Phenomenological contribution to understanding of vocally disruptive behaviour: A clinical case study in a patient with dementia

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSD) cause great suffering in patients and their families. Phenomenology can help clarify the diagnosis and propose some new therapeutic responses using Daseinsanalyse. Separation issues understood using the phenomenological description of the melancholic type (MT) by Tellenbach may further shed light on our understanding of depression in dementia.

SUBJECT AND METHODS

In a 90-year-old woman presenting with advanced (Clinical Dementia Rating 3) mixed dementia and BPSD in the form of vocally disruptive behaviour (VDB), we discuss separation anxiety as the aetiopathogenic hypothesis. Depression and BPSD were assessed using the Neuropsychiatric Inventory, Cornell scale, and Montgomery-Åsberg Depression Rating Scale to confirm our second phenomenological diagnostic hypothesis, ie, melancholy. The Big Five Inventory scale filled in by a proxy was also used to evaluate the patient's premorbid personality. We then propose an explanatory frame of VDB and depression through the standard phenomenological assessment of its relation to time, space, self, and other.

RESULTS

Confirming MT, we found an inhibited temperament and low openness to experience in the patient, as well as a symbiotic relationship with a close relative (the other).

CONCLUSION

Separation anxiety may well explain the patient's MT expressed by VDB. Melancholic type and her symbiotic relationship led to a situation unbearable to the patient and her close relative unable to delegate care to a specialized team.

RUNNING HEAD

Phenomenology in vocally disruptive behaviour in dementia. We have found new explanations in similar clinical cases in dementia as follows. A patient presenting with vocally disruptive behaviour has a melancholic type, a behavioural-inhibited temperament, and marital violence in the past. Phenomenology may help explain this profile with neurobiological disorders. The life trajectory, from childhood into older age, must be taken into account to understand behavioural and psychological symptoms of dementia.

Predictors of Yangsaeng (Health Management) Among Korean Middle-Aged Adults

This study aimed to examine and identify the predictors of Yangsaeng (health management) among Korean middle-aged adults. A cross-sectional descriptive design was employed. Study participants consisted of 150 middle-aged adults in S and G cities, South Korea. Measures included the Yangsaeng scale, the perceived health state scale, the self-efficacy scale, the Beck Depression Inventory, and the family support scale. The analyses showed that the prediction model for Yangsaeng (health management) among Korean middle-aged adults was significant. The value of the adjusted R was 0.635, which corresponded to the explanatory power of 63.5%. The predictor with the most influence on Yangsaeng (health management) among Korean middle-aged adults was family support, followed by perceived health state, leisure activity, self-efficacy, and religion, respectively. This study provided preliminary evidence that family support is a major and primary predictor of Yangsaeng (health management) among Korean middle-aged adults. Concrete interventions and strategies to improve the Yangsaeng (health management) of Korean middle-aged adults were necessary.