The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer’s disease.MethodsFifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI).Results96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05.ConclusionsAll the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Behavioral and Psychological Symptoms of Dementia (BPSD) are relevant since they are frequent and cause distress to caregivers. However, they may not be reported by physicians due to the priority usually attributed to cognitive symptoms.ObjectivesTo verify whether BPSD is being systematically investigated by physicians even in specialized settings and whether their records on medical files are accurate.MethodsAssessment of records on medical files of BPSD reported by caregivers to 182 patients (57.1% men, mean age 67.6±13.5 years) assisted in a tertiary-care behavioral neurology outpatient clinic (BNOC) who also had appointments in other clinics of the same hospital. Alzheimer’s disease (37.9%) and vascular disease (19.2%) were the most frequent causes of dementia.ResultsReport/appointment ratios were 0.58 in BNOC, 0.43 in other neurological, 0.93 in psychiatric and 0.20 in non-neurological, non-psychiatric clinics. BPSD most frequently recorded in BNOC were insomnia, aggressiveness, agitation/hyperactivity, visual hallucinations, apathy, inadequate behavior and ease of crying. Sorted by psychiatrists, categories associated to more BPSD were affect/mood, thought and personality/behavior. affect/mood and sensoperception symptoms were the most frequently reported. Sorted according to Neuropsychiatric Inventory (NPI), categories associated to more BPSD were depression/dysphoria, delusion and apathy/indifference. depression/dysphoria and agitation/ aggression symptoms were the most frequently reported.ConclusionsBPSD reported by caregivers were very diverse and were not systematically investigated by physicians. Notes in medical files often contained non-technical terms.

Este ensaio examina as relações entre psicodiagnóstico e psicoterapia, pressupondo que a prática da psicoterapia implica duas dimensões não coincidentes. Por um lado, é uma prática social reconhecida e regulamentada, uma dimensão pública. Por outro lado, é um certo tipo de relação entre pessoas, uma dimensão privada. O ensaio começa abordando a relação entre a prática do psicodiagnóstico e o debate teórico - sobre a doença mental e seu tratamento - que tem dominado o panorama da Psicologia e da psiquiatria no século XX. Em seguida, apresenta rapidamente a teoria dos tipos lógicos, assentando as bases das análises que se seguirão. Então, examina a prática psicodiagnóstica e psicoterápica em busca de problemas causados pela tensão entre as determinações impostas por aquelas duas dimensões. Finalmente, argumenta por um debate coletivo que permita a construção e o progressivo aperfeiçoamento dos parâmetros que devem balizar a prática do psicodiagnóstico e da psicoterapia.

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