Agitation in Patients with Dementia

出版者:American Psychiatric Publishing, Inc.

作者:Donald P. Hay

页数:288

出版时间:2003-01

价格:USD 72.00

装帧:Paperback

isbn号码:9780880488433

具体描述

Among the most frustrating challenges for any health care professional are treating and alleviating the distress of an agitated patient with dementiaAespecially compelling in the midst of todayAs unprecedented population explosion among adults over age 65. For the first time ever, people age 85 and older represent the fastest-growing segment of our population. As we find ways to meet this challenge, we are also transforming how we think about aging. Instead of the pejorative term Asenility,A which implies that simply to be old is to be infirm, we refer to the ABCs of geriatric psychiatry: disturbances in (A)ffect, (B)ehavior, and (C)ognition, which are not normal at any age. This remarkable monograph offers practical direction on assessing and managing agitation in patients with dementia. Furthermore, this encouraging work shows that successful outcomesAwith response rates as high as 70%Acan be achieved with a systemic approach, involving both patient and caregiver, that includes cognitive, behavioral, psychodynamic, and reminiscence therapies. This concise book identifies and diagnoses the multiple types of agitation in dementia patients. It also explains how to look for and treat the underlying medical etiologies, and recommends treatment and management techniques, including: -Definitional and theoretical conceptualizations of agitation in the elderly; the epidemiology (i.e., the possible relationships involving agitation and dementia, and the dynamic between symptoms and the care setting) and neurochemistry (i.e., the neurobiological changes of behavior involve biochemical and structural causes, not structural causes alone) of agitation -Behavior assessment scales as evaluation tools; differential diagnoses (distinguishing delirium, depression, psychosis, and anxiety from the many precipitating and maintaining factors underlying agitation); clinical assessment and management of agitation in residential and other settings (extremely difficult and frustrating, often leading to staff and caregiver burnout) -Nonpharmacological interventions, such as a systemic approach to psychotherapy for both patient and caregiver (with some response rates as high as 70%), bright light therapy (promising but unproven), electroconvulsive therapy (effectiveAwith minimal and temporary side effectsAfor severe, treatment-intolerant, or treatment-resistant illness), and hormone replacement therapies -The pathophysiology, pharmacology, and clinical data of serotonergic agents, mood stabilizers, neuroleptics, beta blockers, benzodiazepines, and other miscellaneous agents -The legal and ethical issues in treating agitation in patients with dementiaAfinding the balance between autonomy and beneficence in the treatment of an agitated patient with dementia is difficult at best, with the challenge being to allow the patientAs participation as long and as fully as possible This book will appeal to a wide audience of geriatric psychiatrists, primary care physicians and internists, general practitioners, nurses, social workers, psychologists, pharmacists, and mental health care workers and practitioners.

用户评价

这本厚重的书，拿到手就感觉沉甸甸的，光是翻阅目录，就能感受到作者在梳理这个复杂议题时所花费的心力。我首先被它那种近乎田野调查般的细致观察所吸引。书里大量引用了护理人员的口述记录，那些片段生动得让人仿佛能闻到医院特有的消毒水味，感受到那种无助和挫败感交织的情绪。它没有试图用一两句简单的口号来概括“躁动”这个现象，而是将其解构成了无数个微小的、可被识别的触发因素和应对策略的矩阵。比如，书中有一章专门讨论了光线变化、背景噪音（尤其是旧式荧光灯的嗡鸣声）对不同阶段痴呆症患者的皮质醇水平影响，并配有详尽的图表分析，这远超出了我原先对这类书籍的预期。我特别欣赏作者在描述那些极端案例时所保持的冷静和人文关怀，那种“理解而非评判”的基调贯穿始终，让人在面对这些挑战时，内心会生出一种更坚实的力量感。这不仅仅是一本工具书，更像是一份关于“如何看见被忽视的痛苦”的深度报告。

坦率地说，这本书的阅读体验是充满挑战性的，它要求读者具备一定的跨学科知识背景，尤其是对生理反馈机制和认知心理学基础概念的熟悉。我尝试将其推荐给几位刚入行的新护士，他们普遍反映开头几章的术语密度过高，需要反复查阅附录才能跟上作者的论证节奏。然而，一旦跨过那道学术门槛，后续章节带来的知识红利是巨大的。其中关于“环境再设计”的章节尤其具有实操价值，作者提出了一个名为“感官舒缓路径”的概念，通过调整空间布局、引入特定频率的白噪音以及选择具有特定纹理的材料，来系统性地减少环境压力源。这绝非简单的“装饰建议”，而是基于对大脑处理冗余信息能力的深度认知之上的一种精细工程学应用。对于那些负责养老机构设施规划的人员来说，这本书无疑是一份具有前瞻性的蓝图。

我以一个家属的角度来看待这本书，我的母亲正处于中晚期，我们对突如其来的爆发行为感到束手无策。这本书给我的最大启示是“预测”而非“反应”。它详细列举了一套“行为日记”的建立和分析方法，教导家属如何像侦探一样去记录和分析每一次异常行为发生前后的细微环境变化、饮食变化乃至睡眠模式的波动。书中用一系列图示化的流程图，清晰地展示了如何区分哪些是药物副作用导致的，哪些是疼痛的隐性表达，哪些是感官超载的结果。这种系统化的排除法，极大地缓解了我们作为家属的焦虑感，因为它将那些令人恐惧的“随机性”转化为可被理解和干预的“模式”。这本书真正做到了赋权于人，它不是告诉你“该怎么做”，而是教会你“如何去思考”如何去应对你独有的情境。

我得说，这本书的理论框架构建得极其扎实，它巧妙地将神经生物学的最新发现与日常护理实践编织在一起，形成了一个富有张力的叙事结构。我过去接触过一些侧重于行为管理学的指南，它们往往偏向于操作层面的技巧，但《Agitation in Patients with Dementia》的独特之处在于，它深入挖掘了“为什么会发生”的底层逻辑。作者详尽地剖析了“非语言沟通障碍”在躁动爆发中的核心作用，并引入了“需求信号理论”，试图将每一次看似无理的攻击性或不安倾向，重新定义为一种被扭曲的、尚未被满足的基本需求表达。这种视角上的转换，对我个人理解病患的痛苦是革命性的。书中对于不同文化背景下对“躁动”的认知差异的探讨也令人耳目一新，它提醒我们，即便是最普遍的临床症状，也深受社会文化滤镜的影响，避免了西方医学模式的绝对化倾向。阅读过程中，我经常停下来思考，很多时候我们急于“平息”的，其实是他们努力“表达”的最后一点声音。

这本书最让我感到震撼的，是它对护理者自身心理健康的关注，这一点在同类著作中往往被轻描淡写。作者没有将护理者塑造成一个无私的圣人形象，而是坦诚地探讨了长期暴露于高强度情绪压力下的“同情疲劳”和“替代性创伤”的生理表现。其中一个章节详细描述了如何建立有效的“情感缓冲机制”，包括结构化的团队反思会议、定期的专业心理支持介入，以及如何识别护理团队内部的“传染性焦虑”。这种对一线工作者“人”的层面的关注，让这本书的价值超越了对病患的单纯照护指南。它提供了一种可持续的工作模式，一种让专业人士在不耗尽自我的前提下，继续提供高质量照护的切实路径。读到那些关于自我关怀的段落时，我感到了极大的慰藉和被理解。