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IntroductionShort-term randomised clinical trials on valproate in distinct types of disturbed behaviour in dementia showed no effects on agressive behaviour. ObjectivesTo assess the course of disturbed behaviour during medium term treatment with sodium valproate for aggressive behaviour. DesignAn open label observational 12-week follow-up study consecutive to a preceding randomised control trial; assessments at 4-week interval. SettingA psychogeriatric medium-stay ward at a psychiatric teaching hospital and psychogeriatric nursing home wards. ParticipantsPatients who completed a preceding randomised placebo controlled clinical trial on sodium valproate in aggressive behaviour in dementia were included. InterventionThe starting dose of sodium valproate was 2×6 ml of a 40 mg/ml suspension (daily defined dose of 480 mg). The patient's regular physicians managed all treatment decisions, including decisions on dosage and plasma level measurements of sodium valproate and decisions regarding discontinuation. Co-medication was allowed and any change in prescription was recorded. MeasurementsThe Social Dysfunction and Aggression Scale-9 (SDAS-9), the Behaviour Observation scales for Intramural Psychogeriatrics (in Dutch: Gedragsobservatieschaal voor Intramurale Psychogeriatrie (GIP) and the Clinical Global Impression of aggressive behaviour (CGI) were performed at the last week of each 4-week interval. ResultsData of 39 patients (F=24 and M=15) were analysed. At week 12 compared to week 0 mean sodium valproate prescriptions were higher; aggressive behaviour as measured by the SDAS-9 improved. Non-social behaviour, apathetic behaviour, disoriented behaviour and distorted memory improved, but rebellious behaviour increased as measured by the GIP. Seven patients died during this study. Limitations of the studyOpen label observational design; absence of placebo/reference prescription; no systematic measurements of sodium valproate plasma levels and the allowance of psychotropic co-medication. ConclusionLow dose sodium valproate may be effective reducing a broad range of types of disturbed behaviours in aggressive demented patients. The high death rate underlines the fragility of demented patients with aggressive behaviour. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To study the influence of the introduction of a behaviour rating scale on reported incidence and management of aggressive behaviours in patients in a psychogeriatric nursing home. Design An 8-month prospective cohort intervention study. Setting Two wards of a Dutch psychogeriatric nursing home with residents of 65 years and older. Patients All residents of the two wards were included (N =75). Intervention Social Dysfunction and Aggression Scale (SDAS) assessed at weekly intervals during 4 months after a 4 months' baseline period. Assessments During 8 months at 2 months' interval the BOP (ie the validated Dutch version of the Stockton Geriatric Rating Scale); frequency of aggressive behaviour reported at daily nursing staff report; mean prescriptions of psychotropic and somatic drugs; number of days a patient was submitted to physically restrictive measures. Results Eleven patients (N =11) did not complete the study; information on 64 patients was analysed. The frequency of aggressive behaviour reported by the nursing staff increased, while prescriptions of psychotropic drugs decreased. No alteration was found for BOP scores, mean prescriptions of somatic drugs and the use of physically restrictive measures. Conclusions The introduction of a behaviour rating scale does influence the reported incidence and management of aggressive behaviour. Prospective intervention studies should include a stabilization phase for measurements prior to any planned trial. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]