Brief operationalized psychosocial interventions for agitation and psychosis: Use in clinical trials and clinical care.

Background: Neuropsychiatric symptoms such as agitation and/or psychosis impact most individuals with dementia during their illness, leading to reduced quality of life, distress, more rapid clinical decline, and an increased risk of institutionalization. Widely used pharmacological approaches have modest benefits and are associated with significant adverse events.

Methods: A narrative review was conducted to examine the evidence for the benefits of non-pharmacological treatments for agitation and psychosis in people with dementia, with a focus on operationalized approaches that could readily be introduced into clinical practice. In the absence of substantial evidence pertaining to non-pharmacological treatments of psychosis, the review was supplemented with a secondary analysis of an existing WHELD/BPST dataset.

Results: There is substantial evidence that simple non-pharmacological treatment approaches, such as personalized activities with social interaction, are effective in the treatment of agitation or enabling the reduction of psychotropic medication without worsening of agitation. Examples are presented of several operationalized approaches suitable for clinical implementation. In contrast, the treatment response of psychotic symptoms in people with dementia to non-pharmacological approaches is less clear cut. There is emerging evidence that although currently used non-pharmacological approaches do not directly improve psychosis in people with dementia, they do improve quality of life and concurrent neuropsychiatric symptoms such as apathy and agitation.

Discussion: Although best practice guidelines universally recommend non-pharmacological interventions as the first-line treatment for neuropsychiatric symptoms, implementation has been limited. Several tools, such as Brief Psychosocial Therapy, are described which may help bridge this gap into clinical practice.