Behaviour disturbance

Alzheimer s disease A progressive neurodegenerative disorder and the most common type of senile dementia. It is characterised by a marked decline in cognitive functioning and severe behavioural disturbances. 

Elderly patients after admission to a hospital often first show mental signs and symptoms, then show behavioural disturbances (Saravay et al. 2004). Thus if early mental signs and symptoms are identified and acted on, behavioural disturbances and subsequent extended length of hospital stay may be prevented. For cognitive testing many screening instruments are available. The most widely used is probably Mini Mental State Examination (MMSE). 

Medications may be necessary for patients with delirium especially in patients with severe behavioural disturbances and agitation. Any medications used may however be hazardous and actually lengthen the condition. A continuous reassessment of the need for theses kind of drugs should be done. Antipsychotic drugs may be needed especially if vision hallucinations and agitated behaviour are predominant. Short-acting benzodiazepines may be used for a limited time. There is no... 

Benefits of treatment were also seen on measures of activities of daily living and behavioural disturbances. Although there is less evidence for other than mild to moderate dementia. There is evidence of more adverse events in total in the patients treated with a ChEl than with placebo. Although many types of adverse event were reported, nausea, vomiting, diarrhoea, were significantly more frequent. 

Non-pharmacological management and support of the patient and their family are particularly important for the treatment of behavioural disturbances. They should be preferred and should be undertaken in usual practice. They are part of the personalised care plan. In this context, the following are particularly important ... 

Fioravanti M, Yanagi M. Cytidinediphosphochohne (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst Rev 2005. 

Effect on CNS Large doses of glucocorticoids cause euphoria, mood elevation, nervousness, restlessness, which are reversible type of actions. They often produce behavioural disturbances inhuman being and also increase intracranial pressure. 

An overview of animal welfare in organic farming by Vonne Lund is presented elsewhere (see Chapter 8). Animal welfare is reduced in conventional intensive housing systems because of high densities and lack of stimuli like straw, and this may lead to behavioural disturbances, injuries or some diseases. Livestock housing on organic farms should allow for the behavioural requirements of different farm animal species, facilitate efficient management, and use environmentally friendly construction materials and methods. 

Rutgers AW, Links TP, le Coultre R, Begeer JH. Behavioural disturbances after effective ACTH-treatment of the dancing-eyes syndrome. Dev Med Child Neurol 1988 30(3) 408-9. 

Some degree of spellbinding is characteristic of any compromise of frontal lobe function. Beer et al. (2006) noted that orbitofrontal damage is associated with objective inappropriate social behavior. The patients were aware of social norms of intimacy but they were unaware that their task performances violated these norms. The authors call this an impairment of self-monitoring and self-insight. Bach and David (2006) pointed out that self-awareness deficits are very common in patients with traumatic brain injury and key to the development of behavior disturbances Our research found that lack of social self-awareness predicts behavioural disturbance in acquired and traumatic brain injury independent of cognitive and executive function. ... 

Spielewoy C, Roubert C, Hamon M, Nosten-Bertrand M, Betancur C, Giros B (2000) Behavioural disturbances associated with hyperdopaminergia in dopamine-transporter knockout mice. Behav Pharmacol 77 279-290. 

De Deyn PP, Martin M, Deberdt W, Jeandel C, Hay DP, Feldman PD, Young CA, Lehman DL, Breier A. Olanzapine versus placebo in the treatment of psychosis with or without associated behavioural disturbances in patients with Alzheimer s disease. Int J Geriatr Psychiatry 2004 19 115-26. 

The initial clinical review should include a search for known consequences of poisoning, which include impaired consciousness with flacddity (benzodiazepines, alcohol, trichloroethanol) or with hypertonia (tricyclic antidepressants, antimuscaiinic agents), hypotension, shock, cardiac arrhythmia, evidence of convulsions, behavioural disturbances (psychotropic drugs), hypothermia, aspiration pneumonia and cutaneous blisters, burns in the mouth (corrosives). 

Some of the antipsychotics are available as intramuscular injections for patients who are imable or unwilling to swallow tablets (as is common in psychosis or severe behavioural disturbance). Halo-peridol is most often used for these indications on psychiatric inpatient wards (chlorpromazine i.m. being restricted due to hypotension and skin nodule formation). Olanzapine may be given i.m. 

The deterioration of function in dementia of Alzheimer s disease is often accompanied by acute behavioural disturbance and the development of a range of psychotic symptoms. Therapy with atypical drugs is then preferred because they provoke fewer adverse effects than classical antipsychotics. 

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