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How is psychotic dementia defined?

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Psychotic dementia is not a defined disorder but a cluster of psychotic symptoms such as hallucinations, delusions or delusional misidentifications associated with advancing dementia, according to the American Academy of Family Physicians. While behavioral issues are common symptoms of dementia, agitation, wandering or aggressive behavior are not considered psychotic manifestations of dementia. However, some patients with dementia exhibit aggressive behavior as a consequence of their delusional misidentification.

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The common thread between the three major symptoms of psychotic dementia is they involve perceptions that are divorced from reality, reports the American Academy of Family Physicians. Dementia sufferers who experience hallucinations perceive sensory events that are not actually present, while those with delusions or who have beliefs that are contextually inappropriate and those with delusional misidentification no longer correctly identify people or objects in their environment. For example, patients with delusional misidentification may believe family members are impostors or lose the ability to recognize themselves in the mirror.

The treatment for psychotic symptoms of dementia varies depending on the type and severity of the symptoms, explains the American Academy of Family Physicians. Patients with hallucinations usually experience visual hallucinations that are often not frightening and may not require treatment, but those with delusional symptoms may require pharmacological treatment if they suffer distress or pose a danger to themselves and others. Atypical antipsychotics such as quetiapine are the first choice for treatment if drugs become necessary to treat psychotic dementia, though nonpharmacological interventions such as behavior modification are also effective in many cases.

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