Screaming

Abstract: Abstract Dementia is a syndrome characterized by cognitive and non-cognitive symptoms. This book focuses on the clinically distinct categories of non-cognitive symptoms. These are grouped together under the umbrella term Behavioural and Psychological Symptoms in Dementia (BPSD). BPSD include agitation (describing a cluster of related symptoms including anxiety, irritability and motor restlessness, often leading to behaviours such as wandering, pacing, aggression, shouting and night-time disturbances), psychosis (referring to three main categories of symptoms: hallucinations, delusions and delusional misidentification) and mood disorders (depression, anxiety and hypomania). Other symptoms include sexual disinhibition, eating problems and abnormal vocalizations (shouting, screaming and demanding attention). There are many reasons why a patient with dementia may develop BPSD. Because of these potential different aetiologies, a full and careful assessment of possible physical, psychological and environmental factors is essential. This book will inform all of those responsible for caring for the patient with dementia about the identification of BPSD, the nature of the symptoms, assessment of their severity and recommends a structured and sequential approach to management. The authors are internationally respected, combining expertise from the fields of clinical research, psychiatry and clinical psychology to provide an integrated approach to the topic.

Abstract: Background Patients with dementia can demonstrate noisy behaviours such as screaming, repetitive speech, moaning and singing. Such behaviours can be grouped under the title of “Inappropriate Vocalisation” which is used in this article to describe any noise making which impacts detrimentally upon patients, families or those in a caring role. Inappropriate vocalisation is notoriously difficult to treat and clinicians may have to rely on a “trial and error” approach when attempting to limit the distress it causes. Objectives This paper applies a hierarchical approach to Behavioural and Psychological Symptoms of Dementia (BPSD) in attempting to tackle inappropriate vocalisation systematically. Nine steps are ranked within three stages, with evidence for each intervention being considered sequentially in terms of the likelihood for success as the authors attempt to review the relevant literature. Methods The authors performed a search of the medline database using the key words “screaming,” “shouting,” “persistent vocalisation” and “inappropriate vocalisation” combined with the key word “dementia”. Further searches of the references of medline generated articles revealed a second group of articles of use in this review. Results The search generated 53 reviews, research papers, case studies or letters, 36 of which are referenced in this article and the remaining references drawn from reading by the authors around the subject and related problems. Conclusion Interventions for inappropriate vocalisation in dementia are not limited to medication. Environmental factors and behavioural approaches are considered ahead of pharmacotherapy as the concepts of Underlying Illness, Hidden Meaning and Empirical Treatments are used to structure consideration of important, and sometimes overlooked, issues including pain, depression and overall level of stimulation. Copyright © 2005 John Wiley & Sons, Ltd.

Abstract: This study aimed at exploring vocal activity in severely demented patients with vocally disruptive behaviour as identified by nurses Continuous tape-recordings (0700 am–0700 pm) of the vocal activity of 33 residents in psychogeriatric wards were analysed regarding duration, level, number, type, content and direction The activity lasted for a mean of 3387 minutes/patient and the longest episode of each patient had a mean duration of 1035 minutes and turned into shouting in 17 cases The vocal activity consisted of (1) inarticulate sounds or syllables; (2)predominance of inarticulate vocal activity; (3) articulate words or sentences; (4) predominance of articulate vocal activity; and lastly (5) "dialogue vocal activity" No significant relationships emerged when a multiple regression analysis with type as dependent and demographic data as independent variables was applied The vocal activity was: impossible to interpret, directed to others, responsive, or non-directed utterances The communicative function of the words used related to need for someone, incompetence, protest, need for help, in pain and despair/fear—hence, relating to an emotionally negative content, and less often to a positive emotional content The vocal activity seemed possible to interpret as a "language" stemming from strong emotions mostly of a negative nature and a "language" used in monologues which could represent a self-stimulating "language", thus meeting the need for activity The results indicated that patients' emotional state must be attended to