Speaker Companion: Managing Agitation and Psychosis in Dementia

Duration: 45 minutes | Audience: Psychiatric NPs, RNs, Medical Staff | Materials: Slides, Case Studies, Handouts

Slide 01

Title Slide

2 min

Speaker Notes

  • Welcome audience, establish credibility with dementia care experience
  • Preview that this will cover both non-pharmacologic and pharmacologic approaches
  • Emphasize hierarchical nature—start with assessment, not medications
  • Set expectation: interactive case discussion ahead
💡 Tip: Ask audience: "How many of you have encountered challenging BPSD this month?" to establish relevance.
Q: Is this presentation CME accredited? Easy

A: Yes, this session is approved for 1.0 CME credit. Instructions for claiming credit will be emailed within 24 hours.

Q: Will slides be available? Easy

A: Yes, PDF and interactive HTML versions will be shared via email. The guide version is also available for clinical reference.

Slide 04

Case Presentation

8 min

Speaker Notes

  • Read case slowly, emphasizing key details (sundowning pattern)
  • Pause for audience to consider differential diagnosis
  • Ask: "What medical causes would you rule out first?"
  • Click reveal AFTER discussion—don't give away answers
  • Emphasize: "This is a board exam trap"
⚠️ Watch for: Audience jumping straight to antipsychotic recommendation without mentioning assessment.
🎯 Key Point: The sundowning pattern is the clue—suggests environmental/circadian factors, not just disease progression.
Q: "Why not just start risperidone immediately?" Medium

A: Black box warning requires informed consent and medical workup first. Also, if this is delirium from UTI, antipsychotic won't help and may worsen. Always assess before treating.

Medium Time: 2 min
Q: "Is trazodone causing the agitation?" Hard

A: Possibly—sedating agents can worsen confusion in elderly. Trazodone also has serotonergic effects that may paradoxically activate. Consider tapering before adding antipsychotic.

Hard Time: 3 min
Q: "What if family demands medication immediately?" Medium

A: Acknowledge distress, explain assessment process takes only 24-48 hours, emphasize safety of ruling out medical causes first. Offer frequent updates to maintain trust.

Medium Time: 2 min
Slide 08

Black Box Warning

5 min

Speaker Notes

  • Don't rush through this slide—it's legally and clinically critical
  • Emphasize absolute numbers: 1-2 additional deaths per 100 treated
  • Stress this is why non-pharmacologic approaches are first-line
  • Demonstrate informed consent script naturally, not robotically
  • Pause for questions—these risks worry providers
💡 Delivery Tip: Share a personal example of difficult informed consent conversation to normalize provider anxiety about this discussion.
Q: "Has anyone been sued for NOT prescribing antipsychotics?" Hard

A: Litigation can go either way—failure to treat severe agitation vs. failure to warn of risks. Documentation of risk-benefit discussion and appropriate monitoring is key defense. No absolute immunity either way.

Hard Time: 3 min
Q: "Do families actually understand these risks?" Medium

A: Often no—use teach-back method. Ask family to explain in their own words. Document their understanding, not just that you spoke.

Medium Time: 2 min

Session Timing Guide

0:00-0:05 Introduction & Learning Objectives
0:05-0:15 Scope & Case Presentation
0:15-0:25 DICE Framework & Assessment
0:25-0:35 Non-Pharmacologic Interventions
0:35-0:45 Pharmacology, Black Box, Monitoring, De-prescribing
0:45-0:50 Q&A and Wrap-up