Tible O, Mendez M and Armin VG
Background: Behavioural and psychological symptoms of dementia cause great suffering in patients and their families. Phenomenology can help us to clarify the diagnosis and propose some new therapeutic responses, using Daseinanalyse. Phenomenology, that may be complementary to a complete clinical examination, is a Science and a Philosophy. Separation issue and the melancholic type (MT), described by Tellenbach, could explain a melancholy in dementia, using clinical assessment and phenomenology.
Subject and methods: A 90-year-old woman who presents a mixed dementia Cluster Dementia Rating, shouting and howls, is the clinical case. The BPSD crisis factors are highlighted. Our first hypothesis is a separation anxiety. We evaluated depression and BPSD using the NPI*, Cornell scale and Montgomery Asberg Depression Rating Scale in order to confirm our second diagnosis hypothesis that is a melancholy. The Big Five inventory validated-scale (heteroevaluation) was also used to investigate her personality. Thirdly, of his relation to the Time, the Space, the Self and the other (the usual standardized evaluation in Phenomenology), we propose to explain VDB* and melancholy in dementia.
Results: Melancholy was confirmed. We found an inhibited temperament and a low openness to new experience was measured significantly. Phenomenology of the Separation explains here MT and melancholy that is hidden by the howls’ patient. This particular clinical case, the patient who is shouting, must be considered as a psychotic depression in mixed dementia.
Conclusion: MT, melancholy, and a symbiotic relationship led to a situation known as “unbearable” for the patient and the Other (a close relative), unable to separate each other and delegate care to a specialized team. Finally, an effective individualized treatment and perspectives are mentioned.