Objective: To observe (1) the proportion and nature of behavioral and psychological symptoms of dementia (BPSD) in patients treated at a geriatric psychiatry ward in Germany over a time span of 1 year and (2) the use and effect of various pharmacologic interventions in managing BPSD in a real-world scenario.
Methods: This study was a naturalistic, retrospective analysis. Between May 2015 and May 2016, 437 patients aged 65 to 100 years with various psychiatric diseases (including dementia, schizophrenia, and depression) were admitted to a geriatric psychiatry unit in Germany. Their medical charts were reviewed to identify patients with dementia who presented with BPSD according to DSM-5 criteria. Since a decline in behavioral organization is a typical clinical manifestation of delirium, delirious patients with behavioral symptoms at admission were also included.
Results: Of 437 patients, 74 (16.9%) showed severe behavioral symptoms that were categorized into 6 groups: aggression, screaming, wandering, food refusal, self-harm, and a combination of both behavioral and psychological symptoms. Overall, 65 patients (87.5%) showed improvement in their behavior regardless of the pharmacotherapy they were receiving.
Conclusions: BPSD is one of the main reasons for admission to a geriatric psychiatry unit. Most of the patients with BPSD showed an improvement of behavioral symptoms with pharmacotherapy. Nonetheless, a clear correlation between a specific pharmacologic agent and behavioral improvement could not be established. A multimodal concept that involves both pharmacologic and nonpharmacologic approaches in managing BPSD should be the focus of future research.
Arnim Quante, MD, and Atdhe Sulejmani, CandMed
The Primary Care Companion for CNS Disorders 2017;19(4)