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Biomedical subjects

B Geiselmann

Publications and source records attributed to B Geiselmann.

17 recordsLinked to original sources
PubMed2001

Psychiatrists' diagnoses of subthreshold depression in old age: frequency and correlates.

BACKGROUND: Depressive syndromes not fulfilling the criteria for specified disorders (subthreshold depression, SD) may be clinically important. We aimed to study SD in old and very old age, in comparison with subjects with no depressive symptoms (NDS) and subjects with major depression (MD). METHODS: A community-based random sample of 516 subjects, age 70 to 100 years and over, stratified by age and sex, was examined. All participants were investigated by psychiatrists and by geriatricians independently. RESULTS: In 16.5% (N = 85) of the study subjects SD was identified. Study subjects with SD had, similarly to the subjects with MD, significantly more somatic diagnoses and used more somatic as well as psychotropic medications than the subjects with NDS. Self-ratings and observer ratings of depression indicated that SD was a milder depressive state than MD. CONCLUSIONS: Compared with MD, SD is probably a milder form of depression. The increased use of psychotropic medications indicates that at least a portion of these individuals have a disorder requiring treatment. One of the characteristics of SD is co-morbidity with somatic illnesses and physical disability.

Aged↗
PubMed2000

Ventilatory capacity and risk for dementia.

BACKGROUND: Previous studies have found a relationship between single indicators of ventilatory capacity and measures of cognitive function, but have not addressed dementia specifically. This study examined the relationship between different indicators of ventilatory capacity and dementia, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, controlling for important confounding factors. METHODS: Cross-sectional data on participants (n = 437) of the Berlin Aging Study (BASE), which are representative of former West Berlin's living population aged 70 years and older, were analyzed. Ventilatory capacity was measured by spirometry as peak expiratory flow rate (PEF-R), forced expiratory volume in 1 second (FEV-1), maximal expiratory flow at 50% of forced vital capacity (MEF50%FVC), and maximal expiratory flow at 25% of forced vital capacity (MEF25%FVC). Odds ratios (OR) for dementia associated with ventilatory capacity were obtained by logistic regression, adjusting for age, gender, education, ApoE4 status, chronic obstructive pulmonary disease, smoking, heart failure, visual and auditory functioning, grip strength, and former physical activity. RESULTS: Separate analyses for PEF-R, FEV-1, MEF50%FVC, and MEF25%FVC revealed significantly increased odds for dementia among subjects in the lowest compared with the best functioning group in ventilatory testing. The OR associated with PEF-R > or = 2 l/s was found to be 20.4 (confidence interval [CI] 5.1-82.7). For FEV-1, MEF50%FVC, and MEF25%FVC ORs of 7.5 (CI 2.1-27.9), 4.3 (CI 1.5-12.5), and 4.7 (CI 1.3-17) were obtained, respectively. CONCLUSIONS: Ventilatory capacity, measured by spirometry in a representative sample of very elderly people, is cross-sectionally related to dementia. Taking evidence from longitudinal studies into account, this result suggests that decreased respiratory function may increase the risk for dementia, independent from already known risk factors.

Aged↗
PubMed1999

[Everyday activities in depression and dementia in the elderly. Results of the Berlin study on aging].

We investigated time use of persons assigned to seven groups on the basis of psychiatric diagnoses: (a) no dementia or depression symptoms, (b) individuals with dementia symptoms but no DSM-III-R-diagnosis, (c) individuals with dementia according to DSM-III-R, (d) individuals with depression symptoms but no diagnosis, (e) individuals with depression not further specified (NFS), (f) individuals with depression according to DSM-III-R, and (g) individuals with symptoms of both dementia and depression. In general, time-use parameters were similar across the groups. As expected, however, we found differences in specific dimensions. Demented and depressed individuals differed from others with respect to the duration of passive phases and receptive leisure. Instrumental activities, active leisure, length of the waking day, and time spent alone were indicators with differential validity regarding dementia diagnoses--partly even after controlling for physical morbidity. Moreover, we were able to differentiate between dementia and depression on the basis of instrumental activities after controlling for physical morbidity.

Activities of Daily Living↗
PubMed1998

[Depression in the very elderly].

In the Berlin Aging Study (BASE) an age and gender stratified sample of 516 persons aged 70 to over 100 was assessed by means of the semi-structured GMS-A interview, the CES-D-self-rating scale and the Hamiltion-Depression-observer-rating scale. Prevalence rates were 4.8% for Major Depression, 9.1% for all DSM III-R specified depressive disorders and 26.9% of subthreshold depression was included. There was no increase in prevalence rates with age but an increase in scores on the self rating CES-D. The prevalence rates for DSM III-R specified depression in females was 10.3% and almost double that of men (5.6%). Depressed persons do not show significant cognitive impairment as measured with the MMSE in comparison to controls. As compared to the total sample higher prevalence rates of overall depression were seen in persons with multimorbidity (36.8%) and lower rates in married persons. 13.2% of the elderly talked about feeling tired with life, 7.9% had thoughts about death and 1.2% reported suicidal ideation, which was closely linked to depressive disorders. In 44% of depressed cases undertreatment was observed. Only 6% got Antidepressants but 40% benzodiazepines.

Aged↗
PubMed1998

Patient treatment insistence and medication craving in long-term low-dosage benzodiazepine prescriptions.

BACKGROUND: Long-term low-dosage dependence on benzodiazepines in traditionally explained by withdrawal symptoms. Previous research has not given much attention to reports that suggest that many patients oppose stopping benzodiazepines long before withdrawal symptoms have developed. This study investigates the scope of and factors associated with this pre-withdrawal treatment insistence. METHODS: Patients receiving long-term low-dosage benzodiazepines in primary care were asked to take a drug-holiday of at least 3 weeks. Sociodemographic, medication, morbidity and attitudinal variables were assessed in addition to the GPs' perceptions of their patients. RESULTS: Two-thirds of the patients rejected the drug-holiday proposal. Patients who refused a drug-holiday were less educated and were using a higher percentage of long-acting benzodiazepines than patients who accepted the drug-holiday proposal. Those who refused were seen by their GPs as being more complaining, harder to satisfy and less co-operative. CONCLUSIONS: These results provide evidence for drug-seeking or craving behaviour of patients who receive low-dosage benzodiazepine prescriptions. A major problem in benzodiazepine withdrawal occurs before the withdrawal programme has even begun. These data show that benzodiazepine low-dosage dependence should be considered a real form of dependence.

Aged↗
PubMed1997

In an epidemiological sample the apolipoprotein E4 allele is associated to dementia and loss of memory function only in the very old.

The apolipoprotein E4 allele has been reported to be associated with late onset Alzheimer's disease. Here we report the relation of several neuropsychological test parameters and the diagnosis of dementia to the apolipoprotein E polymorphism in an epidemiological sample of 477 subjects aged 70-103 years. The apolipoprotein E4 allele was found to be associated with reduced performance in several sensitive neuropsychological memory tests and with diagnosis of dementia only in the oldest subjects (> 84 years). The association with dementia in this population based sample was much weaker than previously described and became only significant in a logistic regression analysis when age was included in the model.

Age Factors↗
PubMed1997

[Dementia in the very elderly. Results of the Berlin Aging Study].

The frequency of dementia in very old subjects, the risk factors and the consequences of the disease were investigated in the Berlin Aging Study in an age- and gender-stratified design (ages 70-103 years, n = 516). Psychiatrists diagnosed a dementia syndrome according to DSM-III-R, applying the GMS-A and HAS interviews. The dementia frequency steeply increases until the 90-94 year group, but there is no further exponential increase for the 95+ group--instead for men the data show a plateau of dementia prevalence. Low education level turned out to be a risk factor, which explains the gender effect in a logistic regression analysis. The apolipoprotein E4 genotype was confirmed as a risk factor--however, only for the older subjects (85+). Dementia was a major reason for institutionalization. The 2-year mortality was no higher in dementia than for age-matched non-demented controls. The results gave a detailed picture of dementia in the very old. This is a prerequisite for planning facilities for psychiatric diagnostics and therapy as well as nursing care.

Aged↗
PubMed1997

Age-related cognitive decline and vision impairment affecting the detection of dementia syndrome in old age.

BACKGROUND: Currently the Mini Mental State Examination (MMSE) is widely used as a screening instrument for dementia syndrome. Diagnostic validity may be lowered in old age by normal age-related cognitive decline. Furthermore, visual impairment, occurring frequently in old age, leads to missing values which prevent an interpretation of the test result. METHOD: In the Berlin Ageing Study (n = 516, age range 70-103 years) MMSE and clinical dementia diagnosis, made by a psychiatrist investigating all subjects by the Geriatric Mental State-A and History and Aetiology Schedule interviews, were investigated independently. The MMblind was analysed, an MMSE version for vision impairment in which all items requiring image processing are omitted. The study sample is population-based; dementia cases (DSM-III-R) were excluded on the basis of the clinical diagnosis. RESULTS: Norms are reported for very old age regarding MMSE as well as MMblind. There is a considerable age effect on MMSE scores. In contrast to MMSE, sensitivity and specificity of the shorter MMblind version are not reduced. CONCLUSIONS: The considerable age effect requires the adaptation of cut-off values for old age. The blind version of the MMSE seems to be a valid instrument improving the applicability of the MMSE in old age.

Age Factors↗
PubMed1995

The impact of somatic morbidity on the Hamilton Depression Rating Scale in the very old.

The Hamilton Depression Rating Scale (HDRS) is world-wide the most important observer rating scale for depression. Many items of this scale refer to somatic symptoms of depression which cast doubt on the validity of HDRS scores in the presence of somatic comorbidity as, for example, in elderly patients. The present study, therefore, was planned to investigate the validity of the HDRS in cases in which the patient is suffering from a depressive illness together with somatic illnesses. The study population (n = 516) is a representative sample of citizens aged 70 years and older in West Berlin. They were assessed independently by internists and psychiatrists. Each positive item of the HDRS scale was then rated by the internists as to what degree it reflects somatic morbidity. Results show that multimorbidity interferes with the validity of the HDRS. There were 8 items for which more than half of all positive scores as rated by psychiatrists were seen by the internists as being possibly related to somatic disorders. Patients with corrections in the HDRS score showed a somewhat increased rate of medicines and cardiovascular diagnoses. There was less ambiguity for items with greater severity.

Aged↗
PubMed1994

Informed refusal: the patient's influence on long-term treatment.

Outpatient studies in private practices revealed that psychiatric treatments often do not meet therapeutic standards. One possible explanation for this is that the autonomous patient substantially participates in therapeutic decision-making. Basic preconditions for the therapeutic decision-making are the patient's right of self-determination, the doctor's duty to inform, and a risk-benefit assessment on the part of patient and doctor. However, ethical and possibly also legal problems may result if the physician has to be responsible for a treatment decision which was influenced by the autonomous patient, but which is less effective and less safe than the treatment he recommends to the patient. Two outpatient examples will be given where doctor and patient come to different risk-benefit assessments. Emerging ethical problems will be discussed.

Altruism↗
PubMed1994

Demented subjects' competence to consent to participate in field studies: the Berlin Ageing Study.

A violation of the right to self-determination appears to be the main individual risk for participants in the Berlin Ageing Study, which is a community based non-therapeutic study with minimal health risk. In order to minimize the risk, a procedure to test the competence to consent to participate had to be introduced. To protect the participants' right to self-determination, basic capabilities of judgment and reasoning appear to be sufficient to give informed consent in this study. As a result of testing competency, 76% of the severely demented persons had to be excluded from the study, whereas a majority of the persons with mild to moderate dementia could be included.

Aged↗
PubMed1991

Prescription and intake patterns in long-term and ultra-long-term benzodiazepine treatment in primary care practice.

Pharmacoepidemiological data show that long-term treatment accounts for a considerable part of benzodiazepine prescriptions in primary care practice. Prescription and intake patterns were, therefore, investigated in a study of 196 patients who had been treated with benzodiazepines for longer than six months by internists or general physicians in private practice. Patients were 64 years of age on average, half of them being 65 years or older. Females were in the majority (73.5%). The average duration of tranquilizer or hypnotic intake was 11.0 years, or 5.3 years for the current benzodiazepine medication. The mean daily dose was 9 mg diazepam equivalent. All benzodiazepine hypnotics and 61% of benzodiazepine tranquilizers had been prescribed solely for night-time use. Only 6% of the patients were taking benzodiazepines as single medication: on average they were taking 3.1 additional types of medication for other conditions, these being predominantly cardiac and antirheumatic/analgesic in nature. One in five patients was taking additional psychotropic medication. The compliance coefficient was on average 0.8, showing that patients did not tend to abuse benzodiazepines, with noncompliance generally being similar to noncompliance with other forms of medication.

Adult↗
PubMed1989

Benzodiazepine prescriptions and therapist non-compliance.

In an investigation of benzodiazepine (BDZ) prescription patterns, psychiatrists in private practice were found to exhibit "therapist non-compliance" with regard to general medical recommendations for BDZ use. The findings indicate that BDZ prescriptions in general (53% among patients treated with psychotropics) as well as long-term treatment of patients (37%) are quite common among private practice psychiatrists. BDZ treatment is not restricted to "minor psychiatric disorders", and contrary to the guidelines, even patients with substance dependence are not excluded. A positive association was found for BDZ use and patients' self-reported symptoms and health complaints, the number of other medications prescribed and age. In a discussion of therapist non-compliance it is proposed that this may be a consequence of a symptom-based treatment model, individual health concepts, the doctor-patient relationship and physician's cost-benefit analysis. Thus, psychiatrists' non-compliance may reflect to some extent a case-oriented treatment rationale.

Anti-Anxiety Agents↗
PubMed1981

[Decentralised treatment of multiple sclerosis by the general practitioner, district nurse and relatives (author's transl)].

Success of treatment obtained by hospital rehabilitation in patients with multiple sclerosis is frequently lost at home after a short time even if there is no new exacerbation of the disease. There is a lack of competent follow-up treatment which is largely identical with informed care and exercise, e.g. of bladder function. In severely handicapped multiple sclerosis patients investigated at home, nursing was mainly done by a family member in 88%. In order to prevent recurrence of decubital ulcers, cystopyelitis, and other handicaps, the most promising method seems training of relatives. This is best done with the help of district nurses who, however, in their turn, should be better trained in practical courses. Discharge letters from hospitals should not only be sent to the G.P. but detailed nursing instructions should also be sent to district nurses and relatives. For prevention of deterioration, home care prescribed and controlled by the G.P. and performed by relations should be attempted making use of existing legal support. Treatment of chronically handicapped patients should be presented in more detail in medical refresher courses.

Adult↗
PubMed1978

Single motor unit activity in extraocular muscles in man during fixation and saccades.

Extraocular motor unit activity was recorded electromyographically from the lateral and medial rectus muscles in eight normal subjects, together with their EOGs. Twelve motor units showed a discharge pattern characterized by regular firing during positions of fixation, a burst of saccadic "on" activity and complete silence during saccades in the "off" direction. Two other units seemed to be phasic or predominantly phasic. Interval analysis in 7 of the above 12 units during positions of fixation showed a linear rate position relationship of the units together with an extreme regularity of consecutive discharge intervals. The peak frequency of saccadic motor unit activity occurred at the onset of the burst and increased with increasing size of the saccade up to 15--20 degrees. The motor units stopped firing a few milliseconds before the onset of a saccade in the "off" direction but resumed their activity before the end of the eye movement, with an instantaneous discharge rate which was greater than the post-saccadic discharge rate. It was shown that the antagonist muscle plays an active part to end the saccade by serving as a brake.

Adolescent↗
PubMedDate not supplied

Subthreshold depression in the elderly: qualitative or quantitative distinction?

Recent studies revealed that subthreshold depression (or "subclinical" or "subsyndromal" depression) can have clinical validity because it is related to dysfunction and disability and is a risk factor for major depression. However, none of these studies focused on old age. Therefore, one aim of the psychiatric part of the multidisciplinary Berlin Aging Study (BASE) was also to detect milder forms of psychopathological syndromes, especially subthreshold depression, compared with specified forms such as major depression and dysthymia according to the DSM-III-R. The present evaluation shows that subthreshold depression can be characterized in 2 ways: firstly, as a quantitatively minor variant of depression or a depression-like state with fewer symptoms or with less continuity; and secondly, as qualitatively different from major depression with fewer suicidal thoughts or feelings of guilt or worthlessness, while worries about health and weariness of living occur with a similar frequency.

Aged↗