OBJECTIVE: To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs.
METHODS: Systematic review.
METHODS: Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management.
METHODS: We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4.
RESULTS: Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations.
CONCLUSIONS: There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.

UNASSIGNED: High-quality clinical practice guidelines (CPGs) are important for the effective treatment of behavioral and psychological symptoms of dementia (BPSD). However, recommendations provided by different quality guidelines may lead to varied clinical practice outcomes.
UNASSIGNED: To assess the quality of available CPGs for the management of BPSD and summarize the best recommendations for treating BPSD.
UNASSIGNED: This was a systematic review of CPGs for the management of BPSD with data obtained from electronic databases and evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument, consisting of six domains: \"Scope and purpose\", \"Stakeholder involvement\", \"Rigor of development\", \"Clarity of presentation\", \"Applicability\", and \"Editorial independence\". The criteria for high-quality guidelines were set as: the score of high-quality guidelines in the \"Rigor of development\" domain should be ≥60% and as well as a score of >60% in at least three other domains. High-quality guidelines were selected for recommendation extraction, and the final recommendations were formed in combination with the latest meta-analysis and randomized clinical-trial results.
UNASSIGNED: In term of median scores in each domain for the six included CPGs, \"Scope and purpose\" (87.5%) scored better than all others, whereas \"Applicability\" (46.5%) was the domain with the lowest score. Four CPGs (2015 APA, 2018 NICE, 2018 CANADA, 2020 EAN) met the criteria of high-quality guidelines and were used to extract recommendations. From these four CPGs, nine specific recommendations related to the management of BPSD were summarized, of which seven were related to pharmacological treatment and two to non-pharmacological treatment. These recommendations covered the applicability of antipsychotic drugs, medication recommendations, withdrawal times, and several suitable non-pharmacological therapies.
UNASSIGNED: The quality of CPGs for the management of BPSD requires improvement, especially for the \"Applicability\" domain. For psychotic-like symptoms in dementia, the use of antipsychotics should be based on the individual\'s risk-benefit ratio, and the use of atypical antipsychotics seems to be a better choice. Non-pharmacological treatments may be suitable for emotional symptoms and sleep disorders.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209204.

Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome.
The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain.
A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life.
A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics.
The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver\'s quality of life.

WHAT IS KNOWN ON THE SUBJECT?: Supportive observations is the practice of closely monitoring patients who are acutely unwell in order to keep them safe. There are no formal guidelines for nursing staff on what to observe during observations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A consensus of expert opinion suggests that the clinically meaningful behaviours in supportive observations focus on six factors: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These aspects of patient presentation should be a part of the decision-making discussions about observations. The Mersey Care Supportive Observations Recording Tool that emerged from this consensus may assist with recording the relevant information. Abstract Introduction Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim To develop expert consensus on the important aspects of patient presentation that inform clinical decision-making about observations and to develop a recording tool from this consensus. Method A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. Subthemes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice Consensus items should be recorded in observations records and be considered in decision-making about observations. The MSORT may aid observations recording.

Clinical practice guidelines (CPG) provide a framework for evidence-based practice; however, few studies have assessed the methodological quality of CPGs relevant to child and youth mental health. This study was a systematic review of CPGs for the assessment, prevention and treatment of disruptive behavior, including attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD) and aggression in children and youth. Systematic review identified 29 CPGs meeting inclusion criteria that were appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) validated tool. Twenty-two guidelines addressed ADHD, 2 CD, 1 ODD, 2 for Behavior Disorders collectively and 2 for Aggression. Among the 29 guidelines, two that were developed for ADHD (NICE 2013a; Spanish Ministry of Health, 2010) and one practice guideline developed for CD (NICE 2013b) met high quality criteria; one guideline for behavior disorders (Gorman et al. 2015), two for ADHD (AAP 2011a, b; SIGN 2009a, b, c, d, e), and two for aggression (Knapp et al. 2012; Scotto Rosato et al. 2012a, b) met minimum quality criteria. Findings from this review provide important information for clinicians and organizations who want to utilize guidelines to implement best-practice clinical services for children and youth with disruptive behavior.

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ABSTRACTObjectives:Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, a condition occurring in more than 40 million people worldwide. BPSD present a considerable treatment challenge for prescribers and healthcare professionals. Our purpose was to prioritize existing and emerging treatments for BPSD in Alzheimer\'s disease (AD) overall, as well as specifically for agitation and psychosis.
International Delphi consensus process. Two rounds of feedback were conducted, followed by an in-person meeting to ratify the outcome of the electronic process.
2015 International Psychogeriatric Association meeting.
Expert panel comprised of 11 international members with clinical and research expertise in BPSD management.
Consensus outcomes showed a clear preference for an escalating approach to the management of BPSD in AD commencing with the identification of underlying causes. For BPSD overall and for agitation, caregiver training, environmental adaptations, person-centered care, and tailored activities were identified as first-line approaches prior to any pharmacologic approaches. If pharmacologic strategies were needed, citalopram and analgesia were prioritized ahead of antipsychotics. In contrast, for psychosis, pharmacologic options, and in particular, risperidone, were prioritized following the assessment of underlying causes. Two tailored non-drug approaches (DICE and music therapy) were agreed upon as the most promising non-pharmacologic treatment approaches for BPSD overall and agitation, with dextromethorphan/quinidine as a promising potential pharmacologic candidate for agitation. Regarding future treatments for psychosis, the greatest priority was placed on pimavanserin.
This international consensus panel provided clear suggestions for potential refinement of current treatment criteria and prioritization of emerging therapies.

A robust body of scientific research explores the effects of violent media on youths. For practitioners, the volume of interdisciplinary research and controversial findings can be confusing and difficult to generalize for best practice. This article briefly reviews the literature and presents guidelines for parenting and treating youths exposed and enmeshed in violent media. Attention is given to at-risk populations and children presenting with aggressive, violent, and antisocial behavior. Guidelines assume a family based, cognitive-behavioral approach suitable for the eclectic practitioner, with a focus on the complex, developmental, and ecological factors that contribute to presenting symptoms.

Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take \"new exposures\" like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes. Studies, empirical observations, and patient reports clearly indicate interactions between EMF exposure and health problems. Individual susceptibility and environmental factors are frequently neglected. New wireless technologies and applications have been introduced without any certainty about their health effects, raising new challenges for medicine and society. For instance, the issue of so-called non-thermal effects and potential long-term effects of low-dose exposure were scarcely investigated prior to the introduction of these technologies. Common electromagnetic field or EMF sources: Radio-frequency radiation (RF) (3 MHz to 300 GHz) is emitted from radio and TV broadcast antennas, Wi-Fi access points, routers, and clients (e.g. smartphones, tablets), cordless and mobile phones including their base stations, and Bluetooth devices. Extremely low frequency electric (ELF EF) and magnetic fields (ELF MF) (3 Hz to 3 kHz) are emitted from electrical wiring, lamps, and appliances. Very low frequency electric (VLF EF) and magnetic fields (VLF MF) (3 kHz to 3 MHz) are emitted, due to harmonic voltage and current distortions, from electrical wiring, lamps (e.g. compact fluorescent lamps), and electronic devices. On the one hand, there is strong evidence that long-term exposure to certain EMFs is a risk factor for diseases such as certain cancers, Alzheimer\'s disease, and male infertility. On the other hand, the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment. In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis. The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person\'s resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem illnesses - works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.

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