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Treatment of Behavioral Symptoms: When to Consider Antipsychotic Medications in LBD

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Introduction

LBD is a complex disease that can present with a range of physical, cognitive, and behavioral symptoms. Many caregivers find that behavioral symptoms (e.g., hallucinations, delusions, aggression, agitation, apathy, depression and anxiety) are the most distressing and difficult-to-treat aspects of LBD. This paper discusses some of the causes of behavioral symptoms, as well as strategies and treatments to reduce their frequency and severity.

Understanding Behavioral Symptoms

Some behavioral symptoms of LBD are subtle and may go overlooked for some period of time. Other symptoms are easily recognizable the first time they occur. Here are some examples of the kinds of behavioral symptoms seen in LBD:

Behavioral Symptom Definition Examples
Hallucinations Perception of an object or event when the object or event is not really present. Typically visual in LBD, but rarely, hallucinations can be auditory (hearing), olfactory (smell), gustatory (taste), or tactile (touch) as well.

(Also includes illusions – a misperception of an object or event that is real.)

Seeing children or small animals

Seeing bugs crawling on the floor or walls

Smelling bad odors that others cannot smell

Hearing people talking when no one is there
 

Delusions Strongly held false belief or opinion, not based on evidence or data.

Also includes paranoia, an extreme, irrational distrust of others.

Believing spouse is having an affair

Believing relatives long dead are still living

Believing a close relative or friend has been replaced by an exact double (Capgras syndrome)

Believing food or medicine is poisoned

Believing that there are strangers are in the house

Aggression Hostile, injurious, or destructive behavior or attitude. Choking, hitting, biting, spitting

Verbal abuse

Agitation Emotional or physical restlessness. Pacing

Hand wringing

Inability to “get settled”

Constant repeating of words or phrases

Apathy Lack of interest or concern regarding matters of usual importance. Decreased social interaction

Lack of drive for normal activities

Maintenance of ability to enjoy activities once started (versus depression)

Depression Condition of feeling sad or despondent Inability to enjoy activities

Disturbances of sleep, eating, and other normal activities

Anxiety Intense apprehension, uncertainty, or fear caused by anticipation of a threatening event or situation. Asking the same questions repeatedly

Being angry or fearful when caregiver is not present