Assessment and management of behavioral and psychological symptoms of dementia

BMJ, 2 March 2015

Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no “one size fits all solution,” and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.

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Making the case for tackling obesity – why invest?

Public Health England, February 2015

This slideset of infographics illustrating the facts and figures about obesity, the costs, the benefits of investing and the potential routes to action. An accompanying reference sheet is included.

Click here to view the slideset.

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Health and wellbeing: a guide to community-centred approaches

Department of Health, February 2015

Local government and the NHS have important roles in building confident and connected communities as part of efforts to improve health and reduce inequalities.  The project ‘Working with communities: empowerment evidence and learning’ was initiated jointly by PHE and NHS England to draw together and disseminate research and learning on community-centred approaches for health and wellbeing.  This report presents the work undertaken in phase 1 of the project and provides a guide to the case for change, the concepts, the varieties of approach that have been tried and tested and sources of evidence.

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Prime Minister’s challenge on dementia 2020

Department of Health, 21 February 2015

This document sets out what this government wants to see in place by 2020 in order for England to be the best country in the world for dementia care and support and the best place in the world to undertake research into dementia and other neurodegenerative diseases.  It also highlights the progress to date on improving dementia care, support and research.

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Population health systems: going beyond integrated care

King’s Fund, February 2015

Integrated care has become a key focus of health service reform in England in recent years, as a response to fragmentation within the NHS and social care system. Yet efforts to integrate care services have rarely extended into a concern for the broader health of local populations and the impact of the wider determinants of health. This is a missed opportunity. This paper from the King’s Fund aims to challenge those involved in integrated care and public health to ‘join up the dots’, seeing integrated care as part of a broader shift away from fragmentation towards an approach focused on improving population health.

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The Costs of Eating Disorders: Social, Health and Economic Impacts

Beat, 24 February 2015

This economic analysis commissioned by Beat, the eating disorders charity, examines the overall costs of eating disorders to the UK economy, indicates how inconsistent access to treatment can be for individuals, and that the cost to the economy is in the tens of billions of pounds. 

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Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database

BMJ, 18 February 2015

This cohort study aims to assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression.

238 963 patients registered with UK general practices aged 20 to 64 years with a first diagnosis of depression participated between 1 January 2000 and 31 July 2011, followed up until 1 August 2012.

The study concludes that rates of suicide and attempted suicide or self harm were similar during periods of treatment with selective serotonin reuptake inhibitors and tricyclic and related antidepressants. Mirtazapine, venlafaxine, and trazodone were associated with the highest rates of suicide and attempted suicide or self harm, but the number of suicide events was small leading to imprecise estimates. As this is an observational study the findings may reflect indication biases and residual confounding from severity of depression and differing characteristics of patients prescribed these drugs. The increased rates in the first 28 days of starting and stopping antidepressants emphasise the need for careful monitoring of patients during these periods.

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