[BPSD from the Perspective of the New Orange Plan].

Abstract

I have discussed BPSD, especially who should treat BPSD and who can treat them, from the viewpoint of the New Orange Plan. It is desirable for all the doctors to have extensive knowledge about dementia and engage in treatment in cooperation with other departments and, more comprehensively, with nursing-care insurance fields. During the period when a patient has mild BPSD and the burden on caretakers is light, it is possible for his or her family doctor to treat BPSD. However, when a patient has severe BPSD and is in a situation where care is difficult, non-drug therapy often becomes the first choice for the treatment and drug therapy second. In the case that neither of them are effective enough for treatment, short- term hospitalization on a dementia treatment ward (closed ward) in the psychiatric depart- ment is necessary. The doctors who are specialists in dementia consist mainly of psychiatrists, neurophysicians, brain surgeons, geriatricians, and doctors who belong to the Department of General Medicine. If we consider the characteristics of the role psychiatrists play in treating dementia, it can be said that psychiatrists are specialists in treating psychic symptoms, which constitute the core of BPSD. Since psychiatrists use antipsychotics far more often than doctors in other departments, they are specialized in prescribing an antipsychotic according to the symptom. In the case of severe BPSD, psychiatrists can hospitalize the patient on a closed ward and give treatment to him or her if necessary but at the minimum. In other words, psy- chiatrists are in an important position in treating dementia that is different from doctors of other departments, and a psychiatric department seems to be the only department which can follow dementia patients through all the stages of their dementia. I strongly hope that not only dementia-specialized doctors but also all other doctors will develop an interst in dementia, and that dementia patients can access effective services any- where in Japan. The problem of dementia concerns not only people engaged in medical and care businesses but also all people in the community, and I think that it is the most important for the whole of society to try to treat dementia.