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Biomedical subjects

M Orrell

Publications and source records attributed to M Orrell.

43 records · Page 3Linked to original sources
PubMed1995

Insight and psychosis: a social perspective.

The last 5 years have seen a resurgence of interest in insight, with better definitions and operationalizations of the concept. However, recent work has paid little attention to the ways in which patients' understanding of their illnesses may be shaped by perceptions of mental illness and treatment prevailing in their cultures and social groups. We review work by social scientists on cultural and social variations in lay perceptions of mental illness and on the stigma attached to mental illness, and argue that these varying views are likely to be one of the influences on insight, requiring further exploration in research on this subject.

Attitude↗
PubMed1995

Life events and senile dementia. I. Admission, deterioration and social environment change.

This study examines the frequency of life events before admission and before deterioration in 70 dementia patients, in comparison with 50 dementia controls living in the community and 50 fit elderly people matched for age and sex. We hypothesized that there would be an excess of events connoting changes in routine and the social environment. Specific scales were developed to measure these aspects of events. Our results supported the initial hypothesis, confirming that it is the social disruptiveness of change rather than the threat implied by life events that is associated with deterioration. The findings are discussed in the light of current models of the dementia process.

Activities of Daily Living↗
PubMed1995

Management of depression in the elderly by general practitioners: II. Attitudes to ageing and factors affecting practice.

Although general practitioners (GPs) may be able to identify depression in elderly patients many patients do remain untreated. It is possible that negative attitudes could influence treatment. This study aims to investigate GPs' attitudes towards depression in the elderly. A national questionnaire study on the management of depression in the elderly was carried out. It enquired about attitudes towards treatment and diagnosis of depression and ageing and depression. Most GPs were confident about treating depression but agreed that it was difficult to treat and said that they would benefit from more information and training. A small proportion of the sample agreed that depression was a natural consequence of ageing and that most people when elderly get depressed. Older GPs were more likely to see depression as more difficult to treat and stopped medication sooner after recovery. Female GPs felt less confident in management and expressed more interest in further training although this did not appear to reflect the quality of care. In general GPs did not have negative views about depression and ageing; they did, however, identify a need for more training in the management of depression in the elderly.

Adult↗
PubMed1995

Management of depression in the elderly by general practitioners: I. Use of antidepressants.

Depression is a common problem in the elderly but studies have suggested that it is often inadequately treated by general practitioners (GPs). This study aims to investigate how GPs manage depression in the elderly. A national questionnaire study on the management of depression in the elderly was carried out. Case vignettes were used to investigate how GPs manage depression and what influenced their decision making process. Each case vignette had a factor complicating the use of the older tricyclics. The questionnaire was completed by 407 out of 667 GPs (61%). Many GPs chose the newer antidepressants but a substantial proportion preferred the older tricyclics. Many GPs selected subtherapeutic doses, particularly of the older tricyclics. Few GPs said they maintained patients on antidepressants for more than 3 months after recovery and only 1 in 12 continued antidepressants for over 6 months. If these results reflect GPs practice there is a danger that many patients will be inadequately treated and also at risk of relapse because of their antidepressants being stopped too soon after recovery.

Adult↗
PubMed1995

Life events and senile dementia. Affective symptoms.

BACKGROUND: Previous research in the elderly has linked threatening life events with depression. Dementia sufferers are known to be sensitive to stressful changes in their daily life such as relocation. This study investigates whether threatening life events are associated with depressive symptoms in dementia sufferers. METHOD: Using the Life Events and Difficulties Schedule, this study examined life events before admission in a group of 70 dementia patients compared with two control groups: dementia sufferers in the community and mentally fit elderly people matched for age and sex. RESULTS: Life events with severe threat were not significantly more frequent in the dementia patients than in two control groups. However, depressive symptoms in the dementia sufferers were significantly associated with independent severe life events. This strong association was maintained when a multivariate analysis was used to control for the effects of other social factors and severity of cognitive impairment. This association appears to be specific to the threat aspect of life events since there was no association between depressive symptoms and events relating to change in the social environment. CONCLUSION: In dementia sufferers, threatening life events are associated with depressive symptoms. This means that dementia sufferers are responsive to stress in the same way as cognitively intact individuals, and clinicians need to be more aware of the social influences on them.

Adaptation, Psychological↗
PubMedDate not supplied

Whose quality of life is it anyway? The validity and reliability of the Quality of Life-Alzheimer's Disease (QoL-AD) scale.

Quality of life (QoL) is becoming an increasingly used outcome measure in both clinical practice and research. There are now more than 1000 scales available to measure QoL, and it is important that they are assessed for reliability and validity. This study aims to assess the reliability and validity of the Quality of Life-Alzheimer's Disease (QoL-AD) scale, which is dementia specific and brief and uses the patient's own responses. Two separate samples of people with dementia (sample 1, n = 60; sample 2, n = 201) were assessed. Five focus groups were conducted involving both people with dementia and their caregivers; the focus groups showed that people with dementia had higher hopes for their QoL than their caregivers did for them. Questionnaires about the scale were completed by 71 health care professionals working with people with dementia. The scale was found to have good content validity with no additional items required and all items necessary. It also correlated well with the Dementia Quality of Life scale (0.69) and with the Euroqol-5D scale (0.54), indicating good criterion concurrent validity. Construct validity was also good with the principal components analysis showing all 13 items of the QoL-AD loaded on component 1. Interrater reliability was excellent with all Cohen's kappa values >0.70. Internal consistency was excellent with a Cronbach's alpha coefficient of 0.82. Some people with severe dementia and a Mini-Mental State Examination score as low as 3 were able to satisfactorily complete the QoL-AD. The QoL-AD has very good psychometric properties and can be completed with people with a wide range of severity of dementia.

Aged↗