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Biomedical subjects

James Warner

Publications and source records attributed to James Warner.

15 recordsLinked to original sources
PubMed2006

Making sense of dementia in the social world: a qualitative study.

The reactions of others can have a significant effect on the lived experience of dementia. Although the literature contains some theories of dementia that take this into account, few studies have asked people with early stage dementia about their experiences of other people's reactions to their changed condition and social status. In the present study, 12 men and women aged 66-87 with early stage dementia, recruited through an Older Adult Mental Health Unit in London, England, were interviewed to elicit their views on others' reactions to them since receiving the diagnosis. They were also asked what they thought others understood by the terms 'dementia' and 'Alzheimer's Disease'. Transcripts were analysed using Interpretative Phenomenological Analysis. Participants displayed somewhat negative reactions to the term dementia, and were concerned others would associate it with being 'demented'. In connection with this, although they were comfortable sharing their diagnosis with those closest to them, they were reluctant to do so beyond this private inner circle. Participants were keen for those who did know about the condition to respond authentically and honestly to them, helping them when necessary but as far as possible carrying on life as normal. A number of the participants seemed to be trying to work out how dementia differed from age-related memory loss and compared themselves with others to aid their understanding of this. The implications of these findings for clinical practice, carers and wider society are discussed.

Aged↗
PubMed2006

Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology.

The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review the evidence on the drug treatment for dementia. The level of evidence (types) was rated using a standard system: Types 1a and 1b (evidence from meta-analysis of randomised controlled trials or at least one controlled trial respectively); types 2a and 2b (one well-designed study or one other type of quasi experimental study respectively); type 3 (non-experimental descriptive studies); and type 4 (expert opinion). There is type 1a evidence for cholinesterase inhibitors (donepezil, rivastigmine and galantamine) for mild to moderate Alzheimer's disease; memantine for moderate to severe Alzheimer's disease; and for the use of bright light therapy and aromatherapy. There is type 1a evidence of no effect of anti inflammatory drugs or statins. There is conflicting evidence regarding oestrogens, with type 2a evidence of a protective effect of oestrogens but 1b evidence of a harmful effect. Type 1a evidence for any effect of B12 and folate will be forthcoming when current trials report. There is type 1b evidence for gingko biloba in producing a modest benefit of cognitive function; cholinesterase inhibitors for the treatment of people with Lewy body disease (particularly neuropsychiatric symptoms); cholinesterase inhibitors and memantine in treatment cognitive impairment associated with vascular dementia; and the effect of metal collating agents (although these should not be prescribed until more data on safety and efficacy are available). There is type 1b evidence to show that neither cholinesterase inhibitors nor vitamin E reduce the risk of developing Alzheimer's disease in people with mild cognitive impairment; and there is no evidence that there is any intervention that can prevent the onset of dementia. There is type 1b evidence for the beneficial effects of adding memantine to cholinesterase inhibitors, and type 2b evidence of positive switching outcomes from one cholinesterase inhibitor to another. There is type 2a evidence for a positive effect of reminiscence therapy, and type 2a evidence that cognitive training does not work. There is type 3 evidence to support the use of psychological interventions in dementia. There is type 2 evidence that a clinical diagnosis of dementia can be made accurately and that brain imaging increases that accuracy. Although the consensus statement dealt largely with medication, the role of dementia care in secondary services (geriatric medicine and old age psychiatry) and primary care, along with health economics, was discussed. There is ample evidence that there are effective treatments for people with dementia, and Alzheimer's disease in particular. Patients, their carers, and clinicians deserve to be optimistic in a field which often attracts therapeutic nihilism.

Aged↗
PubMed2005

Dementia.

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Alzheimer Disease↗
PubMed2004

Sexual activity among patients in psychiatric hospital wards.

In psychiatric hospitals, sexual activity between patients raises special difficulties regarding consent. We undertook a questionnaire survey of inpatients in the mental health units of three hospitals to identify the nature and frequency of sexual activity. A contemporaneous staff questionnaire was used in an attempt to validate the patient reports. Of the 100 patients who participated (response rate 60%), 30 reported engaging in some form of sexual activity including 10 who had sexual intercourse. All sexual intercourse was consensual, but only 2 respondents used condoms. Staff questionnaires suggested levels of sexual activity congruent with patient reports. This survey underlines the conflict between an individual's right to sexual expression and the need to protect vulnerable patients.

Adult↗
PubMed2004

Rates and predictors of mental illness in gay men, lesbians and bisexual men and women: Results from a survey based in England and Wales.

BACKGROUND: There is a dearth of research into the mental health of gay men, lesbians and bisexual men and women in the UK. AIMS: To assess rates and possible predictors of mental illness in these groups. METHOD: A comprehensive assessment was made of the psychological and social well-being of a sample of gay men, lesbians and bisexual men and women, identified using 'snowball' sampling. RESULTS: Of the 1285 gay, lesbian and bisexual respondents who took part, 556 (43%) had mental disorder as defined by the revised Clinical Interview Schedule (CIS - R). Out of the whole sample, 361 (31%) had attempted suicide. This was associated with markers of discrimination such as recent physical attack (OR=1.7, 95% CI 1.3-2.3) and school bullying (OR=1.4, 95% CI 1.1-2.0), but not with higher scores on the CIS-R. CONCLUSIONS: Gay, lesbian and bisexual men and women have high levels of mental disorder, possibly linked with discrimination.

Adult↗
PubMed2004

Dementia.

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Alzheimer Disease↗
PubMed2004

Dementia.

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Alzheimer Disease↗
PubMed2003

Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study.

BACKGROUND: Little is known about the mental health of gay men and lesbians living in Europe. AIMS: To compare psychological status, quality of life and use of mental health services by lesbians and gay men with heterosexual people. METHOD: Cross-sectional study in England and Wales using 'snowball' sampling. RESULTS PARTICIPANTS: 656 gay men, 505 heterosexual men, 430 lesbians and 588 heterosexual women. Gay men were more likely than heterosexual men to score above threshold on the Clinical Interview Schedule, indicating greater levels of psychological distress (RR 1.24, 95% CI 1.07-1.43), as were lesbians compared with heterosexual women (RR 1.30, 95% CI 1.11-1.52). Gay men and lesbians were more likely than heterosexuals to have consulted a mental health professional in the past, deliberately harmed themselves and used recreational drugs. Lesbians were more likely to have experienced verbal and physical intimidation and to consume more alcohol than heterosexual women. CONCLUSIONS: Awareness of mental health issues for gay men and lesbians should become a standard part of training for mental health professionals, who need to be aware of the potential for substance misuse and self-harm in this group and of the discrimination experienced by many lesbians.

Adolescent↗
PubMed2003

Dementia.

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Alzheimer Disease↗
PubMed2002

Double blind randomised placebo controlled trial of low dose melatonin for sleep disorders in dementia.

BACKGROUND: Disturbance of sleep is common in individuals with dementia where there may be reversal of the sleep-wake cycle. People with dementia of the Alzheimer's type have melatonin secretion rhythm disorders. There is some evidence that treatment with exogenous melatonin is an effective treatment for sleep disturbance associated with dementia. A randomised double blind placebo controlled cross over trial was undertaken to test the hypothesis that slow release exogenous melatonin 6 mg improves sleep for people with dementia. METHODS: Forty-four participants with DSM-IV diagnoses of dementia with sleep disturbance were selected for a seven week randomised double blind cross over trial of slow release melatonin 6 mg versus placebo. Sleep parameters were objectively measured using wrist actigraphy. RESULTS: Twenty-five out of 44 completed the trial. Sleep was significantly disturbed in the sample population. Melatonin had no effect on median total time asleep (n=25, z=1.35, p=0.18), number of awakenings (n=25, z=0.32, p=0.75) or sleep efficiency (n=25, z=0.17, p=0.24). Nor were there any carry over effects from melatonin. CONCLUSIONS: Contrary to previous findings, we found no evidence that two weeks of exogenous melatonin is effective in improving sleep in people with dementia, although possible benefits of melatonin following longer periods of administration cannot be discounted.

Aged↗
PubMed2002

How much do doctors know about consent and capacity?

To assess knowledge of capacity issues across different medical specialties we conducted a cross-sectional survey with a structured questionnaire at academic meetings, lectures and conferences. Of 190 individuals who received the questionnaire 129 (68%) responded-35 general practitioners, 31 psychiatrists, 29 old-age physicians [corrected] and 34 final year medical students. Correct answers on capacity to consent to or refuse medical treatment were given by 58% of the psychiatrists, 34% of the geriatricians, 20% of the general practitioners and 15% of the students. 15% of all respondents wrongly believed that a competent adult could lawfully be treated against his or her will, with no obvious differences by specialty. As judged by this survey, issues of capacity and consent deserve more attention in both undergraduate and postgraduate medical education.

Adult↗
PubMed2002

Dementia.

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Aged↗
PubMed2002

Dementia.

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Aged↗