Psychiatry - August 2008 - (Page 55)

[update on Alzheimer’s] patients who are competent. This makes sense—it respects the wishes and autonomy of the patient who is competent. Yet, it may be that, ethically, clinicians should provide pain relief more readily to patients who are not competent. Patients who are competent often find meaning in other aspects of their lives, which helps offset the pain they feel. Patients who are not competent may be unable to do this. Thus it may be that clinicians should have a lower threshold for relieving the pain of the patient who is no longer competent. Similarly, when patients with AD are in severe emotional pain, the psychiatrist should at least consider giving these patients antipsychotics, notwithstanding the well known greater risks. Psychiatrists should try to help the loved ones of patients with AD in every way they can, not only because the loved ones are important as individuals themselves, but also because the loved ones are important to patients with AD. Afterall, the loved ones of a patient with AD will be the ones who come to visit the patient in the institution and are likely to be more caring toward the patient than anyone else. Psychiatrists should try to imagine all the ways in which they can help the loved ones cope with the illness. The psychiatrist may, for example, help spouses of institutionalized patients anticipate sources of hurt and anger they may feel at some point, such as when patients with AD stop recognizing them. An example is a patient who no longer recognized his wife of more than 50 years and found a girlfriend in the institution where he resided. The wife and I had on many occasions discussed the possibility that he may stop recognizing her at some point, and this dialogue helped her accept this when it finally happened. Often when she would visit, her husband would have one arm around her , though he was not sure who she was, and one arm around his new girlfriend. Psychiatrists should also anticipate that spouses of patients with AD are often concerned they will die before the patients do, leaving no one to attend to the financial and personal needs of the patients. Spouses may also feel greatly troubled that other members of the family, such as their adult children, have the same fear. Consequently, psychiatrists should take initiative and ask loved ones directly if they have this fear and encourage them to gradually make plans in case this happens in order to reduce their anxieties. REFERENCES 1. Rabins PV. Can suicide be a rational and ethical act in persons with early or pre-dementia? Am J Bioeth. 2007;7:47–49. Edvardsson, DL, Winblad B, Sandman P. Person-centered care of people with severe Alzheimer’s disease. Lancet Neurol. 2008;7:362–367. Missotten P, Squelard G, Ylieff M, et al. Relationship between quality of life and cognitive decline in dementia, Dement Geriatr Cogn Disord. 2008;25;564–572. Hoe J, Katona C, Orrell M, Livingston G. Quality of life in dementia: care recipient and caregiver perceptions of quality of life in dementia: the LASERAD study. Int J Geriatr Psychiatry. 2007;22;1031–1036. Chertow H, Massoud F, Nasreddine Z, et al. Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ. 2008;178:1273–1285. Feldman HH, Jacova C, Robillard A, et al. Diagnosis and treatment of dementia: 2. diagnosis. CMAJ. 2008; 178:825–836. Shiroky JS, Schipper HM, Bergman H, Chertow H. Can you have dementia with an MMSE score of 30? Am J Alzheimers Dis Other Demen. 2007;22:406–415. Egerhazi A, Berecz R, Bartok E, Degrell I. Automated neuropsychological test battery (CANTAB) in mild cognitive impairment and Alzheimer’s disease. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:746–751. Ngo-Metzger Q, August KJ, Srinivasan M, et al., End-of-life care: guidelines for patient- 2. 3. 4. CONCLUSION This article highlights several interventions psychiatrists can take to maximize the quality of life of patients who have AD from the time they first present with memory problems to the last stages of this disease. It is important to be aware that the quality of life of the patient with AD is not solely, or in many cases even mostly determined by cognitive capabilities, but rather is significantly determined by social interactions with others. Psychiatrists should anticipate and attempt to meet the needs of the caregivers and loved ones of patients with AD, particularly during the later stages of the disease, as these people play an important role in the social interactions of patients with AD. With no cure for AD available, quality of life issues for patients with AD should be a primary concern of the clinicians who treat them. 5. 6. 7. 8. 9. [AUGUST] Psychiatry 2008 55

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Psychiatry - August 2008 Editor’s Message Editorial Advisory Board Contents Borderline Personality Disorder: Are Proliferative Symptoms Characteristic? Short-acting versus Long-acting Medications for the Treatment of ADHD Baby Stimuli and the Parent Brain: Functional Neuroimaging of the Neural Substrates of Parent-Infant Attachment These Boots Are Made for Stalking: Characteristics of Female Stalkers Managing Attention Deficit Hyperactivity Disorder in the Emergency Department Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings Improving the Quality of Life in Patients with Alzheimer’s Disease The Process of Getting New Drugs to Market Journal Watch Classified Advertising Information for Authors

Psychiatry - August 2008

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