bluuebunny/crossref_metadata_2025 huggingface dataset:
The diagnosis and management of senile dementia in general practice: A study of 301 general practitioners in the montpellier region
Authors: Ledésert Bernard , Ritchie Karen
Published: December 2004

While in most western countries the early diagnosis and community management of dementing disorders in the elderly is very much the responsibility of the general practitioner, a number of studies suggest general practitioners to be poorly prepared for such a task. In a postal questionnaire of 301 general practitioners in the Montpellier region of France, wide variations were found in clinical practice. Of particular concern was failure to use standardized instruments in the diagnosis of cognitive deficits and the high prescription rate of inappropriate laboratory and neurological examinations. The results of the study suggest areas in which general practice procedures may be altered to reduce false positive diagnoses.
Correlation between hospital anxiety depression (HAD) scale and other measures of anxiety and depression in geriatric inpatients
Authors: Wattis John Philip , Davies Keren Nicola , Burn Wendy Katherine , McKenzie Fiona Ross , Brothwell Judith Ann
Published: December 2004

Ninety‐four patients on geriatric wards were examined as part of a study of prevalence of psychiatric disorders in elderly inpatients. A good correlation was found between depression measured on the HAD and on the Montgomery–Asberg scale. Lower, but still highly significant correlations were found between anxiety measured on the HAD and on the brief anxiety scale (BRAS), between anxiety on the self‐rating anxiety scale (SRAS) and the BRAS, and between anxiety on the HAD and the SRAS.
Misdiagnosis in dementia: Comparisons of diagnostic error rate and range of hospital investigation according to medical speciality
Authors: Ryan D. H.
Published: December 2004

Clinical diagnosis was reassessed via case note audit in 146 (73%) patients with a main diagnosis of dementia randomly selected from computer‐linked general and psychiatric hospital morbidity records of dementia patients admitted to Scottish hospitals in the Lothian region between 1968 and 1987. Twenty‐three cases (16%) failed to meet DSM‐III‐R criteria on case note review. There was no significant difference in the case ascertainment rate of psychiatrists, physicians and geriatricians. Cerebrovascular accidents, depression and acute confusional states were the main differential diagnoses in failed cases (75%). The range and cost of hospital investigation in dementia was noted and varied according to specialty with significant differences between specialties in the use of specific tests, secondary investigations and postmortem examination. Diagnostic error rate and use of secondary investigations were contrasted for the periods 1968‐84 and 1985‐87, but there was no evidence of significant change.
Predictors of increased mortality in elderly depressed patients
Authors: Burvill Peter W. , Hall Wayne D.
Published: December 2004

Five‐year standardized mortality rates for a cohort of elderly depressed patients in Perth, Western Australia, were greater than expected (M = 2.047, F = 1.658). These results were very similar to the 4‐year rates in a London study (Murphy et al., 1988), as were the causes of death. There was a significantly greater chance of being alive at the end of 5 years if, on entry to the study, the patients were: female, less than 75 years of age, had no impairment of mobility, had a diagnosis of major depression with melancholia and psychosis, and had a good recovery from the depressive illness at the end of 12 months. Impairment of mobility was the best physical status indicator of subsequent mortality. Two measures of patient's self‐assessment of physical status were as good predictors of mortality as a physician assessment of health, other than impairment of mobility.
Depression in older medical inpatients
Authors: Fenton Fred R. , Cole Martin G. , Engelsmann Frank , Mansouri Iradj
Published: December 2004

This cross‐sectional survey conducted in a university‐affiliated community hospital determines the point prevalence rates and identifies demographic, social and clinical correlates of major depressive episode (MDE) among men and women aged 65–74, 75–84, and 85 and older. Items from the Diagnostic Interview Schedule were used to diagnose major depressive episode (MDE); the Depression Status Inventory and the Depression Diagnostic Scale were used to measure its severity. Among 215 newly admitted medical inpatients, 100 men and 115 women who were at most mildly cognitively impaired, the point prevalence rates of MDE were: similar in the three age groups, 28%, 28% and 24% respectively; over twice as high among women as among men aged 65–74 and 75–84; virtually identical among men and women aged 85 and older. The intensity of the MDEs detected was on average mild. Clinically meaningful statistical associations were observed between certain psychological and clinical correlates and MDE. The psychological correlates were absence of meaning in life and premorbid personality. The clinical correlates were impaired ability to perform routine daily activities relating to self‐care and previous consultation or treatment for an emotional problem. We contrast our results with those of similar surveys, and identify the clinical and research directions we believe that this and similar work should take.
Personality changes in normal and cognitively impaired elderly: Informant reports in a community sample
Authors: Jacomb Patricia , Jorm Anthony , Christensen Helen , Mackinnon Andrew , Henderson Scott , Scott Ruth , Korten Ailsa
Published: December 2004

Personality changes are included in the DSM‐III‐R and ICD‐10 criteria for diagnosis of dementia. However, until quite recently, dementia research has emphasized cognitive decline, with little interest being shown in personality change. Recent studies looking at personality changes in dementia have usually used small clinical samples. In the study reported here, such changes have been assessed in a community sample of persons over 70 years. Information was obtained from a close relative or friend. A single dimension of personality change was found. There was a moderate but significant correlation between personality change and cognitive change. Reports of personality change were also correlated to neurotic symptoms in the informant. Personality change was unrelated to the gender of the informant, the relationship of the informant to their relative or whether they lived with their relative. Also, there was no association between personality change and the elderly subject's age, gender or level of education. Through logistic regression, the neurotic symptom score of the informant was found to be the best predictor of reported personality change. This suggests that caution may be needed in interpreting information about personality change obtained from informants.
Late onset problem drinking in older adults
Authors: Atkinson Roland M.
Published: December 2004

After the first descriptions of late onset alcoholism in the early 1970s, no systematic attention followed for more than a decade. In the past 10 years, however, that has changed, and this report seeks to summarize recently acquired knowledge about late onset problem drinking, including the author's own work on this phenomenon. The incidence of new alcoholism cases does decline with age but remains appreciable into the late sixties. Samples of ageing alcoholics in treatment show that as many as ¼ to ⅔ of cases had onset after age 60. Risk factors for late onset alcoholism include female gender, higher socioeconomic status and (in some but not all studies) life stressors, but neither psychiatric comorbidity nor positive family history of alcoholism appears to contribute in a majority of cases. Compared to longstanding alcoholics, late onset cases tend to be milder and more circumscribed, and they may also fluctuate more, with an apparently high likelihood of spontaneous remission, at least over the short term. These characteristics have implications for the use of brief and informal interventions to prevent and reduce late onset problem drinking, but also suggest caution in interpreting the response of late onset cases to treatment in uncontrolled studies. Present knowledge of late onset alcoholism is fragmentary; more systematic clinical research on its characteristics and treatment is needed.
Affective disorders related to spect patterns in alzheimer's disease: A study of emotionalism
Authors: Lebert Florence , Pasquier Florence , Steinling Marc , Petit Henri
Published: December 2004

Mood disorder in dementia of the Alzheimer type (DAT) is heterogeneous in presentation. A typical feature is emotionalism, defined by Allman (1991) as 'a heightened tendency to cry (or rarely laugh) such that crying occurs more frequently, more easily, more vigorously, or in circumstances that previously would have been out of character'. Given the evidence for the involvement of cerebral laterality in the control of emotion, we investigated the relationship between emotionalism and 99mTc‐HMPAO–SPECT patterns in 14 DAT patients. Right/left frontolateral asymmetry was significantly greater in the eight emotionalism‐positive patients than in the six emotionalism‐negative patients.
Evaluating decisions in mental capacity assessments
Authors: Silberfeld Michel
Published: December 2004

One hundred and eleven capacity assessments are described where three criteria to assess the ability to make decisions were investigated. These were ability to identify options, the ability to understand the consequences of decisions and the ability to implement decisions. The effectiveness of these criteria in differentiating capable/incapable patients supports the idea of decision‐making capacity or decision‐specific capacity. The criteria applied, nevertheless, are not sufficient in all cases to determine capacity.
Caring for an elderly person: Presictors of burden in dementia care
Authors: Grafström Margareta , Fratiglioni Laura , Winblad Bengt
Published: December 2004

In a population‐based study, the burden of caring for an elderly relative was investigated. In this article the nature of burden, reported by the relatives of the elderly, is described according to Pearlin's conceptual model. Background factors and context as a well as primary stressors were analysed. The close relatives were interviewed with a structured burden questionnaire. Among the background variables, gender of the caregiver was strongly associated with a heavy burden. Behaviour disturbances also emerged as a predictive factor of burden. Analysis of the primary stressors indicated that in the mild phase of dementia, long duration of the disease and decreased ADL capacity cause greater burden for the caregiver.
Psychological distress among workers caring for the elderly
Authors: Macpherson Robertson , Eastley Rebecca J. , Richards Hayley , Mian Ihsan Haq
Published: December 2004

The GHQ‐30 was used to assess psychological disturbance among staff working in four long‐stay wards, four homes for the elderly mentally infirm, four elderly persons' homes and four private nursing homes. Rates of disturbance were consistent across all 16 units. Rates of CGHQ caseness were low, compared with published findings from a representative UK community sample. A strong relationship was demonstrated between staff psychological disturbance and aggression from residents over the last week. Disturbed staff were more likely to perceive a lack of support at work, and to report 'shouting back' at aggressive residents. No relationship was found between rates of disturbance and a range of demographic and work‐related factors. Implications for service provision and future research are discussed.
Consumption of psychotropic drugs in nursing home residents: A prospective study in patients permanently admitted to a nursing home
Authors: Nygaard H. A. , Brudvik E. , Juvik O. B. , Pedersen W. E. , Rotevatn T. S. , Vollset Å.
Published: December 2004

In a prospective study, the routine handling of psychotropic drugs in five nursing homes in Bergen, Norway, was examined in patients who were admitted to a permanent stay. A follow‐up was performed after 3 months. Of the 83 patients who were admitted 64% consumed psychotropic drugs, at follow‐up 68%. Both at admittance and after 3 months one‐third of the residents were treated with antipsychotics. For antipsychotics alone evident changes were observed during the observation time. The consumers were more liable to be demented, restless and wandering. The study confirms the high number of residents using psychotropic drugs. It is concluded that 'overprescription' seems to be a general way of treating disruptive behaviour and not confined to nursing homes.
Disturbed behaviour in dementia sufferers: A comparison of three nursing home settings
Authors: Martin Christopher , McKenzie Stephen , Ames David
Published: December 2004

In order to determine whether a specialist psychogeriatric nursing home was fulfilling its intended role of caring for the most behaviourally disturbed dementia sufferers, 24 of its demented residents were compared with 28 demented individuals discharged from a psychiatric unit to ordinary nursing homes and 30 mobile dementia sufferers in nursing home wards of a geriatric centre. Those in the psychogeriatric nursing home showed more disturbed behaviours than those in the other two settings. Scores on the Rating Scale for Aggressive Behaviour in the Elderly were compared with degree of cognitive impairment for the first time in the literature and showed no correlation with degree of cognitive impairment for the first time in the literature and showed no correlation with congnitive performance.
Charles bonnet syndrome plus: Complex visual hallucinations of charles bonnet syndrome type in late paraphrenia
Authors: Howard Robert , Levy Raymond
Published: December 2004

Eighteen of a series of 101 late paraphrenic patients experienced complex, prolonged and repetitive visual hallucinations that resemble the characteristic experiences of individuals with the Charles Bonnet syndrome. The Charles Bonnet syndrome itself is a rare and heterogeneous disorder and the appearance of Charles Bonnet syndrome‐like hallucinations in association with functional psychoses in the elderly has been hitherto largely unrecognized. Cases were predominantly female (reflecting the overall sex ratio described in late paraphrenia), 50% had accompanying auditory hallucinations, 42% were visually impaired and only one patient had insight into the hallucinatory nature of the experiences. Late paraphrenics who experienced these phenomena had significantly lower scores on the MMSE than those who did not. The hallucinations disappeared in 53% of the patients who were treated with antipsychotic medication. Eight of the patients underwent MR brain imaging and in four of these structural abnormalities of the midbrain were found.
The use of risperidone, an atypical neuroleptic, in lewy body disease
Authors: Lee Heidi , Cooney John M. , Lawlor Brian A.
Published: December 2004

A case of senile dementia of Lewy body type (SDLBT) who developed severe and incapacitating extrapyramidal side‐effects (EPSE) following treatment with typical neuroleptics, but responded to and tolerated the new atypical neuroleptic risperidone, is described. The potential benefits of atypical neuroleptics for elderly dementia patients with concurrent psychotic and behavioural symptoms are discussed.
Should general practitioners refer more of their elderly depressed patients to psychiatric services?
Authors: Jenkins D. , Macdonald A.
Published: December 2004

As part of a prevalence and recognition study of 336 elderly attenders at GP surgeries, 65 with high depression scores (who had not been referred for specialist psychiatric services) were randomly allocated either to 9 months' treatment by a multidisciplinary community psychogeriatric team or to continued management by their GP. At follow‐up, elderly men treated by the team had done better than those cared for by their GP, but this was not statistically significant. There was no difference in outcome for elderly women, nor for the group as a whole. It is suggested that while larger studies are awaited, elderly depressed men might profitably be referred to specialist services more often than at present.
Breaking the bad news: What do psychiatrists tell patients with dementia about their illness?
Authors: Rice Karl , Warner Nick
Published: December 2004

Consultants in old age psychiatry were sent a questionnaire concerning their practice in informing dementia patients and their carers about the diagnosis and prognosis. The results showed a wide variation in practice. Carers almost invariably were told of the diagnosis. Patients with severe dementia were almost never told. There was more of a tendency to tell moderately affected sufferers but for patients with mild dementia practice was variable. There was a significant difference between all categories of dementia and the carer category for both diagnosis and prognosis giving. Informing patients of diagnosis differed from informing of prognosis only in the mild dementia category, with the tendency to give diagnosis more frequently than prognosis. Carers were also given diagnosis more frequently than prognosis. The article discusses some of the issues involved in giving information on diagnosis and prognosis to patients with dementia.
The impact of cognitive decline and workload on the costs of dementia care
Authors: Wimo Anders , Krakau Ingvar , Mattsson Bengt , Nelvig Anders
Published: December 2004

Costs of dementia care and its relation to cognitive capacity, activities of daily living (ADL) and behavioural disturbances were studied in a prospective, non‐randomized concurrent control study. The participants consisted of 173 demented patients who at inclusion were cared for in four caring alternatives: 45 in home care, 55 in day care (DC), 49 in group living (GL) and 24 institutionalized patients in Sundsvall, an industrial city in northern Sweden. The use of institutional care and costs were constant for the GL patients, independently of cognitive capacity, ADL capacity and behavioural disturbances, while institutional care and costs of the home care patients and the DC patients increased when cognitive capacity and the ADL capacity deteriorated and behavioural disturbances increased. The main conclusion is that care in GL seems to be a caring alternative in which institutionalization figures and costs are independent of measurements of the degree of dementia. The costs for the municipality and the county council regarding the DC group were lower than GL, particularly in relation to impaired cognitive function. In the sensitivity analysis, however, where ‘hotel costs’ and the value of the families' informal work were included, the costs of the DC and the home care group increased considerably.
Consultation‐liaison psychiatry: A comparison of two service models for geriatric patients
Authors: Swanwick Gregory R. J. , Lee Heidi , Clare Anthony W. , Lawlor Brian A.
Published: December 2004

In general hospitals the psychiatric morbidity in the old and frail is at least 40%. Two models for the provision of a psychiatric service to hospitalized geriatric patients were evaluated in order to identify which model most effectively fulfilled the aims of liaison psychiatry. At present, consultation type services predominate and there is some concern that an active liaison service could increase the referral rate of cases more appropriately dealt with by physicians. In this study an active liaison model was not associated with a marked increase in the referral rate, and when compared to a service with an emphasis on consultation, there was a higher degree of diagnostic accuracy by referring doctors in the liaison type model.
Does admission to a hospital geriatric psychiatry programme improve benzodiazepine and other drug use?
Authors: Williams David , Chiu Edmond , Harvey Ken
Published: December 2004

Seventy‐five consecutive patients admitted to a hospital geriatric psychiatry unit had their medication reviewed on admission and at discharge. Use of benzodiazepines declined significantly from 40% to 20% of patients, but use of other therapeutic groups showed no significant change. The number of patients taking drug combinations with potentially adverse side‐effects decreased significantly between admission (21) and discharge (7). The use of relatively contraindicated drugs also declined. Drug utilization review is a valuable technique for drawing attention to potential problems of prescribing for elderly people.
The day hospital in old age psychiatry: The case against
Authors: Fasey Christopher
Published: December 2004

The day hospital in old age psychiatry has many supporters and is widely felt to be la ‘good thing’. This article suggests there is an opposing view and that more hard data are required before the argument is resolved. Other models of care are mentioned which may be equally valid—comparison between different models is needed.
The prognosis of demented patients — one‐year follow‐up study of a population sample
Authors: Juva Kati , Sulkava Raimo , Erkinjuntti Timo , Mäkelä Matti , Valvanne Jaakko , Tilvis Reijo
Published: December 2004

Functional decline and mortality after 1‐year follow‐up of 93 demented elderly subjects from a random population sample (N =795) were studied in Helsinki, Finland. Seventeen (18%) of the demented patients died as compared to only 5% of the non‐demented subjects. The age‐adjusted risk ratio for 1‐year mortality of demented patients was 3.2 (95% confidence interval 1.8–5.6). Forty‐four per cent (26/59) of the surviving patients who were not bedridden and incontinent at the very beginning of the study suffered further impairment in the following functions: institutionalization (6/21), losing the ability to walk (5/57) or beginning of incontinence (17/30). Sixteen (21%) surviving subjects were already bedbound, incontinent and institutionalized at the beginning of the study. Age, sex or the degree of dementia did not correlate to mortality or functional decline. The number of patients who were institutionalized during the follow‐up was small. The appearance of incontinence and other recorded risk factors (age, degree of dementia or motility) did not seem to predispose to institutionalization. Subjective factors, such as caretaker's burden, probably have a great influence on the ending of home care.
The validity of the judgement of general practitioners on dementia
Authors: Wind Annet W. , Van Staveren Gerrit , Schellevis Francois G. , Jonker Cees , van Eijk Jacques Th. M.
Published: December 2004

This study focused on two aspects of the validity of the judgement of general practitioners (GPs) on dementia: criterion and construct validity. The Cambridge Mental Disorder of the Elderly Examination (CAMDEX) was used as the gold standard to assess the specificity and sensitivity of the GP judgement. Construct validity was studied by comparing patient characteristics that were hypothesized to predict the GP judgement by predictive variables from our data, using logistic regression analysis. In addition, the patient characteristics that predicted a ‘falsel positive’ or ‘falsel negative’ GP judgement were determined. Thirty‐six GPs participated in the study, as well as 475 community‐dwelling patients. The overall agreement between CAMDEX diagnosis and GP judgement was 72%. The sensitivity and speciticity of the GP judgement in making the distinction between ‘normal cognitive functioning + minimall dementia’ versus ‘mild + moderate + severel dementia’ were 52% and 94% respectively. Patient characteristics that predicted the GP judgement on dementia were: age, sex, cognitive functioning, IADL functioning (Instrumental Activities of Daily Living) and memory complaints. All these characteristics, except sex, were hypothesized to do so. Patient characteristics predicting a ‘falsel positive’ or a ‘falsel negative’ GP judgement were cognitive and IADL functioning. Both groups of patients (‘overldiagnosed’ and‘ missed’ by the GP) belong to the in‐between group with some impaired functioning. The finding that impaired IADL functioning is so important in the GP's judgement reflects the significance of dementia diagnosis in general practice: a starting point for adequate care.
Rating the severity of delirium: The delirium assessment scale
Authors: O'keeffe Shaun T.
Published: December 2004

Explicit operational definitions of the DSM‐3 criteria for delirium have recently been published. In this study, the reliability of the Delirium Assessment Scale (DAS), which uses the operationalized criteria to determine the severity of delirium symptoms, was examined. Three independent assessors examined four groups of patients —patients with delirium, patients with delirium and dementia, patients with dementia alone and patients without cognitive impairment. Sensitivity (83–88%) and specificity (79–88%) of the operationalized definitions for the diagnosis of delirium were high. Satisfactory interrater agreement was obtained for all individual symptoms of the DAS (kappa = 0.66–0.99). These results suggest that the DAS may be suitable for monitoring the severity of delirium; prospective studies are required to confirm this hypothesis.
The effectiveness of real versus simulated electroconvulsive therapy in depressed elderly patients
Authors: O'Leary Denis , Gill David , Gregory Susan , Shawcross Charles
Published: December 2004

The results of the Nottingham electroconvulsive therapy (ECT) trial were examined to compare the response of patients aged 60 and over to real versus simulated ECT. The outcome of patients given real compared to simulated ECT was significantly better immediately after six study treatments. Unilateral ECT was an effective as bilateral treatment. The small number of patients studied did not allow for definitive conclusions on whether patients responded sooner to bilateral relative to unilateral treatment.
Weight loss in alzheimer's disease
Authors: Seth Ram. V.
Published: December 2004

Weight loss is commonly observed in patients with Alzheimer's disease and is an accepted symptom of the clinical diagnostic criteria in current use. It is, however, unclear as to whether disease or dietetic factors are responsible for the causation of weight loss. Difficulty also arises due to variability in clinical diagnostic criteria used in defining Alzheimer's disease and clinical heterogeneity with respect to weight loss. This review examines the evidence available for weight loss in Alzheimer's disease and the possible explanations for this.
Factor structure of the geriatric depression scale in a cohort of depressed nursing home residents
Authors: Abraham Ivo L. , Wofford Amy B. , Lichtenberg Peter A. , Holroyd Suzanne
Published: December 2004

We examined factor structures of the 30‐item Geriatric Depression Scale in a sample of depressed nursing home residents at various levels of cognitive functioning (N=917; observation‐to‐variable ratio 30.6:1). Using principal components analysis and orthogonal varimax rotation, a six‐factor structure involving 26 of the 30 items was derived. This solution, which explained 55.1% of the variance, consisted of the following factors: life dissatisfaction, dysphoria, hopelessness/decreased self‐attitude, rumination/anxiety, social withdrawal/decreased motivation and decreased cognition. This factor solution shows that a screening test for depression like the GDS may be able to make stable and independent distinctions between various dimensions associated with depressed mood in nursing home residents. The factors derived map well onto commonly recognized dimensions of depressed mood in frail older adults residing in long‐term care facilities. The proposed six‐factor solution offers a stable, intuitively sound and statistically supported framework for differentiation of depressive screening data into independent dimensions. This, in turn, offers opportunities for clinical differentiation in both practice and research efforts using the GDS.
Diagnosis of psychiatric disorder in elderly general and geriatric hospital patients: Agecat and dsm‐III‐r compared
Authors: Ames David , Flynn Eleanor , Tuckwell Virginia , Harrigan Susan
Published: December 2004

Physically ill elderly patients (N= 236) in a geriatric and a general hospital were interviewed with the Geriatric Mental State (GMS) schedule. Psychiatric diagnoses made by the computer programme ‘AGECAT’ were compared with those made by a psychiatrist who applied DSM‐III‐R diagnostic criteria to the GMS data. Overall kappa for all diagnostic groups was 0.78. Agreement was excellent for organic diagnoses and good for depression. GMS‐AGECAT can be used with confidence to detect common psychiatric disorders in physically ill elderly general and geriatric hospital patients.
Long‐term effects of tacrine in alzheimer's disease: An open study
Authors: Eagger Sarah A. , Richards Marcus , Levy Raymond
Published: December 2004

To study the efficacy and safety of prolonged tacrine administration, we monitored 41 patients meeting NINCDS–ADRDA criteria for probable Alzheimer's disease while taking tacrine on an open basis for a period of up to 192 weeks. Dependent variables were the Abbreviated Mental Test Score (AMTS) and aspartate transaminase levels (AST) as a measure of liver function which was tested every 2 weeks at first and at less frequent intervals thereafter, the 10‐week measure being taken as an index of long‐term liver function. Survival analysis revealed that the median time for the AMTS score to decline from its level at the open label baseline to at least one point below on two successive occasions was 91.5 weeks (range 20–190 weeks). Fifteen patients showed liver function abnormalities during tacrine administration but these abnormalities resolved following reduction of the dose in all but two patients. We conclude that tacrine may temporarily delay the progression of symptoms of Alzheimer's disease and that administration of this drug can safely be prolonged with appropriate clinical supervision. These results may help to guide the clinical use of tacrine now that this drug has been licensed in some countries and is under consideration in others.
The organic and psychological antecedents of delusional jealousy in old age
Authors: Breitner Barbara C. C. , Anderson David N.
Published: December 2004

Seven consecutive cases of delusional jealousy presenting in old age are described with particular reference to possible aetiological factors. It seems most commonly associated with organic psychosyndromes often accompanied by visual hallucinations of a sexual nature. Organic disease rendering the patient housebound, disparity in age and health between patient and spouse and previous experience of infidelity were common antecedents. These may represent aetiological factors of particular significance to elderly populations.
Providing a community psychogeriatric service: Models of community psychiatric nursing provision in a single health district
Authors: Junaid Ola , Bruce Janet M.
Published: December 2004

This study describes the provision of community psychiatric nurses (CPNs) within a single health authority. Nottingham has four specialist psychogeriatric teams. We found wide variation in the caseload per CPN from 25 to 70 per WTE. There was less variation in the casemix of the various CPN teams. The degree of specialist activity provided by individual CPNs within teams varied. The degree of supervision varied from formal weekly 2‐hour sessions to informal ad hoc sessions only. The various models of providing CPN services have important resource implications. The full implementation of the 1990 NHS and Community Care Act on April 1, 1993 has significant consequences for community care. It is therefore important to determine the most effective and efficient models of care.
Dementia sufferers living at home
Authors: Wenger G. Clare
Published: December 2004

Based on a subsample of 61 cases of dementia in an intensive interview study conducted in Liverpool, this article looks at the availability of family care, the characteristics of carers, the problems they face and the service support they receive. The findings confirm those of earlier studies: only two‐thirds of dementia sufferers living in the community have identifiable carers; the average age of carers was 65; dementia cases demonstrated a high level of dependency and need for supervision; and the level of input of domiciliary services was low. It was also found that a substantial proportion of sufferers live alone but most are not without supporters. GPs are identified as the key professionals who act as gatekeepers to other services. It is suggested that presently available services are inappropriate for some carers and that packages of care and support need to be flexible and better tailored to carers' needs.
Wandering: A short report on coping strategies adopted by informal carers
Authors: Dodds Penny
Published: December 2004

Wandering is common in people with dementia. It is one of the behaviours that unpaid carers who are relatives find most difficult to cope with when caring for people with dementia at home. Six carers were interviewed using a descriptive typology of wandering devised by Hope and Fairburn (1990). The aim of the study was to establish the types of wandering behaviour carers experienced, how they dealt with this behaviour and what they did to modify it.
Factors associated with recovery and recurrence of depression in older people: A prospective study
Authors: Green B. H. , Copeland J. R. M. , Dewey M. E. , Sharma V. , Davidson I. A.
Published: December 2004

The Liverpool Continuing Health in the Community Study has followed up 1070 elderly community subjects over 6 years. In the first year 123 subjects had case‐level depression. Three years later 49 (39.8%) of the previously depressed were recovered, 33 (26.8%) were depressed, 16 (13%) were not available for interview and 25 (20.3%) were dead. This study looks at factors associated with the 3‐year outcome of patients who were depressed at year 0. Two outcome groups that were compared were a recovered depression group and a recurrent/persistent depression group. The factors that were significantly associated with a recurrence of depression (or persistent depression) at year 3 were bereavement of a close figure in the 6 months before interview, loneliness and life dissatisfaction at year 3. A variety of traditional risk factors for depression (including age, marital status, physical ill‐health and incapacity) failed to attain significance in predicting recurrent or persistent depression. When combined, both recovered and recurrently depressed groups at year 3 had significantly higher levels of pain and a higher number of serious upsets in the past 6 months and 6 weeks compared to a compared to a control group. The depressed at year 0 were more likely to have entered more dependent forms of accommodation by year 3.
Elderly patients and the Mental Health Act 1983
Authors: Gilmore C. , Wood G. C. , Rigby J. C.
Published: December 2004

A retrospective casenote review was performed on all patients over 65 years of age in one health district who were detained under the Mental Health Act 1983 during the first 6 years of its operation. There were 132 episodes of detention affecting 120 patients. Fifty‐three percent were for organic illness and 47% for functional illness. The organically ill were detained most commonly because the carer was no longer able to cope or, for those living alone, because of self‐neglect. The functionally ill were most commonly detained in the interests of their health only. The majority (52/64) of patients with dementia were not discharged to their previous address after being detained, most of these (29/64) being discharged to residential care. Twenty‐seven percent of the whole sample died within a year of being detained, a rate higher than that in the general population. Only nine tribunals were held in the study period.
Hyponatraemia and selective serotonin reuptake inhibitors
Authors: Ball C. J. , Herzberg J.
Published: December 2004

Part 1 describes the case of a 74‐year‐old woman who experienced a worsening of her psychiatric condition shortly after commencing fluoxetine and was found to have a low serum sodium level. The clinical features of hyponatraemia and its causes are reviewed. Part 2 reviews the reports of hyponatraemia and the selective serotonin reuptake inhibitors (SSRIs) and considers the variation in reports between the different SSRIs. Measurement of a patient's electrolytes is recommended if there is a rapid decline in mental state having started on an SSRI.
Referrals from general practitioners to old age psychiatrists
Authors: Brown Martin T. , Trotter Carol A.
Published: December 2004

A retrospective audit of 209 consecutive general practitioner referrals to an old age psychiatry service was performed to examine the quality of information available at the time of assessment, the diagnostic agreement and the differences between letter and telephone referrals. The information in telephone referrals was less complete, particularly for details of medical history, physical examination and investigations. However, diagnostic agreement was better for telephone than letter referrals. Overall use of cognitive function testing was low and was associated with misdiagnosis between functional and organic illness. In addition, a substantial number of cases of depressive illness were misdiagnosed as anxiety disorders or other functional illnesses. Our study suggests the need for clearer guidelines for referral procedures and continuing efforts to improve communication between general practitioners and old age psychiatrists.
A new performance test of adaptive cognitive functioning: The Medication Management (MM) test
Authors: Gurland Barry J. , Cross Peter , Chen Jiming , Wilder David E. , Pine Zachary M. , Lantigua Rafael A. , Fulmer Terry
Published: December 2004

The Medication Management (MM) Test is a new technique for measuring high‐level adaptive functioning in early dementia. Scoring is based on direct observation of the subject's performance on a structured task, simulating calculations and manipulations involved in the self‐administration of medications. The equipment is lightweight, small and portable. Procedures are brief and readily administered with little training. It is congruent with a general health inquiry and not threatening to the subject's self‐image. The sensitivies and specificities with respect to criterion diagnosis of dementia are as good as five widely used brief cognitive screens, and hold up well in early cases. The scores are not biased by gender, culture or setting; and are less biased by age and education than are conventional cognitive screens.
Interpreting subject and informant reports of function in screening for dementia
Authors: Wilder David E. , Gurland Barry J. , Chen Jiming , Lantigua Rafael A. , Killeffer Eloise H. P. , Katz Sidney , Encarnación Priscilla
Published: December 2004

A related article showed that five widely used screens for dementia predicted criterion diagnosis well with extreme scores, but misclassified many persons when screen scores were intermediate (borderzone). In this article, based on representative samples of community elders from the North Manhattan Aging Project, information on the subject's functioning was added to intermediate dementia screen scores and found to increase specificity, with sensitivity held constant. Informant reports on the subject's functioning predicted criterion diagnosis somewhat better than did the subject's self‐report of functioning.
What is the clinical prevalence of lewy body dementia?
Authors: Shergill Sukhwinder , Mullan Eleanor , D'ath Penny , Katona Cornelius
Published: December 2004

The reported prevalence of Lewy body dementia (LBD) has varied from 12% to 20% in postmortem series. Such series may not be representative of the dementia population as a whole. We have attempted to determine the prevalence of LBD in patients referred to a district general hospital with a diagnosis of dementia. The case notes of a consecutive series of patients with a clinical diagnosis referred to the care of two consultants in old age psychiatry over a period of 1 year (N= 114) were analysed using a checklist incorporating the items of the criteria proposed by McKeith and by Byrne for the in vivo diagnosis of LBD. The analysis was repeated for the subgroup (N = 76) fulfilling ICD 10 criteria for Alzheimer's disease. The prevalence of LBD was 26.3% according to McKeith criteria, 7% according to Byrne probable and 16.6% according to Byrne possible criteria. There were, however, considerable disagreements between different criteria. The frequencies of individual clinical features within subjects fulfilling and not fulfilling LBD were reviewed. Logistic regression analysis revealed the main clinical features capable of differentiation between LBD and other dementias were: presence of visual or auditory hallucinations; extrapyramidal features or neuroleptic sensitivity syndrome; fluctuating pattern of clinical features over a long period of time (McKeith criteria); and presence of classical Parkinsonism with simulataneous or earlier onset of dementia (Byrne criteria). The results were essentially similar in the Alzheimer's disease subsample. A significant proportion of patients with dementia referred to an old age psychiatry service thus fulfil in vivo criteria for LBD. The variation in frequency of diagnosis of LBD by the different criteria suggests that these clinical criteria may need revising.
Continous screaming controlled by electroconvulsive therapy: A case study
Authors: Snowdon John , Meehan Tom , Halpin Rohnda
Published: December 2004

Patients in long‐term care who scream continuously or continually cause considerable distress to other residents and staff. It is suggested that many such patients (whether demented or not) are depressed. However, antidepressants, ranquillizers and behavioural management techniques often fail to control the screaming. This article documents he affectiveness of electroconvulsive therapy (ECT) in the case of a 69‐year‐old woman with mild mental retardation, who had a past history and current evidence of depressive symptoms and who screamed for increasingly prolonged periods during the 4 months perior to ECT. It is recommended that use of ECT be considered in cases of elderly people who scream incessantly, especially if they might be depressed.
Cotard's syndrome in the elderly: Historical and clinical aspects
Authors: Luque R. , Berrios G. E.
Published: December 2004

This article explores the conceptual construction of Cotard's syndrome and includes an analysis of 100 cases of which 20 were over 65. Jules Cotard took the view that délire des négations was only a subtype of depressive illness characterized by sadness, guilt, marked anxiety, suicidal behaviour, insensitivity to pain, and delusions of negation, damnation and enormity. Soon after his death, however, a debate ensued as to whether what he had described was specific to melancholia or could be found associated with other psychoses. This view predominated for more than 80 years. Currently, and despite the fact that the French term déAlire means more than ‘delusion’, some authors use ‘Cotard's delusion’ to refer to the isolated of ‘being dead’. From clinical and evolutionary perspectives, it is unclear why an isolated delusion should merit (as some have suggested) a special brain location. Analysis of the cases so far reported suggests that it is only in the elderly that Cotard's syndrome tends to acquire its clinical completeness. There is no evidence, however, that its presence is a function of disease ‘severity’.
The effects of relocation on elderly people with dementia and their nursing staff
Authors: McAuslane Louise , Sperlinger David
Published: December 2004

The effects of relocating 19 patients with dementia and their nursing staff from an old long‐stay hospital ward to a community nursing home were evaluated. Compared with patients who were remaining in hospital, those relocated patients who were still alive at the time of follow‐up showed no evidence of changes in behavioural dependency or the number of problem behaviours. Nursing staff who were being moved, compared to their colleagues, showed more dissatisfaction with their work in the period before the move. Moving patients and staff together may have helped to minimize the impact of the move on the patients, but this study draws attention to the importance of providing support for staff undergoing such changes.
Traffic lights: Extracting order from the chaos of long‐term care
Authors: Tomenson Barbara , Benbow Susan M. , Jolley David J.
Published: December 2004

Interpreting data on the balance and capacity of long‐term care facilities within districts and their relationship to population ‘need’ has been difficult because of unmonitored cross‐boundary flow, particularly within the independent sector. A simple banding technique is described which distinguishes likely importer and exporter districts. Modest provision of long‐stay hospital care is shown to be associated with less use of rest/nursing home care.
Depression and driving in the elderly
Authors: Rubinsztein Judy , Lawton Claire Alison
Published: December 2004

Elderly, depressed patients have particular problems which may hamper their ability to drive a motor car safely. Attention and psychomotor functioning are important for safe driving. These factors are commonly impaired in depression. In addition, age‐related decreases in these functions have been shown. The elderly often have other disabilities which may hamper driving, for example poor vision and reduced strength. All these factors may be cumulative and need to be considered by the doctor advising an elderly depressed patient on their ability to drive. These issues are highlighted in this article using two case histories of elderly patients involved in motor car crashes who were depressed.
The impact of home assessment on depression in the elderly: A clinical trial
Authors: Cole Martin G. , Rochon Denise T. , Engelsmann Frank , Ducic Danka
Published: December 2004

Many consider home assessment important to the evaluation and management of elderly patients with mental disorders but no controlled studies of the impact of this activity have been reported. Thus, we conducted a clinical trial to determine if home assessment was more effective than clinic assessment in eliciting useful clinical information and in reducing depression, anxiety, functional disability and social isolation among elderly depressed patients referred to an outpatient clinic. Thirty‐two patients aged 65 or older who scored 16 or more on the depression subscale of the Symptom Checklist (SCL‐90) and 4 or less on the Short Portable Mental Status Questionnaire (SPMSQ) and who consented to participate were enrolled in the trial: 15 were randomly allocated to the home assessment group and 17 to the clinic assessment group. Patients in the home assessment group were evaluated at home by a psychiatrist. Cases were assessed on enrolment and 4, 8 and 12 weeks later using five measures: SPMSQ, SCL‐42, Older Americans Research and Service Center Instrument (OARS, Activities of Daily Living and Social Resources Scales) and Evaluation of Change Scales (ECS). There were no significant differences between home and clinic assessment groups in useful clinical information elicited. There were significant improvements over time on the SPMSQ, SCL‐42, Social Resources and ECS but there were no significant differences in improvement of any outcome measures between the groups. Thus, we failed to prove that home assessment improved the assessment or the outcome of the depressed, cognitively intact, functionally independent, moderately socially isolated elderly patients included in this study.