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Randomized Controlled Trial
. 2016:2016:7036415.
doi: 10.1155/2016/7036415. Epub 2016 May 9.

The Interactive Relationship between Pain, Psychosis, and Agitation in People with Dementia: Results from a Cluster-Randomised Clinical Trial

Torstein F Habiger  1 , Elisabeth Flo  1 , Wilco P Achterberg  2 , Bettina S Husebo  3
Affiliations
Randomized Controlled Trial

The Interactive Relationship between Pain, Psychosis, and Agitation in People with Dementia: Results from a Cluster-Randomised Clinical Trial

Torstein F Habiger et al. Behav Neurol. 2016.

Abstract

Background. Neuropsychiatric symptoms are common in people with dementia, and pain is thought to be an important underlying factor. Pain has previously been associated with agitation, and pain treatment has been shown to ameliorate agitated behaviour. So far, the association between pain and psychosis and the effect of pain treatment on psychotic symptoms is unclear. Furthermore, the impact of opioid treatment on psychosis is not established. Aim. To investigate the efficacy of a stepwise protocol for treating pain (SPTP) on psychosis and agitation measured with the Neuropsychiatric Inventory, Nursing Home version, and to explore the impact of opioid analgesics on psychosis. Method. Secondary analyses are from a cluster-randomised controlled trial including 352 patients with advanced dementia and agitation from 18 nursing homes in Western Norway. The intervention group received pain treatment according to SPTP. Results. Pain was associated with disinhibition (adjusted OR: 1.21, 95% CI: 1.10-1.34) and irritability (adjusted OR: 1.10, 95% CI: 1.01-1.21) at baseline. Pain treatment reduced agitation (p < 0.001, df = 1; 300) and aberrant motor behaviour (p = 0.017, df = 1; 300). Psychosis was reduced in people with at least one symptom at baseline (p = 0.034, df = 1; 135). The use of opioid analgesics did not increase psychotic symptoms. Study Registration. This trial is registered with ClinicalTrials.gov (NCT01021696), Norwegian Medicines Agency, EudraCT (EudraCTnr: 2008-007490-20).

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Figures

Figure 1
Figure 1
The efficacy of treating pain on psychosis and agitation.
Figure 2
Figure 2
The efficacy of pain treatment on individual neuropsychiatric symptoms.
Figure 3
Figure 3
Development of delusion during the intervention and washout period.
Figure 4
Figure 4
Development of agitation scores in clusters during intervention and washout period.
Figure 5
Figure 5
Development of agitation/aggression during the intervention and washout period.
Figure 6
Figure 6
Development of aberrant motor behaviour during the intervention and washout period.
Figure 7
Figure 7
Development of the psychosis cluster in patients with one or more clinically significant NPS of psychosis at baseline (NPI-NH ≥ 4).
Figure 8
Figure 8
Development of the agitation cluster in patients with one or more clinically significant NPS of agitation at baseline (NPI-NH ≥ 4).
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References

    1. Selbæk G., Engedal K., Benth J. Š., Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. International Psychogeriatrics. 2014;26(1):81–91. doi: 10.1017/S1041610213001609. - DOI - PubMed
    1. Zuidema S. U., Derksen E., Verhey F. R. J., Koopmans R. T. C. M. Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry. 2007;22(7):632–638. doi: 10.1002/gps.1722. - DOI - PubMed
    1. Hollingworth P., Hamshere M. L., Moskvina V., et al. Four components describe behavioral symptoms in 1,120 individuals with late-onset Alzheimer's disease. Journal of the American Geriatrics Society. 2006;54(9):1348–1354. doi: 10.1111/j.1532-5415.2006.00854.x. - DOI - PubMed
    1. Selbæk G., Engedal K. Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International Psychogeriatrics. 2012;24(1):62–73. doi: 10.1017/S104161021100086X. - DOI - PubMed
    1. Wetzels R. B., Zuidema S. U., de Jonghe J. F. M., Verhey F. R. J., Koopmans R. T. C. M. Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. The American Journal of Geriatric Psychiatry. 2010;18(12):1054–1065. doi: 10.1097/jgp.0b013e3181f60fa1. - DOI - PubMed

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