the staff as well as the other patients. The internist (or the medical resident on a geriatrics rotation) often asks the psychiatrist on the team for the best way to handle the problem this patient presents. The atypical antipsychotic medications are sometimes employed to calm the agitated patient. Benzodiazepines are also considered as potential calming agents. In days gone by, the first-generation antipsychotic drugs (chlorpromazine, haloperidol) were typically used to quell agitation on psychiatric units and represent reasonable choices today. One of our internists (R.P.M.) has had success utilizing a medication typically employed to treat bipolar illness: valproic acid. There is as yet no generally agreed-upon approach to the agitated, acting-out, demented patient. Dr Meyer summarizes what is known and describes her experience within the context of a patient example. |
