bluuebunny/crossref_metadata_2025_split huggingface dataset:
Residential care as an alternative to long‐stay hospital: A cost‐effectiveness evaluation of two pilot projects
Authors: Knapp Martin , Cambridge Paul , Beecham Jennifer , Darton Robin , Thomason Corinne , Allen Caroline 
Published: December 2004

AbstractTwo projects were established to help elderly people with mental health problems move from continuing care hospital wards to local authority residential care homes. The projects were part of a larger programme established in the 1980s to test new policy and practice options. Each hospital resident was interviewed and assessed prior to commencing any programme of activities designed to prepare them for resettlement in the community. Data came from hospital patients themselves, from staff and from interviewer observations. Most of the people who moved from hospital were reinterviewed and reassessed approximately 9 months after discharge. The evaluation revealed that quality of life in residential homes was certainly not inferior to hospital but was less expensive. The residential homes offered more lively and psychologically pleasing environments than hospital. Residents'levels of participation were higher according to staff, and residents had more social contacts. The quality of social contacts also appeared to improve. The two projects thus provided a cost‐effective alternative to hospital for elderly people with mental health problems.
Visual evoked potential in the diagnosis of dementia in people with down syndrome
Authors: Prasher V. P. , Krishnan V. H. R. , Blake A. , Clarke D. J. , Corbett J. A. 
Published: December 2004

AbstractThe diagnosis of dementia in people with Down syndrome (DS) remains controversial. In this study DS patients who had a diagnosis of clinical dementia according to modified DSM‐III‐R criteria were assessed using the flash (P2) and pattern‐reversal (P100) visual evoked potential (VEP). Abnormal VEP recordings were apparent in both demented and non‐demented subjects. None of the demented subjects had the characteristic (P2–P100 latency difference) VEP changes reported in adults in the general population suffering from dementia. The VEP is unlikely to be a useful tool in the diagnosis of dementia in people with DS.
A double‐blind, placebo controlled, multicentre study of tacrine for alzheimer's disease
Authors: Wood Philip C. , Castleden C. Mark 
Published: December 2004

AbstractThe present study was designed to determine whether oral tacrine (tetrahydraminoacridine, THA) improves the symptoms of patients with mild to moderate Alzheimer's disease. The study was a multicentre, randomized double‐blind, placebo controlled, parallel group study with individual determination of maximum tolerated dose over a period of 12 weeks. One hundred and fifty‐four patients (93 women) aged 44–92 years (mean 75) were selected as having probable Alzheimer's disease as defined by NINCDS–ADRDA workgroup classification and a Mini‐Mental State Examination score of 10 or more. Most patients were titrated to 80 mg of tacrine per day. Tacrine improved patients in clinicians‘ global ratings and the relatives’ global rating compared to placebo (p < 0.05). Tacrine did not significantly improve the Mini‐Mental State Examination score, although as with other scores the trend favoured tacrine. There was a substantial variation in response among patients. Twelve patients in the tacrine and four in the placebo group were withdrawn from the study due to raised LFTs or adverse events. No serious sequelae resulted from these. One patient in the placebo group and two in the tacrine group died from causes which were considered unrelated to the treatment.
Factors related to admission of new patients consulting geriatric psychiatric services in montreal
Authors: Lesage Alain D. , Charron Maryse , Punti Rosita , Murphy Carole , Dorvil Henri , Charbonneau Manon , Carpentier Normand 
Published: December 2004

AbstractThe development of and the demand for geriatric psychiatric services (GPS) have increased over the past decade. Psychopathology, autonomy, physical disorders, sociodemographics, social support and caregivers' burden have all been advanced as influencing the elderly's risk of hospitalization. These factors were examined in a 1‐year prospective study of 87 new patients consulting a catchment‐area GPS. Standardized assessments were used, including both patients' and caregivers' independent measures of patients' social network. Entry points to the study were as follows: 70.1% of patients came from an outpatient clinic and 25.3% were admitted directly to psychiatric wards. Subjects were followed up 1 year after discharge or first contact. Overall, 47.1% of the sample was admitted to a higher‐supervision setting during the 1‐year follow‐up, including 20.7% of the total sample admitted to GPS wards. Multivariate logistic regression analysis indicated different factors influencing admission according to the definition of admission. Loss of autonomy was a key factor related to both psychiatric and overall admissions. Previous admission was a predictor of psychiatric admissions only. Relatives' strain and not living with spouse were predictors of overall admissions. The results indicate that functional consequences of disease (eg loss of autonomy) and resilience of relatives are key in predicting the elderly's need for greater supervision.
Erotomania in the elderly
Authors: Chlu Helen F. K. 
Published: December 2004

AbstractThe case notes of 349 Chinese patients of a psychogeriatric unit in Hong Kong were studied retrospectively and only one case of DSM‐111‐R erotomania was diagnosed. This was a 76‐year‐old widow with a delusion that a male cotenant in the old age home was in love with her. She improved after treatment with neuroleptics and the delusions subsided in 3 months. This case shows that the course of erotomania is not necessarily a chronic one and that culture may influence the expression of the disorder.
Impact of ‘open access’ to specialist services—the case of community psychogeriatrics
Authors: Macdonald A. , Goddard C. , Poynton A. 
Published: December 2004

AbstractTo compare patients referred via traditional, medical sources with those referred under an ‘open access’ policy to a community‐based multidisciplinary psychogeriatric service, we studied 1477 first referrals to the service over 58 months. General practitioners referred 45% of all patients, but 53% of all with delirium and 49% of all with depressive syndromes. Social workers referred 20% of all patients, but only 10% of all with depression; they referred 38% of all with alcohol problems and 34% of all with paranoid disorders. Ten per cent of those referred by social workers and 12% of those referred by general practitioners had no psychiatric disorder. Had the service been confined to patients referred from traditional (ie medical) sources, 463 patients with a psychiatric diagnosis would have had to await referral via these sources. There was no evidence that more inappropriate referrals are produced by ‘open access’ to this psychogeriatric service; the assessment of depression by social workers and delirium by general practitioners merits further study.
Ability of the mini‐mental state examination to discriminate diagnostic entities in a psychogeriatric population
Authors: Field Sarah J. , Jackson Henry J. , Hassett Anne M. , Pattison Pip 
Published: December 2004

AbstractThe Mini‐Mental State Examination (MMSE) is widely used in clinical practice. A standardized MMSE (SMMSE) was used to differentiate those patients with dementia or delirium from those with functional psychiatric disorders. Seventy psychogeriatric patients from Royal Park Psychiatric Hospital were interviewed. The SMMSE and the Hamilton Rating Scale for Depression (HRSD) were administered at two time points, 3 weeks apart. The study found that the SMMSE did differentiate those with dementia or delirium from those with functional psychiatric disorders. However, caution should be exercised when interpreting SMMSE results in community settings.
Differentiation between Alzheimer's disease and multi‐infarct dementia: Spect vs MR imaging
Authors: Butler Robert E. , Costa Durval C. , Greco Alina , Ell Peter J. , Katona Cornelius L. E. 
Published: December 2004

AbstractSingle photon emission computed tomography (SPECT) and magnetic resonance (MR) imaging data were obtained in 11 patients with dementia of the Alzheimer type (DAT), 11 with multi‐infarct dementia (MID) and nine elderly, healthy controls. All patients with dementia tolerated a 15‐minute SPECT scan while six patients (27%) did not tolerate the MR examination due to the long acquisition times and/or claustrophobia. Blind qualitative rating of SPECT scans differentiated correctly between dementia and controls in 90% of cases (p < 0.0001; positive predicted value of 91%) and between clinically defined DAT and MID in 77% of cases (p < 0.01; positive predicted value of 80%). It correctly identified clinical group membership (control, DAT or MID) in 71% of cases (p <0.001; predicted positive value of 94%) but failed to differentiate between DAT and MID (positive predicted value of 50%). Overall, MR imaging correctly identified clinical group membership in 61% of cases (p < 0.01). Semiquantitative SPECT data demonstrated reduced regional cerebral blood flow (rCBF) in all regions of interest (ROI) except right frontal and right anterior parietal in both DAT and MID compared with controls (p < 0.05). There was no statistically significant difference between DAT and MID subjects in rCBF in any ROI. Several correlations between rCBF and cognitive variables were found in the MID but not the DAT group. Though the sample in this study is small, our findings suggest that Tc‐99m HMPAO SPECT is a useful and practical tool in the assessment of patients with dementia. It enables the differential diagnosis of dementia and by using semiquantitative data it helps to establish the severity of disease.
An audit of the use of chest radiography in the elderly mentally ill
Authors: Brown Martin 
Published: December 2004

AbstractChest X‐rays are widely used in the investigation of patients with both functional and organic mental illness. For patients with dementia their routine use has been recommended by many authorities. However, the existing evidence to support such use is not strong. A prospective audit was performed to ascertain the yield of chest X‐rays affecting patient management in a series of consecutive admissions covering all diagnoses. The yield of unexpected findings was substantial, but few of these led to a change in medical management and hence potentially to the course of illness. Apparently significant radiological findings did not always correlate with actual physical illness. The low yield of results affecting management does not support the routine use of chest radiography in elderly mentally ill, and its use should be limited to when functional illness is refractory to treatment or when demented patients suddenly deteriorate without obvious cause.
Capacity assessments for requests to restore legal competence
Authors: Silberfeld Michel , Corber Wendy , Madigan Kevin V. , Checkland David 
Published: December 2004

AbstractWe argue that acceptance of competence as decision‐specific, together with a resultant likely increase in limited guardianship orders, will lead to an increase in requests for restoration of legal competence by those under such orders. Six central issues facing the assessor of capacity/competence in the restoration of legal competence are discussed. Suggestions are made as to how these issues can be addressed in forming a clinical judgement. The profile of 17 cases where there was a request to restore legal competence is reviewed.
Antidepressants and the elderly: Double‐blind trials 1987‐1992
Authors: Anstey Kaarin , Brodaty Henry 
Published: December 2004

AbstractWe reviewed all double‐blind antidepressant trials reported between 1987 and 1992 in samples of people aged 55 years or more with a primary diagnosis of major or clinical depression. There was an increase in the annual rate of trials conducted compared with the period from 1964 to 1986. About 27% of patients commencing trials withdrew prior to completion. Of those who completed, there was a general reduction of about 55% in scores on the Hamilton Rating Scale for Depression. No differences in efficacy between drugs were found. Newer antidepressants, particularly selective serotonin reuptake inhibitors, appeared to have fewer side‐effects, but methodological shortcomings limited interpretation of the results. Recommendations for future research are proposed.
The contribution of hypercortisolaemia to the cognitive decline of geriatric depression
Authors: Mitchell Alexander J. 
Published: December 2004

AbstractCognitive impairment in depression is well recognized but poorly understood. A subset of depressed patients exhibit a syndrome of severe neuropsychological deficits which may be partially reversible upon episode resolution. This has been called depressive pseudodementia, the dementia syndrome of depression and depression induced cognitive impairment. The epidemiology, clinical features, natural history and prognosis of this condition support the notion of an underlying organic aetiology. The most plausible neurobiological candidate involved in the pathogenesis is hyperactivity of the hypothalamo‐pituitary‐adrenal (HPA) axis. The homeostatic regulation of the HPA axis becomes increasingly vulnerable to disruption in geriatric depression and perhaps particularly in depressive dementia. Hypercortisolaemia has been correlated with cognitive impairment in depression as well as in other related psychiatric conditions. The mechanism of this abnormality may involve hippocampal dysfunction. Further longitudinal studies are needed to clarify the role of the HPA axis in the cognitive decline of depressive illness.
Clinical and psychosocial variables associated with different types of behaviour problem in new nursing home admissions
Authors: Morriss Richard K. , Rovner Barry W. , German Pearl S. 
Published: December 2004

AbstractThe behaviour problems of 451 subjects at 2 weeks after admission to eight nursing homes were recorded on the Psychogeriatric Dependency Rating Scale. Factor analysis extracted four types of behaviour problem: antisocial behaviour, motor activity, communication problems and demands. Associations between the four types of behaviour problems and demographic, psychiatric, psychosocial and physical variables were examined. Multiple linear regression revealed that the four behaviour problem factors were associated with different clinical variables and possibly different aetiologies. However, only 20% or less of the variance in behaviour problems could be explained by variables examined in the study.
Partnership nursing home care for dementia: The glasgow experience—the first 12 weeks
Authors: Lyons Donald , Cohen Mark , Henderson Tom , Walker Nick 
Published: December 2004

AbstractThe outcome of the transfer of 60 elderly patients suffering from dementia from hospital to nursing home care under a partnership contract was studied at 6 and 12 weeks following transfer. Compared with patients remaining in hospital, there was no significant difference in mortality but the nursing home patients exhibited a greater decline in functional ability and a significant excess of pressure sores. Careful planning is required to ensure that such patients do not suffer as a result of transference of care.
The relationship between cognitive function and agitation in senior day care participants
Authors: Cohen‐Mansfield Jiska , Culpepper William J. , Werner Perla 
Published: December 2004

AbstractThe relationship between cognitive impairment and functional status with agitation was assessed in 200 participants of senior day care programs. Results revealed better than 85% agreement in measures of cognitive impairment (BCRS, MMSE, physician assessment of dementia). Regression analyses showed that physically non‐aggressive and verbally aggressive behaviors were related to level of cognitive impairment (BCRS, MMSE). These results showed that physically non‐aggressive behaviors were manifested at earlier stages of dementia than physically aggressive behaviors, which were not manifested until late stages of dementia. Verbally non‐aggressive behaviors increased with severity of dementia up to moderate‐severe levels of impairment and then diminished. In contrast, verbally aggressive behaviors tended to be manifested fairly consistently across levels of dementia with a small increase at the severest levels. Findings are discussed in relation to previous findings for nursing home residents.
Age and compulsory admission
Authors: Srikumar Siva , Orrell Martin W. 
Published: December 2004

AbstractCompulsory admission is not just restricted to younger psychiatric patients. However, despite the differences in clinical presentation between younger and older adults, there has been very little research comparing different age groups. In this study, elderly and younger adult patients who had compulsory psychiatric admissions were compared according to a number of social and clinical variables. Elderly patients were less likely to have police involvement in an admission but more likely to be referred by their own GP and to live alone. The particular needs of the elderly could be reflected by better guidelines on the use of the Mental Health Act.
Convergent validity of measures of PTSD in an elderly population of former prisoners of war
Authors: Neal Leigh A. , Hill Nicholas , Hughes Julian , Middleton Aisla , Busuttil Walter 
Published: December 2004

AbstractThirty former World War II Far East prisoners of war were assessed with a structured clinical interview for PTSD based on DSM‐III‐R criteria and the results compared with the self‐report measures. Thirty per cent of the subjects fulfilled a DSM‐III‐R diagnosis of PTSD and 90% complained of at least one post traumatic intrusive or avoidant symptom. The Mississippi scale was the most accurate measure of PTSD severity (r = 0.81) and the MMPI‐PTSD subscale was the most efficient dichotomous measure of PTSD (sensitivity = 0.89 and specificity = 0.62). The avoidance subscale of the impact of event scale did not discriminate avoidant symptoms from those of intrusion. Self‐report scales for chronic PTSD used in the elderly should be interpreted with caution and require further evaluation of their validity.
Psychotic symptoms in patients with dementia
Authors: Ballard Clive , Oyebode Femi 
Published: December 2004

AbstractThe current article reviews the current state of knowledge pertaining to psychotic symptoms in patients with dementia, drawing on over 70 studies in this area. The majority of studies utilizing a purpose‐designed structured instrument have found a prevalence of psychotic symptoms in excess of 60%. The annual incidence and resolution rates are, however, considerably lower, in the region of 2%. There is little consensus about which factors are of aetiological importance, although it does seem that those with a dementia of moderate severity have the highest prevalence. Perhaps the lack of clarity in this aetiological research partly relates to the limited attention paid to phenomenology. Some suggestions about future research directions which might improve our phenomenological understanding of these conditions are made. Psychotic symptoms are associated with considerable secondary morbidity, including increased aggression, irritability and distress.
Attitudes of health care professionals towards care of the elderly
Authors: Saarela Tuula , Viukari Matti 
Published: December 2004

AbstractThe effect of a short psychogeriatrics training course for primary health care physicians, nurses and social workers on their attitudes towards care of the elderly was explored using the Snape Attitude Scale before and after the training. Participants' attitudes were not altered significantly. The most positive attitudes were found in a reference group formed by nurses specializing in psychiatry. The groups regarded physicians as having the least interest in geriatric care while social workers were felt to have the greatest willingness to care for the elderly.
Frontal lobe syndrome following herpes zoster
Authors: Tarbuck Andrew F. , Malhi Gurjhinder , Dening Thomas R. 
Published: December 2004

AbstractThe case of a 74‐year‐old woman who developed severe behavioural disturbance as part of a frontal lobe syndrome following herpes zoster is described. It is suggested that the frontal lobe deficits developed as a consequence of vascular complications of the infection.
The taps project. 21: Functional and organic comorbidity and the effect of cognitive and behavioural disability on the placement of elderly psychiatric inpatients—a whole‐hospital survey
Authors: Anderson Jeremy , Trieman Noam 
Published: December 2004

AbstractThis article reports a survey by the Team for the Assessment of Psychiatric Services (TAPS)TheTeam for the assessment of Psychiatric Services (TAPS) is a research team established in 1985 to study the proposed closures of Friern and Claybury Hospitals in North London.
of all inpatients aged 70 years or more resident in Claybury Hospital, London, for more than 12 months. Age, sex, total length of inpatient stay and type of care received were recorded for each subject, and assessments using the Mini‐Mental State Examination (MMSE) and Modified Crighton Royal Behavioural Rating Scale (MCRBRS) were performed. Of 189 inpatients who completed the assessments, 142 (75%) showed unequivocal, severe cognitive disability (MMSE ≤ 17). Patients were assigned to ‘functional’, ‘organic’ or ‘mixed’ diagnosis groups by staff report and case note review. A staff report of ‘mixed’ diagnosis missed a large number of patients who had an original diagnosis of functional psychiatric disorder plus severe measured cognitive disability. Sixty‐five per cent of patients with an original diagnosis of functional psychiatric disorder fell into this category. AFter controlling for age, sex and total length of inpatient stay, patients with a severe degree of reported behavioural problems (MCRBRS ≥ 17) were almost 23 times (95% CI 6.6–79.4) more likely to receive specialized psychogeriatric care than other patients. Severe cognitive disability was not associated with type of care received. Issues related to measurement of cognitive disability across disparate diagnostic groups are discussed.
Use of the mini‐mental state examination to determine the usefulness of subsequent cognitive assessment in moderately to severely demented subjects
Authors: Pearsall Tonya S. , O'neill Desmond , Wilcock Gordon K. 
Published: December 2004

AbstractThis study was undertaken to investigate whether it was possible to identify a ‘cutoff’ score on the Mini‐Mental State Examination (MMSE) below which further cognitive assessment would be of little benefit for research or diagnostic purposes. Evaluation of cognitive assessments in 467 subjects, aged 31–92 (mean 71.4 years), in whom an MMSE score was also available revealed, for those patients scoring ≤5 out of 30, that the majority of a further battery of tasks testing amnesia, aphasia, visuospatial ability and intellectual processing were too difficult. Half of the subjects were too severely impaired to complete 16 of the 17 tasks. When the MMSE score was 8 out of 30 or less, there were eight tasks where a minimum of 50% of patients were untestable. In summary, subjects scoring 8 or less on the MMSE are unlikely to be able to cooperate meaningfully with further cognitive assessment, using psychometric test batteries such as that currently in use in our clinic, and similar batteries.
Pregnancy delusions in elderly depressed women: A clinical feature of Cotard's syndrome?
Authors: Camus Vincent , Schmitt Laurent , Foulon Christine , Lima C. A. DeMendonça , Wertheimer J. 
Published: December 2004

AbstractFive cases of delusions of pregnancy occuring in women over the age of 64 who had major depressive episodes with mood‐congruent delusions are presented. The relation of such delusions to Cotard's syndrome is discussed.