bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consumption of psychotropic medication in the elderly: a re‐evaluation of its effect on cognitive performance
Authors: Allard Jacques , Artero Sylvaine , Ritchie Karen 
Published: October 2003

AbstractBackgroundThere have been few general population studies of the effects of psychotropic treatment on cognitive functioning in the elderly. Current evidence based on studies with numerous procedural shortenings supports the notion of the detrimental effect.ObjectivesTo examine changes in a wide range of specific cognitive abilities across time in a general population sample in order to establish a relationship between psychotropic drug use and cognitive performance, and to estimate to what extent such cognitive changes may be attributable to psychotropic use or other factors, notably age and co‐morbidity.MethodWe analysed the data from the Eugeria longitudinal study of cerebral ageing. Three hundred and seventy two subjects (263 female and 109 male) were visited at their place of residence and given a computerized cognitive examination. Depressive symptomatology and depressive episodes were defined according to ICD‐9 criterias and medication use were established. Four categories of psychotropic consumers was differentiated. Using a logistic regression model, comparisons were made between consumers and non‐consumers.ResultsA significant positive effect in chronic consumers was found on tests of secondary memory (delayed verbal recall: Odds Ratio (OR) = 1.22; 95% Confidence Intervals (CI) [1.04–1.43]; p = 0.013) and this effect is principally attributable to antidepressants with significant effects being shown for both verbal (OR = 1.59; 95%CI [1.18–2.14]; p = 0.002) and visual recall (OR = 1.51; 95%CI [1.05–2.16]; p = 0.025). No effect is found for benzodiazepines.ConclusionsContrary to the common belief that psychotropic drug use has a detrimental effect on cognitive function of elderly people, even long term use is seen to be benign. We attest to the positive effects of antidepressant therapy on secondary memory. Copyright © 2003 John Wiley & Sons, Ltd.
Clinical predictors of response to acetyl cholinesterase inhibitors: experience from routine clinical use in Newcastle
Authors: Pakrasi S. , Mukaetova‐Ladinska E. B. , McKeith I. G. , O'Brien J. T. 
Published: October 2003

AbstractBackgroundAcetyl Cholinesterase Inhibitors (AChEIs) have been in clinical use for the past five years in the UK for the symptomatic treatment of Alzheimer's disease (AD). There are few data on the patterns and predictors of response to AChEI therapy in routine clinical practice. We therefore investigated clinical variables that may distinguish between AChEI responders and non‐responders.MethodsA retrospective sample of 160 consecutive patients with dementia who were treated on clinical grounds with an AChEI was studied. Treatment response was defined in two ways: (a) A clinical response was achieved when there was no deterioration or there was an improvement on a global clinical assessment (CGI) and (b) a Mini‐Mental‐State‐Examination (MMSE) response when there was an improvement of 2 or more MMSE points.ResultsA total of 62 (45%) patients achieved an MMSE response. A diagnosis of dementia with Lewy Bodies (DLB) and Parkinson's disease+Dementia (PDD) was associated with a MMSE response, as were hallucinations, and lower MMSE scores at baseline. 125 (78%) patients achieved a CGI response for which there were no clinical predictors.ConclusionsSeverity of illness, a diagnosis of DLB and PDD, and presence of hallucinations at baseline were predictive of a MMSE response. Non‐AD dementia and severe dementia responded equally well to AChEI treatment and results of further randomised, placebo‐controlled studies are needed to clarify the role of AChEI in the treatment of these disorders. Copyright © 2003 John Wiley & Sons, Ltd.
Does integration really make a difference? A comparison of old age psychiatry services in England and Northern Ireland
Authors: Reilly S. , Challis D. , Burns A. , Hughes J. 
Published: October 2003

AbstractObjectiveThis paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements.DesignThe study employed a cross‐sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information.MeasuresA self‐administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people's services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter‐professional team working.ResultsThe integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked.ConclusionsHealth and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice‐related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services. Copyright © 2003 John Wiley & Sons, Ltd.
The efficacy and safety of ECT in depressed older adults: a literature review
Authors: van der Wurff F. B. , Stek M. L. , Hoogendijk W. J. G. , Beekman A. T. F. 
Published: October 2003

AbstractBackgroundAlthough little doubt exists among practising clinicians in old age psychiatry about the efficacy and safety of ECT in depression, opinions about acceptability differ widely. The objectives of this review were to determine the efficacy and safety of ECT based on both randomised and non‐randomised evidence in elderly with a major depressive disorder.MethodsRandomised and non‐randomised studies on efficacy and safety of ECT in elderly with and without concomitant disorders such as cerebrovascular disorders, Alzheimer's dementia, vascular dementia and Parkinson's disease were selected. Literature was systematically searched in a number of electronic databases.ResultsAlthough 121 studies were included in the review process, only four provided randomised evidence. No negative studies with respect to efficacy were found. ECT is effective in the acute treatment of late life depression. ECT is generally safe, although a number of serious complications possibly related to ECT have been described. Most of the objectives of this review could not be answered or refuted with certainty, because firm randomised evidence on the efficacy and safety of ECT in the depressed elderly is missing.ConclusionsECT is effective in the acute treatment of late life depression and is generally safe. Important questions such as the relative efficacy of ECT over antidepressants, the long‐term efficacy of ECT, morbidity and mortality related to ECT, cost‐effectiveness and the efficacy of ECT in subgroups of patients cannot be answered and need to be studied further. Copyright © 2003 John Wiley & Sons, Ltd.
The impact of religious practice and religious coping on geriatric depression
Authors: Bosworth Hayden B. , Park Kwang‐Soo , McQuoid Douglas R. , Hays Judith C. , Steffens David C. 
Published: October 2003

AbstractObjectiveBoth religiousness and social support have been shown to influence depression outcome, yet some researchers have theorized that religiousness largely reflects social support. We set out to determine the relationship of religiousness with depression outcome after considering clinical factors.MethodsElderly patients (n = 114) in the MHCRC for the Study of Depression in Late Life while undergoing treatment using a standardized algorithm were examined. Patients completed measures of public and religious practice, a modified version of Pargament's RCOPE to measure religious coping, and subjective and instrument social support measures. A geriatric psychiatrist completed the Montgomery‐Asberg Depression Rating Scale (MADRS) at baseline and six months.ResultsBoth positive and negative religious coping were related to MADRS scores in treated individuals, and positive coping was related to MADRS six months later, independent of social support measures, demographic, and clinical measures (e.g. use of electro‐convulsive therapy, number of depressed episodes). Public religious practice, but not private religious practice was independently related to MADRS scores at the time of completion of the religiousness measures. Religious coping was related to social support, but was independently related to depression outcome.ConclusionsClinicians caring for older depressives should consider inquiring about spirituality and religious coping as a way of improving depressive outcomes. Copyright © 2003 John Wiley & Sons, Ltd.
Diagnosis‐seeking at subspecialty memory clinics: trigger events
Authors: Streams Megan E. , Wackerbarth Sarah B. , Maxwell Alan 
Published: October 2003

AbstractBackgroundResearch has shown that dementia often goes unrecognized, and diagnostic assessment is often further delayed. Understanding families' decision to seek care at memory clinics is relevant to efforts to facilitate early diagnosisObjectiveTo examine the population seeking care at two memory clinics and the triggers causing caregivers to seek diagnostic assessment for a family member.MethodWe surveyed a consecutive sample of caregivers who accompanied a patient to an assessment at two university memory disorders clinics. Caregivers (n=416) described events that led them to seek a memory assessment for the patient, as well as who first suggested an assessment and diagnosis received.ResultsChanges in the patient (cognitive, personality/behavioral, physical, or unspecified) accounted for 81% of 903 trigger events reported. Nearly half of the caregivers noting specific patient changes recorded some combination, rather than cognitive changes alone. Of the 338 respondents who noted a change in the patient as a trigger, 85% specified at least one cognitive change, while 40% specified at least one personality/behavioral change. Memory loss was most frequent trigger reported, followed by disorientation and recommendations (lay or professional). Caregivers themselves and non‐specialist physicians were the most frequent sources of recommendations noted by all respondents.ConclusionA broad range of trigger events, beyond cognitive or symptomatic changes, caused caregivers to seek diagnosis at a memory clinic. Awareness of triggers significant to families may help physicians reduce the number and severity of events needed to convince caregivers a memory assessment is indicated. Copyright © 2003 John Wiley & Sons, Ltd.
Validation of a short cognitive tool for the screening of dementia in elderly people with low educational level
Authors: de Yébenes María Jesús García , Otero Angel , Zunzunegui María Victoria , Rodríguez‐Laso Angel , Sánchez‐Sánchez Fernando , Del Ser Teodoro 
Published: October 2003

AbstractAimTo validate the ‘Prueba Cognitiva de Leganés’ (PCL) as a screening tool for cognitive impairment in elderly people with little formal education.MethodsThe PCL is a simple cognitive test with 32 items that includes two scores of orientation and memory and a global score of 0–32 points. It was applied to a population sample of 527 elderly people over 70 with low educational level, who were independently diagnosed by consensus between two neurologists as having normal cognitive function, age associated cognitive decline (AACD, IPA‐OMS criteria) or dementia (DSM‐IV criteria). Individuals with severe visual or hearing defects and those who rejected the exam were excluded from the study. The PCL was validated in a sample of 375 individuals: 300 normal, 42 with AACD and 33 with dementia. The sensitivity, specificity, accuracy and likelihood ratios, as well as the ROC curves for dementia and for AACD‐dementia, were calculated. The confounding effect of sociodemographic variables was assessed by logistic regression analysis and convergent validity by partial correlations of the PCL with other cognitive tests. Inter‐rater reliability was evaluated with the intraclass correlation coefficient.ResultsThe PCL identified dementia (cut‐off ≤22) and AACD‐dementia (cut‐off ≤26), with the following diagnostic parameters, respectively: sensitivity 93.9%–80%, specificity 94.7%–84.3%, positive likelihood ratio 17.8–5.1, negative likelihood ratio 0.06–0.24, and accuracy 94.6%–83.4%. The areas under the ROC curve were 0.985 (95% Confidence Intervals (CI) 0.967–0.995) and 0.904 (95% CI: 0.870–0.932) respectively. The intraclass correlation coefficient was 0.79 (0.74–0.83).ConclusionThe PCL is a simple instrument, which is both valid and reliable, for the screening of dementia in population samples of individuals with low educational level. This instrument could be useful in primary health care. Copyright © 2003 John Wiley & Sons, Ltd.
Cognitive, psychiatric and motor response to galantamine in Parkinson's disease with dementia
Authors: Aarsland D. , Hutchinson M. , Larsen J. P. 
Published: October 2003

AbstractBackgroundCholinesterase inhibitors with additional nicotinic activity, such as galantamine, may be useful in PD patients with dementia (PDD) since stimulation of nicotinic receptors may prevent the down‐regualation that is likely to accompany cholinesterase inhibition and facilitate dopamine release in the striatum.MethodsSixteen PDD patients (six female) with onset of cognitive impairment after at least one year with parkinsonism participated in this open‐label trial of galantamine. Cognitive, psychiatric, and motor symptoms were assessed before and after 8 weeks of treatment with galantamine using unstructured clinical assessment as well as rating scales including the Mini‐Mental State Examination (MMSE), clock drawing test, verbal fluency and selected items from the Neuropsychiatric Inventory (NPI).ResultsAge (mean, SD) was 75.6 (5.2) years, duration of PD 13.4 (5.9), duration of dementia 2.1 (1.7) years, Hoehn and Yahr score was 3.8 (0.8) and baseline MMSE score was 17.7 (6.7). Side‐effects caused discontinuation in three patients, but were rare and mild in the remaining 13. Improvement of global mental symptoms was noted in eight patients, whereas worsening was reported in four. Hallucinations improved in seven of the nine patients with hallucinations before treatment. Parkinsonism improved in six patients, but a mild worsening of tremor was noted in three. Clock‐drawing improved (p = 0.016), and trends towards improvement on MMSE (p = 0.09) and verbal fluency (p = 0.16) were found.ConclusionsAlthough controlled trials are needed, the findings suggest that galantamine is useful in patients with PDD. Copyright © 2003 John Wiley & Sons, Ltd.
Stem‐completion tasks (indirect, direct inclusion and exclusion) are differently affected by equipotent doses of lorazepam and flunitrazepam
Authors: Pompéia S. , Bueno O. F. A. , Galduróz J. C. F. , Tufik S. 
Published: October 2003

AbstractThis study was designed to explore the effects on performance in stem‐completion tasks of two benzodiazepines (BZ) in equipotent doses: lorazepam, a drug that atypically disrupts perceptual priming, and flunitrazepam, a compound with standard BZ effects. The study followed a placebo‐controlled, double‐blind, parallel‐group design. Thirty‐six young and healthy subjects carried out three completion tasks at theoretical peak‐plasma concentrations of drugs: (a) indirect tasks, in which the subjects were instructed to complete stems with the first word that came to mind; (b) direct inclusion tasks/cued recall, in which the participants had to try to use words seen at study as completions; and (c) direct exclusion tasks, in which words seen at study were to be avoided. The PDP was applied to the results in the inclusion and exclusion tasks, to obtain indices of explicit/controlled (C) and implicit/automatic (A) memory. The C index was lowered by both BZs and A was equivalent in all treatments, confirming the general amnestic action of BZs. However, lorazepam led to decreases in completions in the indirect and inclusion tasks, while flunitrazepam impaired performance in the exclusion task. The qualitative differences between the drugs in their effects on performance suggest that these BZs may lead to differences in response bias. Copyright © 2003 John Wiley & Sons, Ltd.
Preliminary investigation of the association between psychotropic medication use and accidents, minor injuries and cognitive failures
Authors: Wadsworth Emma J. K. , Moss Susanna C. , Simpson Sharon A. , Smith Andrew P. 
Published: October 2003

AbstractRationalePsychotropic medication may impair psychomotor and cognitive function, and so increase accident susceptibility. However, few studies examine any association in the framework of other demographic, health and occupational factors.ObjectivesTo examine the relationship between sleeping tablets and antidepressants, and accidents, minor injuries and cognitive failures.MethodsPostal questionnaire study of 3111 individuals who participated in an earlier phase of the Bristol Stress and Health Study.ResultsSleeping tablet use was associated with accidents, minor injuries and cognitive failures both at work and outside work. Antidepressant use was associated with accidents and cognitive failures both at work and outside work. Adjusting for health, demographic and occupational factors explained many of these associations, but sleeping tablet use was independently associated with accidents (both at work and outside work), and antidepressant use with cognitive failures (outside work).ConclusionsAntidepressant and sleeping tablet use were apparently associated with accidents, minor injuries and cognitive failures. Although most of the associations could be accounted for by other factors the results suggested links between sleeping tablet use and accidents, and between antidepressant use and cognitive failures. Copyright © 2003 John Wiley & Sons, Ltd.
The relationship of changes in leptin, neuropeptide Y and reproductive hormones to antipsychotic induced weight gain
Authors: Fitzgerald Paul B. , Scaffidi Antonietta , Morris Margaret J. , de Castella Anthony R. , Kulkarni Jayashri 
Published: October 2003

AbstractObjectivesWeight gain is an important side effect of antipsychotic (AP) treatment. Weight is regulated by multiple systems, including leptin, neuropeptide Y (NPY) and gonadal steroids. The aim was to investigate whether AP‐induced weight gain was related to leptin and NPY abnormalities and whether these were associated with a disruption of gonadal steroid production.MethodsTwenty two female patients with schizophrenia receiving standard AP treatment were studied over a 3‐month period. Plasma leptin, NPY, gonadal steroids and their regulators were measured along with weight and BMI.ResultsWeight, leptin and testosterone levels increased over time. There were significant relationships between a change in oestrogen levels and both a change in NPY levels and a change in BMI. Change in BMI, weight and leptin all correlated strongly with a change in the testosterone/luteinizing hormone ratio.ConclusionsAP treatment results in increase in weight over time and this increase is accompanied by increased leptin levels. AP‐induced weight gain is also associated with disruption of the hypothalamic–pituitary–gonadal axis. Altered regulation of NPY, either through abnormal leptin control or serotonin blockade, is a possible explanation for the effects of AP medication on both weight and gonadal steroid levels. Copyright © 2003 John Wiley & Sons, Ltd.
Effect of pindolol and milnacipran versus milnacipran and placebo on plasma prolactin and adrenocorticotrophic hormone in depressed subjects
Authors: Isaac Maria B. , Isaac Michael T. 
Published: October 2003

AbstractObjectiveEvidence that pindolol accelerates the action of antidepressants has been contradictory, and it is not clear why. The present study analyses the relationship between plasma prolactin (PRL) and ACTH levels and changes in relation to a milnacipran and pindolol combination versus milnacipran plus placebo.MethodEighty depressed patients agreed to take part in a double‐blind randomized trial of milnacipran plus pindolol or placebo. Fifty‐eight of them agreed to also take measures of ACTH and PRL levels. ACTH and PRL plasma levels were estimated on days 0 and 42 of the 6‐week study. Age, gender and time of blood collection were recorded for each individual. The Montgomery–Åsberg depression rating scale (MADRS) was used to measure the response to treatment. The patients were grouped into those with higher versus lower basal ACTH levels using the median of the sample (25 ng/l).ResultsThere were statistical differences in MADRS scores between the treatment groups on day 42. There were correlations between PRL levels on days 0 and 42; age and PRL levels on day 0; time of the PRL sample and the PRL levels on day 0 and day 42; ACTH and PRL levels on day 42. Regression analysis of the 58 patients showed that on day 0, PRL levels were dependent on the ACTH plasma levels on day 0, the time of the collection of the blood sample and the age. On day 42, the PRL levels were dependent on the ACTH levels and the time of the blood collection but not on the age. Patients with lower baseline ACTH levels on day 0 displayed a better clinical outcome when taking the combination of milnacipran and pindolol as shown in the differences in MADRS on day 42. The same group of patients showed lower PRL levels on day 42.ConclusionsACTH plasma levels at baseline or screening may help to predict the response to antidepressant treatment. Copyright © 2003 John Wiley & Sons, Ltd.
Death rates from ecstasy (MDMA, MDA) and polydrug use in England and Wales 1996–2002
Authors: Schifano F. , Oyefeso A. , Corkery J. , Cobain K. , Jambert‐Gray R. , Martinotti G. , Ghodse A. H. 
Published: October 2003

AbstractThe present study reports on all deaths related to taking ecstasy (alone, or in a polydrug combination) occurring in England and Wales in the time frame August 1996–April 2002. Data presented here are based on all information recorded in the National Programme on Substance Abuse Deaths (np‐SAD) database. The np‐SAD regularly receives all information on drug related deaths in addicts and non addicts from coroners. A total of 202 ecstasy‐related fatalities occurred in the chosen time‐frame, showing a steady increase in the number of deaths each year. The ratio male:female was 4:1 and 3 of 4 victims were younger than 29. In 17% of cases ecstasy was the sole drug implicated in death and in the remaining cases a number of other drugs (mostly alcohol, cocaine, amphetamines and opiates) have been found. According to toxicology results, MDMA accounted for 86% of cases and MDA for 13% of cases; single deaths were associated with MDEA and PMA. This is the largest sample of ecstasy related deaths so far; possible explanations are given for the observed steady increase in ecstasy‐related deaths and a tentative ‘rationale’ for this polypharmacy combination is then proposed. Copyright © 2003 John Wiley & Sons, Ltd.