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Importance of Distinguishing Reactive and Proactive Aggression in Dementia Care.
Journal of Geriatric Psychiatry and Neurology ( IF 2.6 ) Pub Date : 2020-05-15 , DOI: 10.1177/0891988720924706 Ladislav Volicer 1, 2
Journal of Geriatric Psychiatry and Neurology ( IF 2.6 ) Pub Date : 2020-05-15 , DOI: 10.1177/0891988720924706 Ladislav Volicer 1, 2
Affiliation
Aggressive behavior is one of the most disturbing symptoms of Alzheimer disease and other progressive neurodegenerative dementias. Development of strategies for management of aggressive behaviors in people with dementia is hindered by a lack of recognition that aggression is not a uniform behavioral construct. It is possible to distinguish 2 types of aggression: reactive or impulsive aggression and proactive or premeditated aggression. Research concerning aggressive behaviors in people with dementia is hindered by scales describing behavioral symptoms of dementia which do not distinguish between reactive and proactive aggressions because they do not consider the factors leading to these behaviors. Reactive aggression is caused by lack of understanding, leading to rejection of care, while proactive aggression could be caused by a psychopathic personality, hallucinations or delusions, and other determinants. It is difficult to underestimate the importance of distinguishing reactive and proactive aggressions in people with dementia because there are different strategies that can be used for management of these behaviors. For reactive aggression, delayed treatment, distraction, improved communication, and change in treatment strategy is useful, while antipsychotic medication may be needed for treatment of proactive aggression. Dementia is increasing the risk of both types of aggressions and antidepressant treatment can be helpful. Most importantly, persons exhibiting reactive aggression should not be labeled "aggressors" because this behavior could be caused by unmet persons' needs, pain and poor communication with care providers.
中文翻译:
在痴呆症护理中区分反应性和主动性攻击的重要性。
攻击性行为是阿尔茨海默病和其他进行性神经退行性痴呆最令人不安的症状之一。由于缺乏对攻击性不是一种统一的行为结构的认识,阻碍了痴呆症患者攻击性行为管理策略的制定。可以区分两种类型的攻击性:反应性或冲动性攻击性和主动性或预谋性攻击性。有关痴呆症患者攻击行为的研究受到描述痴呆症行为症状的量表的阻碍,这些量表不区分反应性和主动性攻击行为,因为它们没有考虑导致这些行为的因素。反应性攻击是由缺乏理解引起的,导致拒绝照顾,而主动攻击可能是由精神病态人格、幻觉或妄想以及其他决定因素引起的。很难低估区分痴呆症患者反应性和主动性攻击的重要性,因为可以使用不同的策略来管理这些行为。对于反应性攻击,延迟治疗、分心、改善沟通和改变治疗策略是有用的,而治疗主动攻击可能需要抗精神病药物。痴呆症会增加这两种攻击的风险,抗抑郁治疗可能会有所帮助。最重要的是,表现出反应性攻击的人不应被贴上“攻击者”的标签,因为这种行为可能是由未满足的人的需求引起的,
更新日期:2020-05-15
中文翻译:
在痴呆症护理中区分反应性和主动性攻击的重要性。
攻击性行为是阿尔茨海默病和其他进行性神经退行性痴呆最令人不安的症状之一。由于缺乏对攻击性不是一种统一的行为结构的认识,阻碍了痴呆症患者攻击性行为管理策略的制定。可以区分两种类型的攻击性:反应性或冲动性攻击性和主动性或预谋性攻击性。有关痴呆症患者攻击行为的研究受到描述痴呆症行为症状的量表的阻碍,这些量表不区分反应性和主动性攻击行为,因为它们没有考虑导致这些行为的因素。反应性攻击是由缺乏理解引起的,导致拒绝照顾,而主动攻击可能是由精神病态人格、幻觉或妄想以及其他决定因素引起的。很难低估区分痴呆症患者反应性和主动性攻击的重要性,因为可以使用不同的策略来管理这些行为。对于反应性攻击,延迟治疗、分心、改善沟通和改变治疗策略是有用的,而治疗主动攻击可能需要抗精神病药物。痴呆症会增加这两种攻击的风险,抗抑郁治疗可能会有所帮助。最重要的是,表现出反应性攻击的人不应被贴上“攻击者”的标签,因为这种行为可能是由未满足的人的需求引起的,