bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rating the severity of delirium: The delirium assessment scale
Authors: O'keeffe Shaun T. 
Published: December 2004

AbstractExplicit 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

AbstractThe 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

AbstractWeight 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

AbstractWe 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

AbstractPhysically 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

AbstractTo 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

AbstractSeven 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

AbstractThis 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

AbstractBased 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

AbstractWandering 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

AbstractThe 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

AbstractA 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

AbstractPart 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

AbstractA 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

AbstractThe 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

AbstractA 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

AbstractThe 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

AbstractPatients 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

AbstractThis 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

AbstractThe 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

AbstractInterpreting 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

AbstractElderly, 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

AbstractMany 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.