Maria, Lapid

Abstract Tactile hallucinations can be highly distressing and lead to psychiatric morbidities and functional impairments. There are no established treatments for tactile hallucinations that occur outside of primary psychotic disorders, and available pharmacologic and nonpharmacologic therapies may have limited effectiveness. We present a case of a 75-year-old female with treatment-refractory tactile hallucinations successfully treated with electroconvulsive therapy (ECT). She endorsed 13 months of distressing tactile hallucinations described as slimly substances on her skin. Symptoms started insidiously, became more severe with time and refractory to multiple antipsychotic medications. She became so severely distressed from the tactile hallucinations that she developed a major depressive episode and became suicidal. Relevant medical history included one prior depressive episode, occipital lobe stroke, restless legs syndrome, and obstructive sleep apnea. She was hospitalized in an inpatient psychogeriatric unit and treated with ECT for 12 sessions over 3.5 weeks. Hallucinations responded well to ECT. Patient experienced some mild memory impairment from treatment. Treatment was optimized with duloxetine titration, addition of mirtazapine and repletion of B6 vitamin. Following the acute course of ECT, she reported an 80 % improvement in tactile hallucinations. Depressive symptoms improved, and suicidal thoughts resolved. She was able to discharge from the hospital and continued with maintenance ECT. Our case illustrates the potential therapeutic role of brain stimulation in the treatment of refractory cases of tactile hallucinations. Further studies are needed to determine effective treatment strategies for treatment-refractory tactile hallucinations to prevent progression to severe psychiatric disturbances and improve quality of life.

Abstract Lucid episodes (LE) occur in people living with dementia who have seemingly lost cognitive capacity. Understanding LEs is a relatively new area of scientific inquiry. Most LE studies have utilized different conceptual and operational definitions. Reaching a definition of LE is critical foundation to facilitate more systematic investigation and new knowledge of LEs. The goal of this study was to convene a group of 13 clinical experts to brainstorm on the key components needed to understand LE among people living with dementia (PLWD). We aimed to reach consensus from the group on (1) potential medical or clinical explanations for LEs; (2) necessary medical and clinical questions to understand LE; (3) interpretation of the presence of LE. Thirteen experts from different disciplines (neurology, psychiatry, psychology, pharmacy, palliative care, hospice, nursing, social work, primary care, geriatrics, and professional home caregivers) participated in a virtual Delphi Method study. Experts provided a range of opinions on potential medical and clinical explanations for LE, necessary questions to understand LE, and did not reach consensus on the presence of LE when presented with clinical vignettes. Panelists highlighted key medical and contextual factors as well as a need to know more information about the general demeanor and typical behavior of the PLWD to make a definitive judgement about whether LE occurred. Clinical consensus on LEs is complex. There is great variability in how behaviors and cognitive fluctuations in PLWD are appraised by clinical experts.

Abstract Lucid episodes (LE) in people living with late-stages of dementia (PLWD) have been reported anecdotally, but less is known about how this seemingly unexpected phenomenon is experienced by family members. This study aims to examine variability in family caregivers’ experiences with LE, focusing on the two most common groups of informal caregivers, spouses and children—whether they may exhibit differential appraisals of and responses to LEs. Using a sample of former and current family caregivers from UsAgainstAlzheimer’s A-LIST, we conducted an online survey to spouse and child caregivers (N = 387). Qualitative semi-structured interviews were also conducted with a subset of these caregivers who have witnessed an LE (n = 22). Survey results indicate that child caregivers were more likely to witness a LE. Among “former” caregivers who have witnessed a LE (n = 140), spouses were likely to appraise LEs more negatively and make changes in care decisions (i.e., end-of-life planning and financial decisions) after LE, compared to child caregivers. Among “current” caregivers who have witnessed a LE (n = 80), spouses were more likely to indicate no special circumstances prior to LE, whereas children were more likely to indicate LEs associated with visits from friends and family; there was no difference in positive and negative appraisals of LE between current spouse and child caregivers. Content analysis of qualitative interviews revealed that observed differences between spouses and children were related to their different caregiving contexts, such as relationship history, living arrangement, expectations/motivation, and care resources.