Teaching Case Studies: Managing Aberrant Behavior In Patients With Dementia
Title: Visual Hallucinations and Paranoid Delusions
Goals and Objectives
Visual well-formed hallucinations, fluctuations in the level of cognition and alertness and extrapyramidal signs are core features of dementia with Lewy bodies. Some patients realize that what they are seeing or hearing are just hallucinations and learn to accept them. Others, however experience these hallucinations as quite real and cannot be dissuaded from the firm belief that they are. In fact, efforts to dissuade them often serve only to confirm the often associated paranoid delusions and this may lead to a catastrophic ending. Hence, it is best not to contradict the patient. Instead, attempts should be made to distract the patient and change the focus of her/his attention.
In this case scenario, we present a 68-year-old man who has been diagnosed with dementia with Lewy bodies. He lives with his daughter. He has visual hallucinations and paranoid delusions: he thinks there are people outside the house plotting to kill him. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted. Upon completion of the activity, providers should be able to:
- Apply the material addressed in the scenario when advising caregivers seeking help with similar situations.
- Provide advice to caregivers about how to avoid aberrant behaviors from developing, escalating, and erupting, along with steps that can be taken to prevent it from occurring.
Before beginning this CME activity, you must review the article in its entirety, located here:
Visual Hallucinations and Paranoid Delusions
R.C. Hamdy, MD1 , A. Kinser, PhD1 , J. V. Lewis, MD1 , R. Copeland, MD1 , A. Depelteau, PhD1 , T. Kendall-Wilson, RN1,2 , and K. Whalen, BA1
1East Tennessee State University, Johnson City, TN, USA
2Alzheimer’s Tennessee, Knoxville, TN, USA
CME Release Date: June 5th, 2018
Content Reviewed: April 3, 2019
Valid for credit through: June 5th, 2020
Course type: Journal CME
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Southern Medical Association and SAGE Publishing. Southern Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Southern Medical Association designates this Journal CME Activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. All healthcare professionals who are not MDs or DOs will receive a certificate of participation.
Instructions for Participation and Credit
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- Read the goals and objectives, accreditation information, and author disclosures.
- Study the educational content and references.
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