scholarly journals Valproate Induced Behavioral Dysregulation in an Adolescent with Intellectual Disability: A Case Report

2020 ◽  
Vol 5 (12) ◽  
Keyword(s):  
Intellectual Disability ◽  
Behavioral Problems ◽  
Long Term Care ◽  
Autism Spectrum ◽  
Abnormal Behavior ◽  
Mild Intellectual Disability ◽  
Term Care ◽  
Behavioral Dysregulation ◽  
Emergency Interventions

A 14-year-old with mild intellectual disability and autism spectrum disorder was admitted to a long-term psychiatric hospital with complaints of treatment resistant aggressive behavior. Her psychopharmacologic regime was Depakote 1500mg, Intuniv XR 2mg twice daily, and Inderal 10 mg thrice daily, for her mood and behavior symptoms, and prn Ativan and Benadryl for acute episodes of agitation. Despite multiple medication trials, she was continued on Depakote for seven months prior to her admission to long term care. During the first month in long term care, she had over 20 emergency interventions due to physical aggression. She was also witnessed to exhibit abnormal behavior and self-harm during this time. There were concerns that Depakote may be contributing to her dysregulated behavior, thus the medication was slowly down-titrated while her other scheduled medications and dosages remained the same. The patient started to require fewer emergency interventions with noted improvement in her behavior. After the complete termination of Depakote, clinical observations were remarkable for mitigation of aggressive and abnormal behavior as evidenced by the patient going six weeks without any emergency intervention. Behavioral dysregulation is a possible adverse effect of valproate. Individuals with intellectual disabilities are most vulnerable to polypharmacy for management of aggression, behavioral problems, and other psychiatric comorbidities. There is a need for pharmacovigilance on the negative behavioral effects in patients receiving valproate.

A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update five years later

2011 ◽  
Vol 24 (4) ◽  
pp. 599-605 ◽  
Author(s):  
Stephen Vida ◽  
Johanne Monette ◽  
Machelle Wilchesky ◽  
Michèle Monette ◽  
Ruby Friedman ◽  
...  
Keyword(s):  
Behavioral Problems ◽  
Educational Program ◽  
Intervention Program ◽  
Long Term Care ◽  
Psychological Symptoms ◽  
Care Center ◽  
Dose Assessment ◽  
Current Evidence ◽  
Term Care

ABSTRACTBackground: While antipsychotic (AP) medications are frequently used in long-term care, current evidence suggests that the risks may offset the benefits, necessitating periodic reassessment of their use. The aims of this present study were: (1) to assess rates of AP use five years after our first intervention to determine the long-term impact; and (2) to implement an updated AP reduction educational intervention program at the same center five years later in order to determine whether AP use could be further reduced.Methods: Participants were residents with dementia receiving AP medication. The educational program component included separate lectures on pharmacologic and non-pharmacologic treatment of behavioral and psychological symptoms of dementia (BPSD). Completion of the Nursing Home Behavior Problems Scale (NHBPS), physician interviews concerning AP treatment plans for subjects with dementia, and AP administration and dose assessment occurred both at baseline and again between four to five months after the educational program.Results: Of 308 long-term residents with dementia, 53 (17.2%) were receiving regular APs, primarily for agitation, aggressivity, other behavioral problems and psychosis. Of these, six died and one was transferred, leaving 46 participants. At five months, ten (21.7%) residents were no longer receiving APs and seven (15.2%) were on a lower dose; thus, 17 (37.0%) were either discontinued or on a lower dose. There was no worsening of NHBPS scores.Conclusion: Despite the low prevalence (17.2%) of AP users at the beginning of the current study compared to that observed five years prior (30.5%), it is still possible to further decrease the proportion of users.

Abnormal behavior of residents in a long-term care facility and the associated stress of care staff members

2001 ◽  
Vol 33 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Itsugi Nagatomo ◽  
Yasuaki Akasaki ◽  
Masataka Tominaga ◽  
Wataru Hashiguchi ◽  
Masahiro Uchida ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Care Staff ◽  
Abnormal Behavior ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Staff Members

Recruiting Out-of-Home Caregivers for Children with an Intellectual Disability in the Shared Family Care Program

1993 ◽  
Vol 18 (4) ◽  
pp. 23-27 ◽  
Author(s):  
Jill Volard ◽  
Christine Baxter ◽  
Cliff da Costa
Keyword(s):  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Long Term Care ◽  
Service Providers ◽  
Family Care ◽  
Care Program ◽  
Short Term ◽  
Term Care ◽  
Recent Evaluation

Recruiting caregivers for children with an intellectual disability who require out-of-home respite or longer-term care is a problem which has challenged service providers for many years. This paper summarises findings of a recent evaluation of Shared Family Care, a foster care program in Victoria for children with intellectual disabilities/developmental delay. Current recruiting is not succeeding in meeting the demand for either respite, short term or long term care. Findings of the evaluation suggest that factors such as use of appropriate media, and running effective recruitment campaigns is only part of the answer. It is also important at every stage to address caregiver satisfaction with the job and employ strategies to find potential caregivers in the community.

scholarly journals Instrument Development and Validation of the Comprehensive Ability of Older People Assessment scale

2020 ◽  
Author(s):  
Weitong Li ◽  
Yuan Zhu ◽  
Yujing Chen ◽  
Yalou Pu ◽  
Guihua Xu
Keyword(s):  
Factor Analysis ◽  
Correlation Analysis ◽  
Older People ◽  
Behavioral Problems ◽  
Long Term Care ◽  
Care Service ◽  
Assessment Scale ◽  
Validity And Reliability ◽  
Term Care

Abstract Background: At present, many aging assessment instruments have been developed at home and abroad, but the quality of care service in China's pension institutions is uneven, and there is still a lack of a unified tool for assessing the ability of the elderly uesd by evaluators of long-term care institutions.Method: The Comprehensive Ability of Older People Assessment scale was completed by a sample of 971 older people from 4 long-term care facilities in China and the data were collected between April 2018-December 2019. One-way analysis of variance and multiple regression analysis were used to screen scale items, while focus group interviews were used to integrate the subjective and objective items. Confirmative factor analysis and expert judgment were applied to explore construct validity. Reliability was explored through internal consistency estimation using Cronbach’s alpha and homogeneity evaluation using corrected item-total correlations. Cluster analysis and discriminant analysis were used to segment the comprehensive ability assessment scores and discriminant function was established to determine the boundary value of each segment, with correlation analysis used to perform reverse verification.Results: Factor analysis yielded 40 items with six dimensions, including ‘Mentation and cognitive,’ ‘Perception and communication,’ ‘Emotional problems,’ ‘Mental and behavioral problems,’ ‘Daily life and social participation,’ and ‘Skin and oral status’. The Cronbach’s α was 0.951 while the dimensions show a Cronbach’s α 0.760–0.946. The rationality and scientificity of the scale was proved by the correlation analysis of reverse validation.Conclusion: The 4-grade Comprehensive Ability of Older People Assessment Scale had good validity and reliability and should be considered for institutional assessors.

scholarly journals Home- and Community-Based Waivers for Children With Autism: Effects on Service Use and Costs

2014 ◽  
Vol 52 (4) ◽  
pp. 239-248 ◽  
Author(s):  
Zuleyha Cidav ◽  
Steven C. Marcus ◽  
David S. Mandell
Keyword(s):  
Service Use ◽  
Long Term Care ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Community Based ◽  
Term Care ◽  
Outpatient Visits ◽  
Disability Group ◽  
Comparison Groups

Abstract We examined (a) the associations between Medicaid home and community-based waiver participation and service use and expenditures among children with ASD; and (b) how states' waiver spending moderates these effects. We used 2005 Medicaid claims to identify a sample of children with autism spectrum disorder (ASD). We selected two comparison groups who had no waiver participation: (a) children who were eligible for Medicaid through disability (disability group), and (b) children who had at least one inpatient/long-term care (IP/LT) episode (IP/LT group). Waiver participants were less likely to use IP/LT services and had lower associated expenditures than the disability group. As states' waiver spending increased, waiver participants became increasingly less likely to use IP/LT services. Waiver participants had more outpatient visits and associated expenditures; this difference increased as state waiver spending increased. Compared with the IP/LT group, waiver participants had lower IP/LT expenditures, more outpatient visits, and associated expenditures. Higher state waiver generosity increased this effect on outpatient visits and expenditures.

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