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BURNS, ALISTAIR; PERRY, ELAINE K.; McKEITH, IAN
doi: 10.1002/(SICI)1099-1166(199609)11:9<765::AID-GPS378>3.0.CO;2-5pmid: N/A
FERNANDEZ, ANTONY; LICHTSHEIN, GIL; VIEWEG, W. VICTOR R.; WINFREY, CHARLES J.
doi: 10.1002/(SICI)1099-1166(199609)11:9<773::AID-GPS387>3.0.CO;2-Cpmid: N/A
The Charles Bonnet syndrome comprises complex vivid visual hallucinations without significant psychopathology or disturbed consciousness and has been known for several hundred years. A consensus is lacking whether eye and brain disease are necessary or exclusionary criteria for this syndrome. We describe the recent onset of complex and vivid visual hallucinations in a 73‐year‐old man with macular degeneration and a history of recurrent major depression. We discuss ophthalmologic and radiographic findings in the context of syndrome cause.
doi: 10.1002/(SICI)1099-1166(199609)11:9<779::AID-GPS388>3.0.CO;2-Spmid: N/A
‘Impaired judgement’ remains a diagnostic (and predictive) criterion for delirium, dementia and substance‐related disorders, and yet its diagnosis and measurement are hampered by the absence of an operational definition. Most of the important research into judgement as a psychological function has been carried out in developmental and industrial psychology, in the experimental analysis of perception, medical diagnosis and legal decision‐making. Models generated in these fields, although important, are only tangentially relevant to ‘impaired judgement’ as it is met with in clinical practice. This article explores some models of judgement and their application to dementia. It concludes that judgement is not a unitary function but a composite of subroutines. Hence, both low‐ and high‐level analyses are required: the former to explore aetiology, differential diagnosis and treatment, the latter for the assessment of psychosocial competence. A model for the understanding of judgement is also suggested.
JUNAID, OLA; PAGE, KIM; BLAGDEN, KAREN; McCAULEY, PATRICIA; BISWAS, ASIT; JONES, ROB
doi: 10.1002/(SICI)1099-1166(199609)11:9<787::AID-GPS375>3.0.CO;2-6pmid: N/A
This study examines the impact of the National Health Service (NHS) and Community Care Act on the discharge of patients from inpatient psychogeriatric wards in Nottingham. All inpatients discharged from five psychogeriatric acute assessment wards between April 1 and September 30, 1993 were included in the study. The dependency of each patient was assessed using the balance of care method and relationships between dependency and destination at discharge were examined. The dependency status of patients discharged between April 1993 and September 1993 was compared with the dependency and destination at discharge of all inpatients admitted during the corresponding period in the previous year. There was a larger proportion of high‐dependency patients admitted in 1993 than in 1992. There was no difference between the two periods in the median length of stay. No association was found between length of stay and dependency, nor between dependency status and destination at discharge. The first 6 months of the implementation of the Act has had negligible impact on discharge activity in these wards as measured by length of stay and destination at discharge.
GUPTA, KAMAL; COUPLAND, LINDI; FOTTRELL, EAMONN
doi: 10.1002/(SICI)1099-1166(199609)11:9<795::AID-GPS377>3.0.CO;2-5pmid: N/A
This article presents findings from the first 2 years of a community‐based multidisciplinary open access service in an urban area. Eleven hundred and twenty‐one referrals were received for 971 patients. Twenty‐three per cent of all community referrals were made by non‐traditional agencies, of which 90% were found to suffer from a formal mental disorder. For the whole sample, dementia (40.6%) and depression (19.5%) were the most common diagnoses and social workers referred proportionately fewer patients suffering with depression (7.8%). The mean length of hospital stay reduced from 87.22 days to 58.25 days over a 3‐year period. There was an increase in readmission rates and the bed occupancy remained the same (approximately 94%) in spite of a 25% reduction in available bed days. Both GPs and patients expressed satisfaction with the services provided.
AGARWAL, MANOJ R.; FERRAN, JOSE; OST, KATHERINE; WILSON, KENNETH C. M.
doi: 10.1002/(SICI)1099-1166(199609)11:9<801::AID-GPS379>3.0.CO;2-Hpmid: 11656762
The Law Commission has recently proposed a legal test of capacity to consent to treatment. Consent to treatment in phase three trials in Alzheimer's disease is usually obtained from both the subject and a carer or next of kin. This article examines the relevance of the Law Commission recommendations in accessing informed consent from early dementia sufferers and their carers subjected to a double‐blind, placebo‐controlled trial of a potentially therapeutic agent. A total of 15 subjects were administered questionnaires to determine whether they fulfilled the criteria (as laid down by the Law Commission) for capacity to give informed consent. Carers were given a similar questionnaire to assess their understanding of subjects’ capacity to consent and to assess whether consent was a ‘true choice’. None of the subjects fulfilled all the recommended criteria. Four of the subjects probably did not exercise an ‘independent will’ to give informed consent and therefore failed the ‘true choice’ test. Is a single ‘test’ for informed consent, with stringent criteria, likely to impede future research activity in dementia patients? The role and involvement of carers in the decision‐making process need to be considered so that subjects are not unnecessarily excluded.
BAILLON, SARAH; NEVILLE, PETER; BROOME, COLIN
doi: 10.1002/(SICI)1099-1166(199609)11:9<807::AID-GPS383>3.0.CO;2-Gpmid: N/A
Members of community mental health teams for the elderly (CMHTE), officers in local authority social services residential homes for the elderly (Part III homes) and GPs in Leicestershire were sent questionnaires regarding contact and the relationship between CMHTE and Part III homes. There was general agreement between the three groups on the role of CMHTE members in the homes and the benefits of regular liaison involvement of a team member in a home. There was a high level of agreement for open access to CMHTE from Part III home officers by all three groups surveyed.
doi: 10.1002/(SICI)1099-1166(199609)11:9<813::AID-GPS386>3.0.CO;2-Ipmid: N/A
Day care services are now widely used by people with dementia. Research on day care has focused on benefits to caregivers. The impact of day care attendance on the person with dementia has been relatively neglected. Caregivers of new attenders at a dementia‐specific day centre were asked to describe any change noted in their relative since attendance at the day centre had commenced. Forty‐two per cent of new attenders included in the study showed a marked improvement in mood and/or behaviour, attributed by caregivers to day centre attendance, which was maintained in most cases 9 months after initial attendance. All those showing a marked improvement were female. There was a trend for day care responders to live alone though this failed to reach significance at the 5% level. Other factors such as age, degree of cognitive impairment, level of dependency and behavioural disturbance and frequency of day care attendance did not differentiate responders from non‐responders. However, female responders tended to have less cognitive impairment than female non‐responders. Although the number of subjects in the study is small, the findings have implications for service provision and may indicate directions for future research.
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