bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity of a brazilian version of the mental status questionnaire as a screening test for dementia among elderly urban subjects. A pilot study
Authors: Blay Sergio Luis , Mari Jair De Jesus , Ramos Luiz Roberto , Ferraz Marcos Pacheco T.
Published: December 2004

Validity of the Mental Status Questionnaire (MSQ) was assessed by comparing the screening scores against a standardized psychiatric evaluation, the Clinical Interview Schedule. In a pilot study patients with dementia were divided into two subgroups: Mild and moderate/severe cases. Including patients with mild dementia in the dementia group, the best balance between sensitivity and specificity fell at cutoff point 1/2. The validity coefficients were as follows: Sensitivity 80.0%, specificity 60.5% positive predictive value 10.5%, negative predictive value 98.1%, and overall misclassification rate 38.5%Including mild dementia in the non‐dementia group, we observed that with six errors in the questionnaire the validity coefficients for moderate/severe dementia were: sensitivity 100.0%, specificity 94.4%, positive predictive value 16.7%, negative predictive value 100.0%, overall misclassification rate 5.5%. A discriminant analysis was run in order to select the most discriminant MSQ items for detecting dementia. Factors associated with misclassification in the questionnaire were investigated.
Depression in the elderly in the community: Effect of physical illness and selected social factors
Authors: Evans Mavis E. , Copeland John R. M. , Dewey Michael E.
Published: December 2004

Depressive illness in the elderly may be the result of a physical illness, the cause of secondary physical problems, coincidental tophysical illness or the result of an aetiological factor common to both conditions. Analysis of a cross‐sectional community sample of 396 elderly people showed depression to be significantly linked to presence of headaches, dyspnoea, and malignant disease known to the patient. It was not linked with heart disease nor arthritis per se, although those on anti‐arthritic or analgesic medication were significantly more depressed. The subjective description of physical health given by the patient also correlated strongly with depression.

Depressive illness is sometimes unrecognized and frequently untreated with a consequent reduction in quality of life for many patients. Clinicians must be aware of the possibility that depression may coexist with physical illness, and that both conditions may need appropriate treatment.

Further analysis of the above sample, controlling for physical illness and the additive effect of the variables concerned, showed depression to be positively correlated with adverse social factors such as not going out because of physical disability, feeling lonely, having a shopper and having hearing difficulties. The home help service was identified as a probable protective factor, implying the importance of this service in supporting the emotional as well as the physical needs of its clients.
The families of the institutionalized dementing elderly: A preliminary study of stress in a French caregiver population
Authors: Ritchie Karen , Ledésert Bernard
Published: December 2004

The present study describes the development of a measure of stress in the family caregivers of institutionalized dementing elders using a brief two‐dimensional scale. Univariate and multivariate analysis of the responses of 257 French adult caregivers to the scale suggest that a year after the admission to care unhappiness is expressed by a third of the population, principally due to exclusion from the caregiving role, financial burden, problems with family and poor contact with staff. Responses appear to be independent of the degree of dementia, the presence of associated pathology in the institionalized elder and recency of admission. Significantly greater satisfaction with care lower levels of stress were reported by caregivers with a relative in non‐medical communal care as opposed to a long‐stay hospital.
An investigation of the sundowning syndrome
Authors: Rindlisbacher Peter , Hopkins Robert W.
Published: December 2004

Geriatric clinicians have observed that some demented individuals show increased agitation, restlessness and confusion in late afternoon, evening or night. This has popularly been named ‘sundowning’, or the ‘sundowning syndrome’. References to ‘sundowning’ in clinical writings disagree on virtually every aspect of the syndrome, and little research has been conducted to investigate this phenomenon.

In this study, agitation was measured in terms of motor activity, using an electronic monitor with a movement sensor. A total of 12 demented Alzheimer's patients were continuously monitored for four days each. Analyses indicated that some subjects showed increased afternoon activity, but these individuals did not correspond to nursing‐assigned groups of ‘sundowners’ and ‘non‐sundowners’. Movement correlates of ‘sundowning’ were seen in Alzheimer's patients presumably in the mid‐stages of the dementia, and less so in patients with more years of illness.
Mental illness among new residents to residential care
Authors: Clark Stella Anne
Published: December 2004

The prevalence of organic impairment, depressive illness and anxiety was assessed in 32 subjects (group A) within two weeks of admission to one of four local authority homes for the elderly in Fife, Scotland. This group was compared with an age and sex matched control group (group B) who continued to live at home. Both groups were reinterviewed six months later.

Levels of organic impairment, depression and anxiety were significantly higher in group A at the time of admission. At follow‐up, levels of organic impairment and depression remained unchanged in both groups. The level of anxiety was significantly lower in group A but remained unchanged in group B at follow‐up.

Forty per cent (13 subjects) of group A were diagnosed at first interview as suffering from major depressive episode, minor depressive disorder, generalized anxiety disorder and/or phobic disorder but no‐one was receiving treatment.

This study reinforces the case for specialist assessment prior to admission to residential care as advocated by the British Geriatric Society. Improved liaison between social and psychiatric services is essential if psychiatric morbidity in the elderly is to be identified and treated, and residential places are to be used appropriately.
Psychiatric diagnoses made by the agecat system in residents of local authority homes for the elderly: Outcome and diagnostic stability after four years
Authors: Ames David
Published: December 2004

Eighty‐six residents of 12 local authority homes for the elderly were interviewed with the Geriatric Mental State (GMS) in 1985/6 after having been classed as depressed by a screening interview. The data so gathered were analysed by the computerized diagnostic program AGECAT in order to derive psychiatric diagnoses for these residents. All were traced after four years; 61 were dead. The 25 survivors were reinterviewed and given a second AGECAT diagnosis. In 1985/6 70 of the 86 examined were ‘diagnostic cases’ of psychiatric disorder. After four years 22 of the 25 survivors were classed as diagnostic cases. AGECAT diagnoses of organic psychosis were stable over four years within this population though the majority of subjects so diagnosed died within four years. Cases of depression had a more varied prognosis, with death, continunce as cases of depression or progression to organic psychosis being the most common outcomes. Recovery from any class of AGECAT disorder was an uncommon event.
Screening scales for dementia: Toward reconciliation of conflicting cross‐cultural findings
Authors: Gurland Barry J. , Wilder David E. , Cross Peter , Teresi Jeanne , Barrett Virginia W.
Published: December 2004

A compendium instrument of five widely used dementia screening scales was applied to 550 subjects 65 years and older. Black, Hispanic and white groups were approximately equal in size. Recruitment was designed to produce an uneven and unknown mix of dementia cases and normals among these groups. A complex challenge to assessment and classification was thus contrived, approximating key aspects of the problem posed to cross‐cultural epidemiology. The published scoring systems of these dementia screens gave drastically conflicting results for absolute and culturally relative rates of cognitive impairment. The conflicts between scales appeared to be largely due to the varying sensitivities of the scales and, to a lesser extent, sociocultural bias. The conflicts were partially resolved through adjustments of the scale cut points.
Medication used by elderly people at home: Changes over 10 years
Authors: Malcolm M. T.
Published: December 2004

The medication actually taken by 223 elderly people referred for a psychiatric opinion and seen in their own residence was compared with that reported in a very similar study made 10 years earlier. Though the average age had increased by two and a half years and there had been a great increase in those living in care homes (where more medication was used), the average consumption of medications fell. Numbers of patients on no medication doubled. Drugs used for physical illnesses and depression were unchanged. There was a marked fall in use of benzodiazepines, especially by day, and chlormethiazole. A move to shorter acting benzodiazepines was recorded. Suggested reasons for this change include: availability of alternative management techniques and therapies, education of prescribers, threats of litigation and a change in attitude of patients, relatives and staff.
Changes in elderly suicides in the USA and the developed world 1974–87: Comparison with current homicide
Authors: Pritchard Colin
Published: December 2004

Between 1974 and 1987 there were increases overall in male suicide rates in the USA, with the greatest increases among elderly men. While female suicide levels overall fell in the USA, elderly female suicide rates failed to show the same improvement. Compared with the rest of the western world, suicide rates for elderly people in the USA were among the worst. Suicide was far more prevalent than homicide, but this is not reflected in the media, where homicide is given a high profile but where there is relative silence surrounding suicide among elderly people.
Interaction between narcolepsy—cataplexy and bipolar mood disorder in an elderly woman
Authors: Meats Philip , Hellewell Jonathan , Jolley David
Published: December 2004

An elderly woman who presented with a manic depressive psychosis and the narcolepsy‐cataplexy syndrome is described. Cataplexy occurred only during hypomania. Other narcoleptic symptoms were more evident during depression. We are not aware of previous reports of an interaction between these two conditions, which is of considerable interest.
The treatment of late age onset psychoses with electroconvulsive therapy
Authors: Figiel Gary S. , Botteron Kelly , Zorumski Charles F. , Jarvis Michael R. , Doraiswamy Murali , Krishnan Ranga
Published: December 2004

The authors describe the clinical course and the brain imaging findings of six patients with late age onset psychoses who were treated with electroconvulsive therapy (ECT). In all five patients who failed to respond to ECT, one or more structural brain changes (lateral ventricular enlargement and/or subcortical structural changes) were observed. In addition, all six patients developed an interictal ECT‐induced delirium. Consistent with previous ECT‐induced delirium studies, caudate hyperintensities were present in the three patients who received brain MRI scans. The potential clinical correlates of structural brain changes in LAOP patients will be described, along with proposed areas of future research.
Late‐life paranoia: Possible association with early trauma and infertility
Authors: Gurian Bennett S. , Wexler Debra , Baker Errol H.
Published: December 2004

We have collected data on 39 persons with late‐life onset of paranoid symptoms, all but two of whom are women. We identified a subset of nine patients that met the criteria for delusional disorder. This group differed significantly from both demented and long‐term schizophrenic patients on a number of variables. There was only one live birth among these nine women; more than half were refugees or holocaust survivors; there was an absence of a predicted sensory loss; and the manifestation of the paranoia was qualitatively different. Several issues are discussed: there is a late‐life delusional state that is neither schizophrenia nor dementia; the paranoia in these delusionally disordered patients cannot be accounted for exclusively by the social isolation hypothesis; there is an interaction among early trauma, the absence of children, and the appearance of paranoid ideation late in life.
Who does what for whom? Audit and dynamics of an acute psychogeriatric assessment unit
Authors: Rands Gianetta
Published: December 2004

An acute psychogeriatric inpatient assessment unit was studied over a six‐month period. Information collected retrospectively from case notes included details of each patient's circumstances, support, diagnosis and treatment. Input data from each of the professionals in the multidisciplinary team were collected and patient outcome was judged by a professional blind to the nature of this project. Characteristics of this patient group are summarized. The occupational therapist, psychologist and social worker concentrated their time on the same set of patients who were not those judged most demanding by the nursing staff. The OT concentrated on patients with a good outcome and the social worker tended to see patients with long admissions.

The results are discussed for their relevance to allocation of resources, multidisciplinary team functioning, and clinical audit.
Diagnosis of dementia. II—Diagnostic methods: A survey of current consultant practice and review of the literature
Authors: Smith C. W. , Byrne E. J. , Arie T. , Lilley J. M.
Published: December 2004

Inaccuracy in the diagnosis of the dementia syndrome is widely reported. In a postal survey which asked hospital specialists about their use of diagnostic criteria and explored their knowledge of the aetiology of the syndrome, clear differences between research findings and clinical practice emerged. Clinicians are unlikely to use research diagnostic criteria and about half of the respondents consider the results of investigations to be essential in the diagnosis of the dementia syndrome. The frequency of contact with new patients with the dementia syndrome influenced some aspects of knowledge of its aetiology.
The diagnosis of depression in patients with dementia: Use of the cambridge mental disorders of the elderly examination (CAMDEX)
Authors: Logie Susan A. , Murphy J. Barry , Brooks D. Neil , Wylie Shona , Barron Elizabeth T. , McCulloch James
Published: December 2004

The prevalence of depression in 80 well‐diagnosed demented patients was examined using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) based on information from patients, caregivers and professionals. The overall prevalence of DSM‐III‐R major depressive illness was 5%, but the identification of depressed patients and the prevalence rate varied with the source of information used. The symptom profiles of the patients were examined in more detail. The significance of these findings and the use of operational diagnostic criteria in the investigation of coexistent depression and dementia are discussed.
Case report: Frontal lobe tumor presenting as late onset depression
Authors: Goodman Adam J. , Kumar Anand
Published: December 2004

A 64‐year‐old female with no past psychiatric history presented with a two‐month history of depressive symptoms. She met DSM‐III‐R criteria for major depressive episode with melancholia. Physical exam revealed a left‐sided Horner's syndrome, and MRI scan of the brain revealed large bilateral frontal lobe masses that were neurologically silent. This case demonstrates that intracranial tumors can present as late onset depression without significant accompanying neurologic deficits.
Death in dementia: A study of causes of death in dementia patients and their spouses
Authors: Ryan D. H.
Published: December 2004

The certified cause of death in 455 married dementia patients admitted to a psychogeriatric unit between 1971 and 1986 was studied. The cause of death in 154 spouses of dementia patients who died within the study period was also recorded, and analysed for concordance between patients and spouses. The pattern of mortality was similar for male and female patients. Bronchoopneumonia was the most common certified cause of death (40%) in the patient group, and ‘non‐specific’ causes of death accounted for 63% of mortality. The pattern of mortality was significantly different to that in the general population, and non‐specific deaths were twice as common in the patient group. Comparison with previous studies shows that the pattern of mortality in dementia patients has remained relatively unchanged over the past 50 years despite alterations in medical practice. Common cause of death between patient and spouse was analysed and no evidence of significant concordance was found, but cause of death among spouses tended to follow the pattern of mortality in patients and was significantly different to that found in the general population. Possible explanations for the unchanging pattern of mortality in dementia are considered, and the case for an intrinsic mechanism of terminal weight loss and decline is discussed.
Eating disorders in later life: A review
Authors: Cosford Paul , Arnold Elaine
Published: December 2004

Eating disorders are considered to primarily afflict young people to the exclusion of the elderly. However, reports in the recent literature have challenged this view, with both anorexia nervosa and bulimia nervosa being described in later life. Although in some reports the diagnosis appears doubtful, the majority appear to demonstrate the classical features of these condtions. They have many similarities with younger sufferers, including clinical features, maladaptive psychological functioning, and a close relationship with other psychiatric conditions, such as depression and obsessive‐compulsive disorder. The aetiology of eating disorders in the elderly appears to be multifactorial, involving both vulnerability factors and precipitating factors. The outcome is often poor, although behavioural modification leads to a significant benefit in most cases. It is probable that these disorders are poorly recognized in the elderly, possibly because of a lake of suspicion and because the symptoms are often assumed to be secondary to an alternative physical or psychiatric cause.
Dissocial personality disorder in the elderly: A case history
Authors: Howard R. , Bandyopadhyay D. , Cook M.
Published: December 2004

A case of dissocial personality disorder in a 71‐year‐old woman presented with dangerous and apparently suicidal behaviour. Such cases are rare and potentially difficult to distinguish from treatment‐resistant depression or organic cerebral conditions. In view of this, investment in prolonged inpatient assessment and an adequate trial of treatment for depression is justified. The prognosis for beneficial change is not good and eventual management may involve little more than providing an environment in which behaviours can be safely contained.
Short screening tests for dementia in the elderly population. I. A comparison between AMTS, MMSE, MSQ and SPMSQ
Authors: Hooijer C. , Dinkgreve M. , Jonker C. , Lindeboom J. , Kay D. W. K.
Published: December 2004

The coexistence of many screening tests for senile dementia raises the question of their potential differences. In an elderly community sample (n = 358), four different tests were applied in parallel. All tests were able to identify similar samples of subjects regarding sample size, age, education or depression. We failed to prove one test to be superior in predicting CAMDEX or AGECAT diagnoses of dementia. Yet, the individuals identified by different tests, and especially the cases of minimal dementia, were only partly identical and partly unique for each of the tests. There is a clear need for greater consensus about the use of screening tests for dementia.
Mental calculation in mild Alzheimer's disease: A pilot study
Authors: Parlato Vincenzo , Lopez Oscar L. , Panisset Michel , Iavarone Alessandro , Grafman Jordan , Boller FrançLois
Published: December 2004

The purpose of this study was to determine whether dyscalculia is present in the early stages of Alzheimer's disease (AD) and if it is associated with a characteristic neuropsychological pattern. We examined 28 probable AD patients with scores of 18 or greater on the Mini‐Mental State Examination (MMS) and with an educational level of 12 or more years. The ability to perform mental calculation was assessed by two tests: the Stamp Test (ST) and the Serial Seven Subtraction Test (SSST). The other cognitive domains were evaluated with an extensive neuropsychological battery. We found significant differences in performances on the calculation tests between patients and controls. The ST was correlated with attention and visuospatial skills, whereas the SSST was correlated with both receptive language and the MMS; both test were similarly correlated with productive language. This study suggests that impairment in mental calculation can be an early sign of AD. The ST seems to represent a more complex task dependent on attentional resources, whereas the SSST would be a purer measure of anarithmetia.
Which factors affect treatment response in late paraphrenia?
Authors: Howard Robert , Levy Raymond
Published: December 2004

Sixty‐four patients with late paraphrenia who had been prescribed neuroleptic treatment for at least three months in the previous year were clinically reviewed in order to asses their treatment response. At the time of assessment, 42.2% of the patients showed no response, 31.3% a partial response and 26.6% a full response to treatment. Compliance with medication, receiving depot rather than oral medication, and use of a community psychiatric nurse if the patient was an outpatient all had a positive effect on treatment response. Despite their better treatment response rate, patients prescribed depot medication received on average a lower daily dose in chlorpromazine equivalents than those prescribed oral medication. Improved compliance, greater clinical efficacy and a reduction in the dose of neuroleptic medication administered are all good reasons to commence treatment of late paraphrenia with a depot antipsychotic medication.
Morale in old age: A review of the evidence
Authors: Wenger G. Clare
Published: December 2004

This article presents a review of the literature on morale. It presents data on the correlates of morale and refers to related research on self‐image, self‐esteem and well‐being. The aim of the article is to give an overview of factors associated with morale identified in the literature. These are summarized in the table. The article points to the relevance of some of these findings for practice. Attention is drawn to the likely overlap and covariance of many of the correlates and it is suggested that multivariant approaches to the analysis of morale may lead to greater understanding of the primary factors. A statistical modelling approach to the problem is promised in a later article.
Falls among geropsychiatry inpatients are associated with prn medications for agitation
Authors: Aisen Paul S. , Deluca Teresa , Lawlor Brian A.
Published: December 2004

A retrospective chart review study was conducted to determine risk factors associated with falls. All patients on a 23‐bed geropsychiatry service who fell during the course of one calendar year (17 patients, 30 falls) were compared to a control group of 30 non‐fallers from the same service and time period. The group of patients who fell during hospitalization was characterized by more frequent history of falls (18% vs 0%, p < 0.05) and ambulatory impairment (76% vs 47%, p < 0.05) and longer length of hospital stay (81 days vs 46 days, p < 0.02). There was no difference in number of medical diagnoses or standing medications between the fallers and non‐fallers, but the fallers were more frequently administered benzodiazepines (0.088 doses/day vs 0.034 doses/day, p < 0.03) and neuroleptics (0.039 doses/day vs 0.014 doses/day, p <0.06) on a PRN basis for agitation. We conclude that falls among geropsychiatry inpatients are associated with the administration of PRN benzodiazepines and neuroleptics to control agitation.
Community psychiatry of old age: A UK perspective
Authors: Dening Tom
Published: December 2004

This article is based on the examination of seven old age psychiatry in England in 1991, and it addresses the main issues in the organization of community‐orientated clinical services for elderly people with mental disorders. The current practice of old age psychiatry places much emphasis on assessment of patients at home wherever possible. Domiciliary assessments were performed by all the services, but there were marked differences in emphasis. The most controversial issue was whether all patients should initially be seen by a psychiatrist or whether assessments by non‐medical professionals were acceptable. Several areas of recent development in old age psychiatry are also discussed.
The nature of wandering in dementia: A Guttman scaling analysis of an empirical classification scheme
Authors: Albert Steven M.
Published: December 2004

Hope and Fairburn (1990) presented a typology of wandering behaviors based on the frequency of such behavior in a sample of community‐dwelling, demented elders. They then linked the nine types of wandering behaviors to a set of etiological components to show that the apparently disparate types of behavior lumped together as ‘wandering’ may actually have distinct neurologic or neuropsychiatric origins. In fact, the distribution of the types of wandering behavior in the sample points to a single latent variable, with a hierarchical structure that demonstrates the centrality of purposeless behavior in the class of wandering behaviors. This is shown in a Guttman scalogram.
Fragmentation of activity periods in Alzheimer's disease
Authors: Hopkins Robert W. , Rindlisbacher Peter
Published: December 2004

Activity cycles were studied in 12 subjects clinically diagnosed with Alzheimer's disease. Subjects wore a movement sensor attached to a solid‐state ambulatory monitor for 96 consecutive hours each. Varying degrees of fragmentation of the normal diurnal activity pattern were observed. Subject variables such as age, estimated duration of illness, cognitive ratings, and months since first admission were compared for degree of association with the movement data. Simple regression analyses showed that an estimate of the duration of illness was superior to others in predicting the degree of fragmentation in activity rhythms. Pathology in the suprachiasmatic nucleus of the hypothalamus is discussed in the light of these findings.
Health, social functioning, and marital status: Stability and change among elderly recently widowed women
Authors: Bennett Kate Mary , Morgan Kevin
Published: December 2004

Four‐year changes in mental and physical health, morale and social functioning were assessed in a random sample of elderly women widowed during the course of a longitudinal study, together with never‐married and still‐married controls. All groups showed an age‐related decline in mental and physical health, with the widows, the never‐married, and the still‐married displaying differing patterns of psychological change over time. However, while widows showed significantly greater changes in morale and personal disturbance, their levels of social functioning remained stable over the four‐year period. The results confirm earlier findings of lifestyle stability after the loss of a spouse and indicate that, in addition to bereavement per se, single status and ageing itself may contribute substantially to the measured longitudinal effects of widowhood.
Case report: Neuroleptic malignant syndrome in an elderly patient: Problems in management
Authors: Adityanjee  , Jayaswal S. K. , Chan S. P. , Subramaniam M.
Published: December 2004

An elderly patient with probable dementing illness was treated with haloperidol and trifluoperazine for control of agitation. The patient developed neuroleptic malignant syndrome characterized by cogwheel rigidity, deterioration in sensorium, hyperpyrexia, mutism, autonomic dysfunction, elevated leucocyte count and serum creatinine phosphokinase. After an initial diagnostic delay treatment with very low doses of bromocriptine resulted in hypotension followed by acute renal failure and death. Problems in the management of NMS in elderly patients with concurrent psychiatric illness and/or dementing illness are discussed.
Ageing and comorbidity among low‐income psychiatric outpatients
Authors: de Figueiredo John M. , Boerstler Heidi
Published: December 2004

The objective of this study was to determine if non‐psychiatric morbidity increases with age in a group of low‐income psychiatric outpatients. Data on demographics, presenting complaints, DSM‐III diagnoses and use of psychiatric services were collected on all individuals (N = 382) admitted to a psychiatric outpatient clinic serving low‐income population. Non‐psychiatric morbidity was identified on the basis of medical history, physical examination, and laboratory investigations. Bivariate analyses were done to determine the significance of the associations of comorbidity with other variables. A logistic regression was done using the presence or absence of comorbidity as the dependent variable. Age was the only variable which was significantly predictive of comorbidity. Additional resources should be allocated for the diagnosis and treatment of comorbidity among low‐income elderly.
Comparison between general practitioners with high or low use of a psychogeriatric domiciliary visit service
Authors: Orrell Martin W. , Hardy‐Thompson Christine , Bergmann Klaus
Published: December 2004

In a catchment area survey of general practitioners regarding their use of the psychogeriatric domiciliary service, a comparison is made between those doctors with a high or low use of such visits in the care of their elderly patients. General practitioners with a high use of the service tended to be more satisfied with the service and more prepared to attend domiciliary visits. The high users were also more likely to consider the patient's physical disability as an important factor in their decision to request a visit in preference to another method of assessment. However, high users were less likely to have had previous psychiatric training and more likely to feel susceptible to pressure from relatives. Although in some ways high users seemed to be using the service more appropriately, psychiatric training may be important in helping the general practitioner to cope with elderly patients.
Oxiracetam in the treatment of primary dementia of the Alzheimer's type: A small case series
Authors: Dager Stephen R. , Loebel J. Pierre , Claypool Keith , Case Mary , Budech Christopher B. , Dunner David L.
Published: December 2004

A 16‐week open‐label trial of high‐dose oxiracetam (up to 3200 mg per day), was not clinically effective overall in treating a small cohort of patients with mild‐moderate dementia of the Alzheimer's type (DAT). However, one of six patients did demonstrate evidence of progressive clinical improvement followed by relapse after discontinuation of medication. Resumption of treatment with oxiracetam after a 6‐month interval was associated with a similar pattern of improvement on neuropsychological testing and enhanced social functioning which was sustained during an additional 5 years of treatment. Following death due to unrelated causes, brain histopathologic findings were consistent with late‐stage DAT despite the patient's sustained clinical improvement while under treatment with oxiracetam.
A survey of geriatric psychiatrists in the US regarding research
Authors: Jeste Dilip V. , Fitten L. Jaime , Clemons Brenda , O'Neal Sheila , Harris M. Jackuelyn
Published: December 2004

A questionnaire survey was conducted to elicit responses regarding research‐related experiences and attitudes among the members of the American Association of Geriatric Psychiatry. Nineteen per cent of the 1200 members to whom the questionnaire was sent responded. An analysis revealed that, while an overwhelming majority (85%) of the respondents felt that geriatric research was important, most encountered enormous barriers. These barriers ranged from funding and time constraints to a lack of training programs and institutional support, to the methodological issues in doing research on an elderly population. A majority of the respondents suggested that more funding be made available for research, and for research training (fellowship and residency programs), start‐up projects for private practice research, and improvement of methodology and protocols. Another frequent recommendation was for increasing collaboration among investigators, including setting up centers for cooperative studies and training.
Foundation funding sources in geriatric mental health
Authors: Harris M. Jackuelyn , Halpain Maureen
Published: December 2004

As federal and state funding sources become increasingly more competitive, other sources of funding for research, education and clinical programs need to be considered. In 1989, over $81 million was given by private sources in support of programs that directly benefited the elderly. This article examines methods for seeking private funding and provides a list of foundations with either specific or possible interest in geriatrics and mental health. We also offer specific suggestions for enhancing the chances of obtaining funding from these foundations.
The ethics of conducting research with older psychiatric patients
Authors: Fitten L. Jaime
Published: December 2004

The ethical context in which geropsychiatric research is carried out today in the United States has its origins in events of the 1960s and 1970s. Three main trends can be identified. The first is sociopolitical and involves the challenge to tradition and authority manifested in that period with its consequent moral pluralism and focus on new forms of individualism. Ethical thinkers redirected their attention to more normative questions and moral problems in medicine came under close scruitiny. Regulatory changes affecting research followed. The second trend greatly influenced the type of research that would predominate in psychiatry after the mid‐1970s. This trend involved the redirection of psychiatric thinking towards renewed interest in psychopathology, nosology and quantitation which was dormant during the preceding psychodynamically oriented decades. The final trend was the aging of the American population. Whereas before the 1960s there was little interest in aging the age‐related neuropsychiatric conditions, subsequent decades ushered in much interest and support for human aging research. New moral problems have naturally arisen. Most of them have involved vulnerable subpopulations of elderly. Nontheless, while small areas of disagreement remain and regulation is incomplete, research in geriatric psychiatry now proceeds within a well‐structured context of ethical guidelines and government regulations.
Psychiatric disorders in the nursing home: A selective review of studies related to clinical care
Authors: Rovner Barry W. , Katz Ira R.
Published: December 2004

Existing research demonstrates that nursing homes are the modern mental institutions for the elderly in the United States, but that training of staff and physicians, processes of care, and the recognition and treatment of mental disorders lag behind the current state of scientific knowledge. The prevalence of diagnosable psychiatric disorders has been estimated to be 80% or higher. The most common of these disorders are the dementias, primarily Alzheimer's or vascular, that can be uncomplicated or complicated by the presence of hallucinations, delusions, depression or behavioral symptoms. Other common disorders include depression and delirium. Problems currently under investigation include the effectiveness of special care units for patients with dementia, the characterization and treatment of the non‐cognitive, psychiatric symptoms of dementia, including consideration of the appropriate use of psychotropic medications, and the recognition, diagnosis, and treatment of depression. Although there is a clear need for more research, the available data already demonstrate the need for augmented psychiatric input into nursing home care.
Alzheimer's disease, the phenomenon of parent fixation and bowlby's attachment theory
Authors: Miesen Bère M. L.
Published: December 2004

Sooner or later many Alzheimer's disease (AD) patients behave as if their deceased parents are still alive. This phenomenon is called parent fixation (PF) and is considered within the theoretical framework of Bowlby's Attachment theory. The hypothesis is that PF is an expression of their need to feel safe and secure. Explorative research indicates that PF is correlated with the level of cognitive functioning and attachment behaviour. The results show that (1) AD can be considered as a "strange situation" which activates attachment behaviour; and (2) the PF which occurs in AD patients has different meanings for the different stages of dementia. The conclusion is that in Alzheimer's disease patients there is more to be taken into account than cognitive disabilities and neurobiological deficits. A great deal of their behaviour can be better perceived and understood as the result (eg aggression) of attachment behaviour in a situation that is experienced as insecure.
Daytime vocal activity in institutionalized severely demented patients identified as vocally disruptive by nurses
Authors: Hallberg Ingalill R. , Edberg Anna‐Karin , Nordmark Åsa , Johnsson Kristina , Norberg Astrid
Published: December 2004

This study aimed at exploring vocal activity in severely demented patients with vocally disruptive behaviour as identified by nurses. Continuous tape‐recordings (07.00 am–07.00 pm) of the vocal activity of 33 residents in psychogeriatric wards were analysed regarding duration, level, number, type, content and direction. The activity lasted for a mean of 338.7 minutes/patient and the longest episode of each patient had a mean duration of 103.5 minutes and turned into shouting in 17 cases. The vocal activity consisted of (1) inarticulate sounds or syllables; (2)predominance of inarticulate vocal activity; (3) articulate words or sentences; (4) predominance of articulate vocal activity; and lastly (5) "dialogue vocal activity". No significant relationships emerged when a multiple regression analysis with type as dependent and demographic data as independent variables was applied. The vocal activity was: impossible to interpret, directed to others, responsive, or non‐directed utterances. The communicative function of the words used related to need for someone, incompetence, protest, need for help, in pain and despair/fear—hence, relating to an emotionally negative content, and less often to a positive emotional content. The vocal activity seemed possible to interpret as a "language" stemming from strong emotions mostly of a negative nature and a "language" used in monologues which could represent a self‐stimulating "language", thus meeting the need for activity. The results indicated that patients' emotional state must be attended to.
Evaluation of the hospital anxiety and depression scale as a screening instrument in geriatric medical inpatients
Authors: Davies Keren Nicola , Burn Wendy Katherine , McKenzie Fiona Ross , Brothwell Judith Ann , Wattis John Philip
Published: December 2004

The Hospital Anxiety and Depression Scale (HAD) was developed as a screening instrument for use in medical patients. The depression subscale has been validated as a measure of severity in elderly depressed psychiatric inpatients. This study assessed its usefulness as a screening instrument in inpatients in a geriatric medical unit. One hundred geriatric inpatients were evaluated using the Geriatric Mental State (Community Version) to identify cases. The HAD lacked sensitivity and specificity in this situation.
The prevalence of psychiatric illness in acute geriatric admissions
Authors: Katherine Burn Wendy , Nicola Davies Keren , Ross Mckenzie Fiona , Ann Brothwell Judith , Philip Wattis John
Published: December 2004

The prevalence of psychiatric illness among 100 elderly medical inpatients was determined using the Geriatric Mental State Schedule, in its Community Version. Due to the difficulties in assessing this group of patients, less than half of those admitted could be included in the study. The diagnostic cases identified were in three groups: organic brain disease (chronic brain failure), depression, and anxiety. Depression was found in 23%, anxiety in 7% and organic brain disease in 13%.
‘What becomes of demented patients referred to a psychogeriatric unit?’ An approach to audit
Authors: Reddy Subbalekshmi , Pitt Brice
Published: December 2004

A 1‐year follow‐up study was undertaken of a random sample of 40 elderly patients living at home given a diagnosis of "dementia" after referral to the Psychogeriatric Department at St Charles' Hospital, London, W10. Eighteen (45%) patients were admitted to institutional care. There was an association between physical disability and institutionalization. A similar tendency was observed for social disturbance and hospital admission. The 1‐year survival rate for the sample was 82.5%. All the seven patients who died were moderately/severely demented. Twenty‐three patients (55%) had informal key carers. Half of these showed considerable stress according to the General Health Questionnaire and the Strain Scale scores. All the recommendations made by the psychogeriatric team were carried out without much delay.
Age‐related correlations in patient symptom management strategies in schizophrenia: An exploratory study
Authors: Cohen Carl I.
Published: December 2004

The role that symptom management strategies play in the remediation of schizophrenia with age has been largely neglected. The aim of this study is to examine whether there are age‐related alterations in symptom management strategies. A total of 86 schizophrenic outpatients (age range 19–69 years) were queried about management strategies for 29 symptoms. Of the nine strategies employed ‘social diversion’ was significantly associated with increased age and ‘acceptance’ and ‘fighting back’ showed positive and negative trends with increased age, respectively. These age‐associated differences in management strategies are hypothesized to represent an interaction of trial and error procedures unique to the disorder intertwined with life‐span changes.
A comparison between three psychogeriatric rating scales
Authors: Jensen Elmo , Dehlin Ove , Gustafson Lars
Published: December 2004

This study compares a new psychogeriatric rating scale, the Organic Brain Syndrome (OBS) scale, which is a combined observation and interview scale, with two other scales. Twenty‐eight elderly demented patients took part in the study. The OBS scale was compared to the Gottfries, Bråne and Steen (GBS) scale, the Mini Mental State Examination (MMSE) scale and a global rating. The correlations between OBS, GBS and MMSE were high, showing that the concurrent validity is good. The ratings of the OBS scale were independent of the patient's physical disabilities as measured by Katz's index, ie the discriminant validity was good. The analyses show similarities and differences between the clinical dimensions described in the rating scales. The OBS scale contributes unique clinical information and is a valid instrument for assessment of dementia symptoms.
Normalization of sexual behaviour in a female with dementia after treatment with cyproterone
Authors: Nadal Miguel , Allgulander Swante
Published: December 2004

Compulsive behaviours can be a feature of different psychiatric diseases but overt hypersexuality is nevertheless a rare condition in females, especially in the absence of endocrinological alterations. We present here the case of a 49‐year‐old female who, after several confusional episodes, required hospitalization first at the Psychiatry Clinic and later on at the Psychogeriatric Unit when the diagnosis of dementia of Pick's type was suspected, and who developed an overt hypersexuality manifested in the form of open and frequent masturbations. Due to the failure of conventional therapy, the antiandrogen agent cyproterone acetate was used resulting in a normalization of her sexual behaviour. No main side‐effects could be observed and the drug was withdrawn after a few months of treatment. In our opinion, the antiandrogen cyproterone should be considered in similar cases when other therapies fail.
Prediction of first episode of clinical depression in patients newly admitted to a medical long‐term care facility: Findings from a prospective study
Authors: Foster Jeffrey R. , Cataldo Janine K.
Published: December 2004

A cohort of 104 patients newly admitted to a medical long‐term care facility was studied over 1 year for evolution of depression. Seven variables that were associated with level of depression were used in discriminant function analyses. Results showed that the variables had about 90% accuracy in predicting depressed versus non‐depressed groups with good sensitivity and specificity. The variables measured: coping with admission; life satisfaction at admission; affective and non‐affective symptoms at admission; clinical health status after admission; friends in hospital after admission; and changes in affective symptoms after admission before the onset of depression.
Is caring for elderly relatives with depression as stressful as caring for those with dementia? a pilot study in melbourne
Authors: Yeatman Richard , Bennetts Kerryn , Allen Nicholas , Ames David , Flicker Leon , Waltrowicz Wendy
Published: December 2004

The 30‐item General Health questionnaire (GHQ‐30) scores of the primary carers of 31 elderly patients with depression were compared with the GHQ‐30 scores of 30 primary carers of dementia sufferers. Carers of dementia sufferers who lived with their demented relative had GHQ‐30 scores almost four times higher than those carers who lived apart from a dementia sufferer. There was no difference in the GHQ‐30 scores of carers of depressed subjects living with or apart from their affected relative. Carers of demented patients tended on average to have higher GHQ‐30 scores than carers of depressed patients, but this difference was almost entirely accounted for by the fact that more carers of demented patients lived with their ill relatives. Patient and carer age and sex and severity of patients' depression were not related to the GHQ‐30 scores of their carers.
Predictors of depressive symptoms and low self‐esteem in a follow‐up study of elderly people over 10 years
Authors: Coleman Peter , Aubin Anne , Robinson Maureen , Ivani‐Chalian Christine , Briggs Roger
Published: December 2004

We report a follow‐up study of measures of depression and self‐esteem in a sample of elderly people, 101 of whom were reinterviewed 10 years after initial assessment and 70 of these again 13 years later. The initial assessment included a wide range of social, psychological and medical measures. The results of logistic regression analysis showed the most significant predictors of the emergence of depressive symptoms and/or low self‐esteem over this period of time to be receipt of help with household tasks, a negative attitude to ageing, and percveived inactivity. High self‐esteem, was also associated with resilience against depression. Despite the close association between measures of depression and self‐esteem, further investigation into the sources of self‐esteem can provide evidence on the origins of depressive disorders.