Responding to and Treating Hallucinations in Lewy Body Dementia

People with Lewy body dementia are more likely to experience hallucinations than those with Alzheimer's or vascular dementia, and in general, they experience them earlier in the disease process than people do with other types of dementia. For some people, these hallucinations may even be one of the first symptoms of Lewy body dementia they experience.

Up to 80% of people with Lewy body dementia experience visual hallucinations. These hallucinations are often recurrent and very detailed. Hallucinations of adults, children or animals are common.

Some research has found a correlation between the presence of hallucinations and an increased amount of cognitive impairment in Lewy body dementia. Hallucinations in LBD have also been associated with a decrease in quality of life; thus, having an awareness of how to respond to them can be very helpful for both the person living with LBD and his caregiver.

Responding to Lewy Body Dementia Hallucinations

It can be difficult to know how best respond to hallucinations in Lewy body dementia. Because these hallucinations often occur earlier in the disease process, some people respond well to gentle reality orientation and reassurances that the hallucination isn't real. Although it's not recommended to try to persuade someone with Alzheimer's disease that what they're seeing or hearing isn't there, in Lewy body dementia, you may want to try that method first since there are usually fewer cognitive deficits in the person with Lewy body dementia when they're experiencing hallucinations.

If your family member directly asks you if you see the person that he sees across the room, experts and family members recommend being truthful and acknowledging that although you don't see her, you know that he does. Family members have told stories about how their loved one with Lewy body dementia caught them in small untruths and became angry and agitated.

If your loved one is very upset and distraught about his hallucination, you will want to use caution and provide some extra space between you and him. In his distress, it's possible he could mistake you for his hallucination or experience a catastrophic reaction and become combative. Reassure him and ask him if you can come sit by him before entering his space.

You can also try using validation therapy and ask him what the person looks like, how long they've been there, and what makes the person go away.

Other options include using distraction by going into a different room or for a walk outside, turning on some music, talking about the football game or calling the dog over to your loved one for some  pet therapy.

Treatment of Hallucinations in Lewy Body Dementia

When someone with Lewy body dementia experiences hallucinations, treatment might follow a similar protocol to treatment of hallucinations in other kinds of dementia with a very important exception: the use of anti-psychotic medications. About half of people with Lewy body dementia are extremely sensitive to typical antipsychotic medications including Haldol and can experience severe and life-threatening reactions to them. Atypical anti-psychotics may be less likely to provoke a serious reaction but caution is very important when considering the use of antipsychotic medications in Lewy body dementia.

It's also important to note that in some people with Lewy body dementia, Sinemet ( carbidopa / levadopa)—a medication that may be prescribed to treat the movement challenges of the disease—can cause or worsen hallucinations in these people.

Research has shown that some people with Lewy body dementia who experience hallucinations have benefited from cholinesterase inhibitors. This class of medication has been approved by the US Food and Drug Administration to treat Alzheimer's disease and is often used for other dementias as well. Cholinesterase inhibitors include the drugs Aricept (donepezil), Exelon (revastigmine) and Razadyne (galantamine).

A Final Word 

Finally, remember that Lewy body dementia, like other dementias, is a disease that affects the whole family. No matter how much you love the person, caring for someone with Lewy body dementia can be very draining on both your physical and emotional energy. If you're running on empty or just at a loss for what to do, consider attending a support group or looking into other ways to provide in-home care or facility care for your loved one.

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Schizophrenia Needs early diagnosis For its treatment

A 55-year-old man did not interact with anyone for 15 years apart from the one day every month he stepped out of his house to withdraw money from the bank and pick up groceries. Due to delusions he claimed he was a US intelligence agent and told some people he personally knew former president George Bush.

The patient of schizophrenia - a psychotic illness- frequently claimed he could control the world's nukes.

Help came his way only when his sister arrived and, with police help, took him to a counsellor who diagnosed him to be suffering from schizophrenia in which a person develops a split personality, may not be able to distinguish his own thoughts and ideas from reality.

Psychiatrist  said most patients or their family members refused to believe that there was something wrong with the patient's brain. "Many people try to look for alternative therapies to cure their loved ones," she said.

In this case, the counsellors spent a lot of time and energy to get him back to normal. He is now living with his sister.

"Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms, including delusions - unusual beliefs not based on reality - and changes in behaviour," said counsellor .

"It is important that schizophrenia is diagnosed as early as possible, as the chances of recovery improve the earlier it is treated," said a counsellor.

There is no single test for schizophrenia. It is most often diagnosed after an assessment by a mental healthcare professional, such as a psychiatrist, she said.

A medical rehabilitation expert, stressed on avoiding alternative therapies for a patient's well-being.

"Some patients land in the net of quacks or black magicians who promise all kinds of magic remedies, but there is no alternative to modern medical therapies, including those for schizophrenia," she said.

The exact cause of schizophrenia is not known. A majority of experts believe the condition is caused by a combination of genetic and environmental factors. It is thought certain things make you more vulnerable to developing schizophrenia and that certain situations can trigger the condition.

Experts say schizophrenia is usually treated with a combination of medication and therapy appropriate to each individual. In most cases, this will be anti-psychotic medicines and cognitive behavioural therapy (CBT).

People with schizophrenia usually receive help in the form of community-based support. "Many people recover from schizophrenia. Support and treatment can help reduce the impact of the condition on the patient's life,"she said.




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Bipolar Disorder Drugs May 'Tweak' Genes Affecting Brain

Medications taken by people with bipolar disorder may actually be nudging hundreds of genes that direct the brain to behave more normally, according to new research.

The study suggests that anti-psychotic drugs activate a wide range of genes, changing their function. 

"A gene's activity in any given cell will vary depending on what it's exposed to.

It's not often that scientists stumble upon something in research that they totally weren't expecting to see. "It was a major surprise to us that people treated with an antipsychotic [medication] had changes in the gene expression pattern.

The findings could help point the way to new gene-targeted and stem cell therapies, and provide valuable insight into what causes manic-depressive mood swings.

However, a genetics expert not connected to the study was more cautious about drawing implications from its findings.

Bipolar disorder, also known as manic-depressive illness, affects about 5.7 million American adults, or about 2.6 percent of the U.S. population aged 18 and older, according to the U.S. National Institute of Mental Health (NIMH). The brain disorder causes severe and unusual shifts in mood, energy, activity levels, and the ability to carry out routine daily tasks.

The new research, published in a recent issue of the journal Bipolar Disorders, involved examining 26 brains donated to a nonprofit brain bank. Fourteen of the brains were from people who had bipolar disorder. Of those, seven were from people who had been taking one or more antipsychotic medications -- such as clozapine, risperidone and haloperidol -- when they died. Twelve brains were from those with no mental health condition.

In comparing the brains, the scientists observed that the genes of those that had been exposed to anti-psychotics at the time of death or during their lifetime were similar to those from people who did not have bipolar disorder. This suggests that the drugs may normalize or suppress the kinds of brain pathology one would expect in bipolar disorder, according to the researchers.

The study also supports the idea that the ability of brain cells to effectively communicate with each other may be impaired in people with bipolar disorder. The researchers found that the brains of people who were taking anti-psychotics and those who did not have bipolar disorder showed striking similarities in how their brains relayed signals between cell gaps, or synapses, and on high-speed neuronal "freeways" called the nodes of Ranvier.

While anti-psychotic medications can often be effective in moderating the effects of bipolar disorder, the side effects are often difficult for people to deal with. These include metabolic syndrome -- a combination of symptoms that increase the risk of developing cardiovascular disease and diabetes -- as well as weight gain, increased blood sugar levels, and tremors.

"It's still not known if these changes just happen to occur or play a key role in the therapeutic effect," said a Dr. 

The researchers don't have data on what medications the brains were exposed to during their lifetimes. Patients [with bipolar disorder] are exposed to antidepressants, drugs of abuse, and other medications, and we don't have medication exposure data on the brains [of the people without bipolar disorder].

According to the study, the research represents a step toward a radical evolution in the design of drugs for psychiatric conditions by the pharmaceutical industry.

"A lot of these psychiatric illnesses fluctuate, but now we give medications at a constant rate, almost as if we were giving a diabetic the same amount of insulin no matter what the person's blood sugar is," a  researcher said. "Medications as we know them will change based on our understanding of the biological mechanisms behind disease."

Older people taking psychiatric drugs are more prone to fall

Seniors taking psychiatric drugs may be at extra high risk for 

falling according to a new  research.

Of about 400 elderly people in the study, those who took 

medications including antidepressants and anti-psychotics 

were twice as likely to report having fallen three or more times 

in the previous year, researchers found.

The new study can't prove that falls were due to the effects of 

the drugs, themselves, and not to seniors' underlying medical 

conditions, for example.

But a number of side effects of psychiatric drugs - from 

changes in thinking and attention to drops in blood pressure - 

could put elderly people at greater risk for falls, according to  

the Dr. 

Seniors are especially vulnerable to falls, which at their worst 

can cause hip fractures, head injuries or death.

If possible (psychiatric drugs) should be avoided for elderly 

patients with other risk factors for falling.

In particular, the researchers found a higher rate of multiple falls 

among people taking antidepressants, antipsychotics and 

short-acting benzodiazepines, which include the anxiety drug 

alprazolam (marketed as Xanax) and the insomnia drug 

temazepam (Restoril).

That pattern held after the team took into account any 

depression or cognitive impairment among the seniors, as well 

as their exact age, their living situation and how much they 

typically walked each day.

Seniors and their families should come to each healthcare visit 

with a list of all medications an elderly person is taking and 

what each was prescribed to treat said the Dr. Sometimes, he 

noted, a person gets put on an anti-psychotic for delirium while

in the hospital, for example, and ends up staying on it for years 

for no good reason.

Many of our old people have multiple (conditions) that need 

medication to control them or make them feel better. Every 

time somebody is considering adding something, review 

everything else they're taking to make sure there is a solid 

indication for everything they're already on," the Dr. advised.

Many different factors may raise the risk of falls and fractures, 

such as age, osteoporosis or a history of stroke.

Drugs end up being the thing that you can modify," the Dr. said.