Biomedical subjects
J Lindesay
Publications and source records attributed to J Lindesay.
Psychiatric services for elderly people. GPs happy with multidisciplinary teams.
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An evaluation of the multidisciplinary approach to psychiatric diagnosis in elderly people.
OBJECTIVE: To determine the accuracy of psychiatric diagnoses made by two community psychogeriatric teams operating a multidisciplinary assessment procedure. DESIGN: Comparison of team diagnosis with independent formal assessment and consensus diagnosis by research psychiatrists. SETTING: Two community psychogeriatric teams with similar operational policies in an inner London health district. SUBJECTS: 100 people aged 65-90 (70 women) newly referred to the teams. MAIN OUTCOME MEASURES: Concordance between team and research diagnoses. RESULTS: Agreement between team and research diagnoses ranged from 90% to 99% for the specific psychiatric disorders studied. There was no significant difference between medical and non-medical team members in their diagnostic performance compared with the research psychiatrists. Increased diagnostic accuracy by team members was associated with longer experience of team working, regardless of the team members' professional background. CONCLUSIONS: The multidisciplinary approach to the assessment of referrals to these community teams for the elderly is not associated with misdiagnosis of psychiatric disorder.
Polycythaemia, delirium and mania.
The case is described of a 65-year-old woman who initially presented with delirium caused by polycythaemia rubra vera. Following venesection she was discharged home recovered, but presented again shortly after with an episode of mania associated with relapse of her polycythaemia.
Phobic disorders in the elderly.
Sixty confirmed cases of phobic disorder identified in an urban elderly community sample were compared with 60 controls matched pairwise for age and sex. Cases reported higher rates of specific and non-specific neurotic symptoms, and all were assigned to a diagnostic CATEGO class, compared with seven of the controls. A past history of chronic psychiatric disorder other than phobia was commoner in the cases. Most cases had more than one fear; agoraphobic main fears were predominantly of late onset and associated with moderate to severe social impairment, whereas specific main fears were associated with early onset and minimal social impairment. The onset of agoraphobic fears in old age was attributed by most cases to an episode of physical illness or other traumatic event. Increased rates of palpitations, dyspnoea, giddiness and tinnitus not attributable to anxiety were identified in the cases. Cases did not differ from the controls in socio-economic status, or in the number or quality of current intimate confiding relationships, but they reported higher rates than controls of parental loss before the age of 18 years. Cases reported higher rates of contact with general practitioners, but only one was in contact with psychiatric services at the time of interview. Cases also reported receiving more help in personal care from family members.
Attempted suicide and the lunar cycle.
An analysis of 383 cases of attempted suicide presented to the Accident and Emergency Department during 12 complete lunar cycles (one year) gave no support for an association between attempted suicide and the lunar cycle, especially the full moon. No control for weekends or holidays was made.
Section 47 and its use with mentally disordered people.
This paper reports a survey of implementations of Section 47 of the National Assistance Act (1948) in four Regional Health Authorities between 1983 and 1986. The majority of those compulsorily removed from their homes under the Section were elderly people in poor physical health suffering from a major psychiatric disorder. The initial mortality was very high, and 41 per cent of the sample died within three months of removal. There is no mechanism for appeal or review for people removed under Section 47. The Mental Health Act (1983), which does have these safeguards, could have been used in many of these instances, but was not because of misunderstandings about its scope and poor liaison between geriatric and psychiatric services. It is recommended that the Mental Health Act should be used where it is appropriate and that Section 47 should be reformed to provide an equivalent protection of civil liberties.
Age, sex and suicide rates within birth cohorts in England and Wales.
The relationships between suicide rates at different ages within male and female birth cohorts in England and Wales are examined. There is a sex difference in the pattern of mean correlations of within-cohort rates for various time intervals, with females showing a significant negative correlation between rates separated by 10-15 years. The full correlation matrix of age-specific rates indicates that this negative mean interval correlation is due to negative correlations between rates at age 35-44 years and rates at other ages. This suggests that the acceleration-deceleration model of suicide may be applicable to female rates, with a reduction in suicide associated with pregnancy and motherhood and a rebound increase in rates thereafter.
Phobia and childhood parental loss.
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Nonsuicidal mortality in late-life depression.
While suicide is the most dramatic cause of premature death in depressed older persons, it is a rare event in old age. Most of the excess mortality associated with late-life depression is due to "natural causes," especially cardiovascular illness. In the past much of the premature death related to psychiatric disorders was the result of epidemics in large, overcrowded institutions, and even today institutional factors may account for some excess mortality. A recent prospective study comparing depressed patients with nondepressed controls found that neither the initial level of physical health nor social factors explained the excess mortality, but it suggested that some of the excess is due to physical causes not readily apparent or disabling. The effects of grief, tricyclic antidepressants, chronic dysphoria, smoking and alcohol abuse, and organic brain disease are considered. Evidence suggests a complex interaction between depression and physical illness (particularly cardiovascular disease) that develops throughout life. Pursuant to these findings, some questions for future research are offered.
The Guy's/Age Concern survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community.
A sample of 890 people aged 65 years and over living at home in the Lewisham and North Southwark Health District was interviewed using a structured schedule containing CARE organic brain syndrome and depression scales, and items dealing with anxiety symptoms. Total prevalence rates were 4.6% for cognitive impairment, 13.5% for depression, 3.7% for generalised anxiety, and 10.0% for phobic disorders. Cognitive impairment increased exponentially with age, and was associated with lower occupational class. There was no significant association between occupational class and depression, generalised anxiety, or phobic disorder in this sample. Cognitive impairment, depression and agoraphobia were associated with significantly higher levels of dependency in the tasks of daily living.
Increased mortality rates in late-life depression.
Physical illness at referral and subsequent mortality were studied in a group of elderly patients with depression, and compared with age/sex-matched controls. The depressed group was significantly less well at first interview, and had a significantly higher 4-year mortality. When the effect of physical illness was controlled, the depressed patients (particularly the men) still had a significantly higher 4-year mortality, suggesting that the greater mortality in the depressed group was not due to differences in physical health alone.
Depression, dementia, and disability in the elderly.
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60 years of suicide in England and Wales. A cohort study.
In a cohort analysis of suicides recorded in England and Wales from 1921 to 1980, there was no discernible trend across the younger cohorts, but there was a fall in the suicide rates of successive older cohorts over this period. The impact of period events (eg, World War II and the detoxification of domestic gas) is demonstrated in these cohorts. In addition to the period effects, there was evidence of a more prolonged cohort effect on suicide rates of the middle-aged and elderly associated with these events. Little relationship was found between early and later suicide rates within cohorts, casting doubt on the usefulness of predicting the future rates of cohorts from their early behavior.
Validity of the General Health Questionnaire (GHQ) in detecting psychiatric disturbance in amputees with phantom pain.
The 28-item General Health Questionnaire (GHQ) was validated against the PSE-derived Index of Definition in a sample of amputees with long-standing phantom and stump pain attending a Limb Fitting Centre. This form of the GHQ is a sensitive identifier of overt psychiatric disorder in this setting.
Neuroleptic malignant syndrome and lethal catatonia.
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Phantom sensations: is perceived body image congenital or acquired?
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Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons.
OBJECTIVES: To investigate factors affecting the uptake of health and social services by elderly Asian Gujarati. METHODS: Four hundred and five Hindu Gujaratis and 381 whites aged 65 years and over residing in Leicester were randomly sampled from the Leicestershire District FHSA list by a computerized method based on linguistic analysis of the patient's name. One hundred and fifty Hindu Gujaratis and 152 whites were interviewed with response rates of 72% for the Asian Gujaratis and 80% for the white groups. The outcome measures were the activities of daily living (ADLs), incontinence, auditory/ visual deficits, cardiovascular disease, cognitive impairment (measured by the Mini-mental State Examination), depression, use of GP and hospital services, knowledge of community health and social services, willingness to use, suitability and cultural accessibility. RESULTS: The poorer uptake of services by elderly Asian Gujarati could not be explained by better health. They were significantly more likely to be dependent in six of the 14 ADLs and had higher rates of diabetes and impaired vision. Significantly more Asian Gujaratis than whites lived with others (84 versus 52%, p < 0.0001) with a greater availability of alternative sources of help and support. The knowledge and understanding of services were significantly poorer in the Gujarati group; fewer Asian Gujaratis knew how to apply for services and of those applying, fewer had been successful. Where services had been obtained, the levels of dissatisfaction were higher in the Gujarati group. The literacy rates were low in the Gujarati sample with 79% being unable to read or write in English and 27% unable to read or write in their mother tongue. CONCLUSIONS: The lower uptake of services by elderly Asian Gujarati is not the result of better health but may be explained by greater family support together with a lack of knowledge of and dissatisfaction with what is available. Health services will need to reappraise and revise some of their practices if they are to cater adequately for this growing population with many needs as yet unmet.