Hastened death due to disease burden and distress that has not received timely, quality palliative care is a medical error.

All healthcare services strive to achieve the six factors of quality health care - safe, effective, patient-centered, timely, efficient and equitable. Yet multiple structural, process, policy and people factors can combine to result in medical error and patient harm. Measuring the quality of palliative care has many challenges due to its presence across multiple health sectors, variable skill and experience of providers and lack of defined processes for providing services.

Neuropsychiatric symptoms of dementia: consent, quality of life, and dignity.

Degenerative forms of dementia are progressive, incurable, fatal, and likely to cause suffering in conjunction with personal incapacity. Timely diagnostic disclosure and counseling can facilitate important advance care planning. The risk of harm associated with neuropsychiatric symptoms (NPS) of dementia often has to be balanced against the risk of harm associated with medication management of NPS.

Behavioral and psychological symptoms in moderate to severe Alzheimer's disease: a palliative care approach emphasizing recognition of personhood and preservation of dignity.

The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in moderate to severe Alzheimer's disease (AD) can be challenging, and ethical dilemmas often arise. Clinicians often perceive a disconnect between evidence-based guidelines and the challenges of treating BPSD in moderate to severe AD. Reconciliation of salient ethical issues can help bridge this disconnect.

Sublingual sufentanil for incident pain and dementia-related response agitation.

Patients with moderate to severe dementia commonly exhibit agitation and aggression in response to personal care. Incident pain is a common factor underlying response agitation that in turn can obstruct the delivery of essential nursing care. Medications commonly used to manage response agitation have specific risks in patients with dementia.

Alternatives to atypical antipsychotics for the management of dementia-related agitation.

Numerous recent studies have challenged the widely held belief that atypical antipsychotics are safe and effective options for the treatment of behavioural problems such as agitation in patients with dementia. Accordingly, there is a need to reconsider the place of atypical antipsychotics in the treatment of patients with dementia. The present article is intended to assist clinicians with the assessment and pharmacological management of agitation in patients with dementia.

Differentiating the dementias. Revisiting synucleinopathies and tauopathies.

Dementia is a common, chronic and progressive illness. Many different types of dementia exist. It is important to have knowledge of the various dementia presentations so that the clinician can differentiate one type from another.

Disconnection of language and memory in semantic dementia: a comparative and theoretical analysis.

In this paper, we present an illustrative case of Semantic Dementia (SD) and we review the literature on this relatively rare progressive neurodegenerative disorder. After reviewing the clinical, neuroimaging, neuropathological, and genetic features of SD, we propose a theoretical framework that addresses features of SD and relates them to features of other well known neuropsychiatric syndromes. Our 'on-line / off-line disconnection' model seeks to conceptualize SD as a syndrome of disconnection between two large distributed cortical networks, namely, between those networks that subserve language function and those that subserve memory function.

Successful ECT in a patient with an orbital cavernous hemangioma.

There are no cases in the literature describing the use of electroconvulsive therapy (ECT) in a patient with an intraorbital vascular mass. We report the clinical course of a 69-year-old female with a cavernous hemangioma of the left orbit who was successfully treated with ECT for major depressive disorder. There were no apparent effects on the orbital hemangioma as a result of ECT-related blood pressure elevations measured up to 195/90 mm Hg despite pretreatment with intravenous esmolol.

Phenotypic spectra of bipolar disorder in responders to lithium versus lamotrigine.

Objective: We conducted a study of clinical presentation and family history in patients responsive to either of two commonly used mood stabilizers, lithium and lamotrigine.

Methods: The sample included 164 subjects from 21 families of bipolar probands, 14 responders to lithium and seven to lamotrigine. Diagnostic information on first-degree relatives was obtained in a blind fashion through a combination of direct interviews (SADS-L) and family history assessments (FH-RDC).