Biomedical subjects
Publications and source records attributed to D Luchins.
A case study of a 100-year-old patient with visual hallucinations and visual impairment is presented. The patient was fit with optical aids in an effort to reduce the hallucinations, operating on the "phantom vision" theory, which postulates that visual hallucinations associated with visual impairment result from the brain's attempt to "fill in" for compromised visual input.
OBJECTIVES: To determine the prevalence of grief and bereavement services in nursing homes. To highlight the importance of grief and bereavement as provided in the Medicare hospice benefit for the end-stage Alzheimer's Disease (AD) patient and family residing in long-term care facilities. DESIGN: Telephone survey of nursing homes. PARTICIPANTS: One hundred twenty-one nursing homes in the Lower Peninsula of the state of Michigan. MEASUREMENTS: The facilities were asked questions about on-site grief and bereavement services, services routinely offered by licensed hospice agencies. RESULTS: Fifty-five percent of the homes sent sympathy cards after the patients death. Ninety-nine percent of the facilities surveyed did not provide materials to the family or primary caregiver on the grieving process or bereavement after the death. None of the facilities sent a letter after the patients death informing them of local, community or on-site bereavement support group meetings. Seventy-six percent of the homes were not able to offer a referral to a counseling or psychiatric professional when bereavement intervention was deemed appropriate. Fifty-four percent of the homes usually went to the funeral home or the funeral of a patient who died it their facility. Ninety-eight percent of the nursing homes neither visited, made phone calls, nor provided written communication (i.e., bereavement newsletter) to the family members after the patients death. CONCLUSION: The study demonstrated few grief and bereavement services for families of patients residing in long-term care facilities. Because grief and bereavement is part of the career of most Alzheimer's caregivers, access to the Medicare hospice benefit should be encouraged for families of patients with end-stage Alzheimer's Disease residing in nursing facilities.
Onset of visual hallucinations in elderly individuals is a widespread problem with an elusive etiology. Many patients with this problem have visual and cognitive deficits. Intervention with optical aids has not been investigated as a means of treating these hallucinations. The authors report 3 cases in which optical aids were evaluated for efficacy in reducing frequency of visual hallucinations in elderly patients with dementia and visual deficits.
To determine the correlates of burnout, 47 employees of a state psychiatric hospital completed measures of burnout, collegial support, prolonged anxiety, physical health, and job attitude. Results showed that burnout was associated positively with anxiety, frequency of illness, and contrary job attitudes, and correlated negatively with level of satisfaction with the collegial support network. Partial correlations showed that satisfaction with support systems diminished the effects of burnout on frequency of illness and job attitudes. Tests for divergent validity showed that these findings were specific to burnout and not other measures of job satisfaction or fulfillment. The results suggest that facilitating staff satisfaction with colleagues may reduce burnout and some of its deleterious effects.
Diagnoses of all individuals admitted between 1989 and 1991 to a State of Illinois Hospital were examined to determine the prevalence of patients meeting DSM-III-R criteria for late-onset schizophrenia. Four prevalence rates were determined for each year based on the frequency of late-onset patients in (1) total psychiatric admissions, (2) total admissions over age 45, (3) admissions with diagnoses of schizophrenia, and (4) admissions over age 45 and diagnosed schizophrenia. Results showed that the mean (across the three years) of the four prevalence rates of late-onset schizophrenia ranged from 0.24% to 4.1%. This range is far below prevalence rates on hospitalized patients previously reported in the literature (6 to 34%). Reasons for discrepancy are discussed.
Identification of advocates of behavioral innovation from the ranks of line-level clinical staff has been suggested as a means to implement these innovations in real-world settings. Peer nomination strategies that have been used in management research were adopted for this study so that nursing, professional, and administrative staff at a state hospital could nominate behavioral program advocates from their ranks. Subjects also completed measures that assessed knowledge of behavior therapy and perceptions of barriers to implementing interventions. Results showed that more than 90% of the sample nominated advocates. Tests that sought differences between advocates and nonadvocates showed the two groups to be similar demographically, but the former group was more likely to come from the ranks of professionals and administrators, was significantly more knowledgeable about behavior therapy, and perceived significantly fewer barriers to implementation. These results may help program administrators identify staff members who will.
OBJECTIVE: To test the null hypothesis, ie, that there are no gender differences in psychiatric problems manifest in patients with Alzheimer's disease. DESIGN: Survey. SETTING: Patients living in the community and evaluated at Alzheimer's disease and geriatric outpatient programs. PATIENTS: Three hundred twenty-eight women and 186 men clinically diagnosed with Alzheimer's disease using NINCDS/ADRDA or DSM-III-R criteria. MEASUREMENTS: Psychiatric signs and symptoms recorded following a psychiatric interview, including the Hamilton Depression Rating Scale. RESULTS: Approximately two-thirds of both men and women had psychiatric problems, but women had significantly more multiple symptoms. When pairs of symptoms were analyzed for independence, agitation was only significantly associated with paranoia in men, whereas in women agitation was significantly associated with most other psychiatric problems. CONCLUSION: The higher prevalence of multiple psychiatric problems in women may be due to many factors, including sociodemographic influences, physician bias, and/or other differences between men and women. The finding of a different pattern of association of symptoms with agitation in men and women deserves replication.
OBJECTIVE: To describe drug use patterns by persons with Alzheimer's disease, multi-infarct dementia, and mixed Alzheimer's disease and multi-infarct dementia. DESIGN: Multicenter, patient registry. SETTING: Community-living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings. PARTICIPANTS: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM-III-R criteria, 162 multi-infarct cases by DSM-III-R criteria, and 97 mixed cases by DSM-III-R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older. MEASUREMENTS: The average number of all prescription and non-prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini-mental status score at the time of diagnosis or evaluation. RESULTS: Alzheimer patients average 2.3 drugs compared with multi-infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini-mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini-mental status score in a patient with multi-infarct or mixed dementia, the greater the use of cardiovascular drugs. CONCLUSION: Drug use by Alzheimer patients was lower than in multi-infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.
This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement.
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The study explores whether an atypical form of obsessional illness can be delineated and separated from the conventional form of obsessive-compulsive neurosis (OCN). From a group of 45 obsessive patients, 8 were selected on the basis of 3 criteria: presence of a severely debilitating main obsessive symptom; bordering on the delusional; no schizophrenic symptoms. Assessment and outcome measures included the Psychiatric Questionnaire, the Leyton Obsessional Inventory, Fear Survey Schedule, and IPAT Self-Analysis Form. Self-assessment forms allowed patients to make social adjustment and neurotic symptom ratings. In a multimodal approach, patients were assigned to behavioural and pharmacological treatments on the basis of severity. Reassessment took place after 50 sessions of therapy. Results of analysis of variance statistics indicated that the atypical group had a more malignant form of illness, with more varied and severe obsessions. A poorer prognosis for the atypical group was indicated by: greater social maladjustment, poor employment records, illness of longer duration showing no remissions despite more courses of treatment, and poor response to treatment throughout. The atypical group manifested fewer characteristic features of OCN (example: fewer precipitating events). On the other hand, schizophrenia was not imputed, although delusion-like experiences in the atypical group suggest a psychotic form of illness. The term "obsessive psychosis" suggested by Strauss and recently investigated by Weiss et al and Robinson et al is proposed for our atypical group. Results are compared with those of other investigators. It is concluded that the delineation of a subgroup of obsessional illness is desirable for research and therapy since a form of atypical obsessional illness or obsessive psychosis can be differentiated on aetiological, phenomenological and prognostic factors.
We compared patients with senile dementia of the Alzheimer's type (SDAT) and age-matched controls with respect to T8+-cell-mediated suppressor function using a pokeweed mitogen (pwm)-induced IgG secretion assay. The responding B cells were allogeneic to the T-regulator cells. T8+-cell-mediated suppression was lower in SDAT patients than the controls when we used either 2 X 10(4) or 5 X 10(4) T8+ cells. Suppressor function was lower in both SDAT and elderly controls than in young adults. SDAT patients and controls did not differ with regard to T4+-cell-mediated helper activity. In SDAT patients, there seems to be an exaggeration of the age-related decline in suppressor-cell function. Whether such changes reflect accelerated changes of intrinsic lymphocyte properties or aberrant neural influences on lymphocytes remains to be resolved.
To explore the possible role of serotonin (5-HT) in the etiology of schizophrenia, platelet 5-HT concentrations were determined in 41 schizophrenic (and schizoaffective, mainly schizophrenic) patients diagnosed by the RDC and 34 normal controls. There was a significant difference between the patient and control groups with the 16 paranoid, 11 undifferentiated, and 8 schizo-affective depressed patients having significantly higher mean platelet 5-HT concentrations than the controls. An analysis of variance considering the effect of race, sex, and diagnosis demonstrated a significant difference between black patients and black controls but no significant difference between white patients and white controls. Within the patient sample, platelet 5-HT concentrations were positively correlated with severity of auditory hallucinations (on the PSE) and negatively correlated with lack of insight (on the PSE) and conceptual disorganization (on the BPRS). In a subsample of 21 patients, there was no relationship between platelet 5-HT and CT findings of either enlarged ventricles or cortical atrophy.
Eight chronic schizophrenic patients were maintained on a diet free of gluten, cereal grains, and milk (CM-F diet) and challenged in a double-blind manner with dietary wheat gluten and placebo. While on the CM-F diet, each patient received a daily challenge of 30 g of gluten for 5 weeks and a placebo challenge for 8 weeks. No deterioration in clinical status as measured by the BPRS was noted on gluten challenge. Serum alpha 1 acid glycoprotein measurement demonstrated no evidence of inflammatory response to gluten challenge. The data suggest that sensitivity to dietary gluten is not characteristic of young chronic schizophrenic patients.
A survey of 14 published studies found no consistent association between specific HLA antigens and schizophrenia. Since these studies lacked diagnostic or biological criteria, an investigation was undertaken using recognized diagnostic criteria and CT scan findings. Typing for HLA antigens at loci A, B and C was carried out on 130 patients. Among 92 black schizophrenic patients there was an increase of HLA-A2 which remained significant even after correcting for the number of antigens studied. When the patients for whom CT scans were available were divided according to the presence or absence of evidence of brain atrophy, there was an increase of A2 in the black schizophrenic patients without evidence of atrophy, which remained significant after multiplying by the number of antigens studied. However, there was no significant increase of A2 in those with evidence of atrophy. Similar trends held for the white population but they failed to reach significance. The need for HLA studies on biologically defined groups of schizophrenic patients is stressed.
Handedness in the NIMH monozygotic (MZ) schizophrenic twins was examined and compared to the report of Boklage. Both our findings and Boklage's suggest the existence of a subgroup of schizophrenics characterized by abnormal lateralization and a milder form of schizophrenia. However, unlike Boklage, we hypothesize that this subgroup of schizophrenics is not restricted to MZ twins.