ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}Treatment studies of geriatric depression should focus not only on recovery and remission but also on relapse, recurrence, disability, quality of life, cognitive impairment, and exacerbation of medical morbidity. Each of these outcomes appears to have different predictors. Medical burden may influence geriatric depression, response to antidepressants, and overall disability, as well as specific conditions underlying geriatric depression (e.g., Alzheimer's disease, stroke, or parkinsonism). Measures of medical morbidity, cognitive impairment, and perhaps structural brain abnormalities should be considered as possible influences on treatment response. Studies of geriatric depression associated with specific disease entities are necessary, using instruments that avoid rating symptoms and signs that are part of a concurrent dementia syndrome or result from a medical illness. However, there should also be ratings with an “all‐inclusive” approach that disregards the origin of depressive symptoms—whether from depression, dementia, or the medical illness. This strategy will reduce the risk of underdiagnosing depression.(American Journal of Geriatric Psychiatry 1995; 3:280‐289)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}The authors assessed the consequences of stopping antipsychotic medication in nursing home patients with dementia, as mandated by federal regulations (OBRA 87). They studied three patient groups: 1) a group (“clinical judgment”) whose antipsychotics were discontinued at the discretion of their physicians; 2) a group (“empirical”) with mandated cessation of antipsychotics in the facility; and 3) a comparison group of patients not receiving medication. The primary outcome measure was the necessity to resume antipsychotic or other psychotropic medication (“failure”). Also, assessments of behavior, function, neurologic status, and cognition were performed by blind raters. The failure rate in the empirical withdrawal group was 50%, 10 times that of the clinical judgment group. Among failures, the most striking result was increased verbal and physical aggression. No failures occurred in the comparison group. There were no benefits of antipsychotic withdrawal in terms of neurological performance, functional status, or cognition.(American Journal of Geriatric Psychiatry 1995; 3:290‐299)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}It is increasingly important that assessments for dementia do not introduce bias against different cultural/language groups. In this study the authors investigated the usefulness of the Fuld Object‐Memory Evaluation (OME) as a culture‐fair screen for dementia. Because the OME uses common and familiar household objects, the authors hypothesized that it would retain minimal cultural/language bias, an issue that has been addressed in few other investigations. Results indicate that the OME has a high degree of sensitivity, 95.9%, for mildly impaired Spanish‐speaking patients and 95.5% for English‐speaking patients diagnosed with mild Alzheimer's disease. The specificity for Spanish‐speaking and English‐speaking control subjects was 100% and 96.7%, respectively. Sensitivities and specificities were reduced when only one trial of the OME was used. Sensitivity of the OME greatly exceeded that of the Folstein Mini‐Mental State Exam in this mildly impaired dementia group. Therefore the OME may serve as a brief, reliable, culture‐fair test when screening patients for possible dementia.(American Journal of Geriatric Psychiatry 1995; 3:300‐307)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}The authors assessed the use and side effects of neuroleptics (especially tardive dyskinesia [TD]) in elderly patients in Japan (N = 73; mean age 76 years, 32 men and 41 women) admitted for the first time to six psychiatric hospitals. The comparison group was 74 elderly patients with dementia admitted to nursing homes or psychiatric hospitals and not treated with neuroleptics. The mean dose of neuroleptics in the Japanese elderly patients was lower than that in Western countries; however, the prevalence of side effects was higher, possibly because of polypharmacy. The total number of psychotropic drugs correlated significantly with the number of side effects. Incidence of dyskinesia in the patients treated with neuroleptics (for a mean of 20 months) was significantly greater (44%) than that in non‐neuroleptic‐treated patients (14%). A significant risk factor for TD was long‐term neuroleptic therapy, whereas age, gender, psychiatric diagnosis, neuroleptic dose, and antiparkinsonian drug use were not risk factors.(American Journal of Geriatric Psychiatry 1995; 3:308‐316)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}The authors compared the efficacy of titrated, moderatedose and fixed, high‐dose strategies for right unilateral (RUL) electroconvulsive therapy (ECT) in a group of elderly patients. Nineteen depressed patients (mean age 76 years) were randomized to receive either fixed, high‐dose RUL ECT (n = 10) or titrated, moderate‐dose RUL ECT (n = 9). Blind Hamilton Rating Scale for Depression ratings were made before and after each treatment. Patients on the fixed, high‐dose regimen responded faster and received fewer treatments (mean = 5.7) than the titrated, moderate‐dose group (mean = 8.0). The fixed, high‐dose group received greater cumulative stimulus charge but less cumulative EEG seizure time. Final depression ratings and memory self‐ratings were similar for the two groups.(American Journal of Geriatric Psychiatry 1995; 3:317‐324)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}The authors examined the interrelationships between low vision, depression, and functioning in older adults. Seventy patients over age 65 attending a low‐vision clinic were interviewed by a geriatric nurse‐practitioner, using a structured clinical format to diagnose depression according to DSM‐III‐R criteria. In all, 38.6% of patients met criteria for major depression. There was no association between depression and severity of visual impairment, but a direct relationship was found between depression and functional impairment. Depression was the most powerful variable associated with functional impairment (adjusted R2= 0.20; P < 0.0001). Depression frequently co‐occurs with visual impairment in this population. Appropriate recognition and treatment may reduce functional disability and improve quality of life.(American Journal of Geriatric Psychiatry 1995; 3:325‐329)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}The authors used the 1982 and 1988‐89 American Psychiatric Association's Professional Activities Surveys (PAS) to describe changes in selected characteristics of United States psychiatrists treating patients age 65 and older. High geriatric case volume (HGCV) categories were considered if these exceeded 20% during the last typical full work week. The authors compared selected demographic and work‐setting variables across surveys and generated a logit multivariate regression model to predict geriatric case volume. Between 1982 and 1988‐89, the overall proportion of psychiatrist respondents reporting HGCVs increased by 98.6%, with significant increases for all demographic and most primary work‐setting categories. The analysis suggests that during the 1980s the proportion of American psychiatrists reporting HGCVs increased across a broad range of demographic and work‐setting categories, but growth in case volume in outpatient service settings lagged behind.(American Journal of Geriatric Psychiatry 1995; 3:330‐338)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}Because of the unmet mental health needs of older persons in the community, Medicare‐certified home health agencies are increasingly taking the role of health providers. Here the authors review their experience and argue that the pathology seen in home mental health care situations is similar to that seen by specialized mental health outreach teams. Also the relations between the home care team and the psychiatric consultant require skillful management even when the team are mental health specialists. The authors offer guidelines for psychiatric consultants, given the extent to which home care services survive in a volatile, cost‐contained environment.(American Journal of Geriatric Psychiatry 1995; 3:339‐347)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;{L‐End}The authors describe the establishment of a Geriatric Psychiatry Consultation‐Liaison Team (GPCLT) at a Veterans Administration Medical Center (VAMC) that previously had no organized geriatric psychiatric service. Geriatric psychiatric consultation was required by three intermediate‐care units treating older, chronically medically ill veterans with psychiatric symptoms or disorders. The GPCLT comprised a black, female geriatric psychiatrist and a white, male social worker. This combination of disciplines maximized skills, and the ethnic‐gender differences of team members addressed questions of racial tension and gender issues between patients and VAMC staff members. The compliance with recommendations of the GPCLT, ranging from 89% to 98% across the three units, its selection as a clinical site for a university‐affiliated Geriatric Psychiatry Fellowship Program, and the increase in the total hours of social work time assigned to the GPCLT documented the positive perception of the team by both the VAMC and the affiliated university. Specific recommendations are presented for consideration by other, similar settings.(American Journal of Geriatric Psychiatry 1995; 3:348‐352)

ISSN:1064-7481    

出版商:OVID    

年代:1995

数据来源: OVID