Understanding
Behaviour in Dementia
that Challenges
A Guide to Assessment and Treatment
Ian Andrew James
Jessica Kingsley Publishers
London and Philadelphia
First published in 2011
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
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Philadelphia, PA 19106, USA
Copyright © Ian Andrew James 2011
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Library of Congress Cataloging in Publication Data
A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84905 108 8
ISBN pdf eBook 978 0 85700 296 9
Contents
Chapter 1Introduction to Behaviours that Challenge
Chapter 2Causes and Assessments
Chapter 3Using Psychotropic Medication to Treat Challenging Behaviour
Chapter 4Psychological and Other Non-pharmacological Approaches
Chapter 5Conceptual Models Used to Aid Assessment and Treatment
Chapter 8Service Development and Provision
Figures
Figure 1.2BC management protocol
Figure 2.2Challenging behaviour grid, incorporating carer reaction and beliefs (plus worked example)
Figure 3.1Anti-psychotic side-effects
Figure 4.1The position of the non-pharmacological approaches in the treatment of BC
Figure 4.2Promoting good 2-way interactions: the wedding cake model
Figure 4.3Themes associated with well-being
Figure 4.4Benefits of dance psychomotor therapy (Guzman-Garcia et al. in press)
Figure 4.5a) Triad for someone with a mild dementia
Figure 4.5b) Triad for someone with a moderate-severe dementia
Figure 5.1Conceptualisation of dementia (CoD)
Figure 5.2The person behind the barrier of the disease (adapted from Stokes 2001)
Figure 5.3Conceptual model of behavioural problems in dementia (Kunik et al. 2003)
Figure 5.4Cohen-Mansfield’s model of unmet needs (2000a)
Figure 5.5Examples of approaches to the management of verbal agitation, from the TREA model
Figure 5.6James’ challenging behaviour (JBC) model
Figure 5.7Newcastle clinical model (James 1999)
Figure 5.8Understanding Mrs Smith’s anger based on her fear and shame
Figure 5.9Mapping the triads for Mr and Mrs Taylor
Figure 6.1Overview of the NCBT’s formulation
Figure 6.2NPI results for NCBT outcome audit
Figure 7.1Gordon’s formulation sheet
Figure 7.2John’s formulation sheet
Figure 7.3Isabel’s formulation sheet
Figure 7.4Betsy’s formulation sheet
Figure 7.5Typical example of a negative sequence occurring prior to the intervention
Figure 8.1NCBT activity grid (Mackenzie 2008)
Tables
Table 1.1List of common behaviours that challenge (BCs)
Table 1.2Some questions to be used in the case of physical non-aggressive behaviours
Table 1.3BC categories derived from an audit of NCBT clinical work
Table 2.1The common biopsychosocial causes of shouting
Table 2.2The common biopsychosocial causes of sexual disinhibition