Psych360’s Cognitive Preservation Program focuses on Dementia and Alzheimer’s diseases. The goal of this program is for early mental health intervention as it relates specifically to these diseases. Many times, the tendency is to wait or delay mental health provider care for a variety of reasons.
However, earlier appropriate and reasonable clinical mental health medical care can be offered to the patient is a better practice. In addition, earlier treatment means a proactive approach can be administered, rather than a reactive response to the symptoms of the disease process. This is critical in minimizing the symptoms and slowing the memory loss associated with the disease process.
The fewer disruptions to routine and quality of life, the more manageable the disease process.
There are mainly two types of medication therapies for this disease:
Secondary symptoms of most types of dementia include depression, anxiety, agitation, aggression, hallucinations, delusions, paranoia, insomnia, and other sleep disorders. These can be problematic, and the more severe these symptoms, the greater the impact on the patient’s condition. Behavioral symptoms, in particular, are common and can exacerbate cognitive and functional impairment and influence a more rapid decline of the disease. They can be found across most varieties of dementia, such as frontotemporal dementia, vascular dementia, and of course Alzheimer’s disease
The following psychotropic medications have been used to clinically treat these secondary symptoms. Psychotropic medications can include antidepressants, antipsychotics, and anti-anxiety medications, as well as mood-stabilizers and hypnotic medications. These drugs may be prescribed, at times, to treat some of the behavioral and emotional symptoms of dementia and Alzheimer’s disease. This class of medications is typically used after attempting non-pharmacologic interventions consistently and finding them to be ineffective.
While these medications can be productive at times, minimizing the addition of medications is important in reducing polypharmacy. If successful, this can result in improved cognition, quality of life, and overall general health.
It is the goal of this clinical program to implement a coordinated medical effort in order to preserve the mental health and cognitive function of the patients leading to enhanced quality of daily life and memory preservation for as long as possible during the disease process.
Any drug that affects brain activities associated with mental processes and behavior.
These drugs include, but are not limited to, drugs in the following categories:
These medications receive gradual dose reductions (GDR), and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
Within the first year in which a resident is admitted on a psychotropic medication or after the prescribing practitioner has initiated a psychotropic medication:
For any individual who is receiving a psychotropic medication to treat expressions or indications of distress related to dementia, GDR may be considered clinically contraindicated for reasons that include, but that are not limited to:
Diagnoses alone do not necessarily warrant the use of an antipsychotic medication.
Appropriate indications for antipsychotics:
Antipsychotic medications may be indicated if:
If antipsychotic medications are prescribed, documentation must clearly show the indication for the antipsychotic medication, the multiple attempts to implement care-planned, non-pharmacological approaches, and ongoing evaluation of the effectiveness of these interventions.
Residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record.
PRN orders for psychotropic drugs (except antipsychotics) are limited to 14 days, except if the prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days. In this case, he or she should document their rationale in the resident’s medical record and indicate the duration for the PRN order.
PRN orders for antipsychotic drugs, which are limited to 14 days, cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident (in person) for the appropriateness of that medication.
Psych360 Evaluation Guidance:
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