Behavioural and psychological symptoms of dementia: a new framework for holistic understanding and non-pharmacological management

• Published in: BJPsych advances 2022-01, Vol.28 (1), p.11-20
• Main Authors: James, Ian Andrew, Gray, Kristina, Moniz-Cook, Esme, Lee, Katy, Reichelt, Katharina, Richardson, Jonathan
• Format: Article
• Language: English
• Subjects: Behavior; Caregivers; Delirium; Dementia; Memory; Old Age; Pain; Psychotropic drugs
• ISSN: 2056-4678; 2056-4686
• DOI: 10.1192/bja.2021.12

The National Institute for Health and Care Excellence (NICE) informs us that the first-line treatments for behavioural and psychological symptoms of dementia (BPSD) are non-pharmacological. Although psychotropics used to be the main strategy in the management of behaviours that challenge, there has been an increase in the use of biopsychosocial formulations since 2010, and there are now over a dozen to choose from. However, many are overly focused on obtaining information about the agitation, and less specific about providing details of the actions required to manage the behaviours. The NICE guidelines too fail to provide specific guidance on which non-pharmacological approaches to use. This article argues for giving equal weight to both the collection of meaningful information and the development of ‘informed actions’, because it is the actions that lead to change. The article outlines a management programme providing a framework for the assessment, formulation and treatment of agitation in dementia. The work draws on theory, evidence-based practice and practice-based evidence to provide a model with sufficient structure and flexibility to be useful for clinicians across a range of settings and professional groups.