Biomedical subjects
P Rabins
Publications and source records attributed to P Rabins.
The impact of OBRA '87 on psychiatric services in nursing homes. Joint testimony of the American Psychiatric Association and the American Association for Geriatric Psychiatry.
The Institute of Medicine has formed a Committee on Improving Quality in Long-Term Care, which is examining the legislative and quality-of-care impact that the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) had on long-term care. The American Psychiatric Association and the American Association for Geriatric Psychiatry were asked to provide written and oral testimony before the Committee in March 1998. The two organizations summarized the key outcomes of OBRA '87 on the psychiatric needs of individuals who receive services in long-term care settings. The written testimony also encouraged the Committee to insist that the long-term care industry develop, test, and refine psychiatric and mental health quality outcome measures for nursing facilities and other long-term care settings.
Pernicious anemia and reversible dementia: Strachan and Henderson 30 years later.
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Late paraphrenia revisited.
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Management of behavior disturbance in Alzheimer disease: current knowledge and future directions.
Assessment and treatment of behavior problems in patients with Alzheimer disease and related disorders is a seriously neglected area of study. Despite the fact that such problems are integral to the disorder, little is known about effective management. This article summarizes the current thinking on five areas of prime importance to patients, care providers, and health care professionals: agitation, assault/aggression, screaming, wandering, and depression/apathy/withdrawal. Methodological guidelines for studying these disorders are provided. Emphasis is on recognizing that behavior problems are important areas of study in their own right as well as in conjunction with studies of cognition.
Confrontation naming deficit in dementia of depression.
Unlike patients with irreversible dementia, elderly depressed patients with cognitive impairment are thought to have relatively preserved recognition, memory, and language abilities. To test this hypothesis, the authors compared memory and naming performance in elderly hospitalized patients with major depression alone, reversible dementia of depression, or irreversible dementia. All patient groups performed worse than nondemented, nondepressed control subjects on memory tasks. Patients with dementia of depression performed worse than depressed patients with normal cognition on tests of free recall, delayed recall, and verbal delayed memory but not on tests of delayed visual memory. Patients with dementia of depression and patients with irreversible dementia were severely compromised in both speed and accuracy on the confrontation naming task.
Health services research in nursing homes: a systematic review of three clinical geriatric journals.
This article presents the results of a systematic review of five years of health services research found in nursing home studies published in three major geriatric journals. This review indicates that very little services research has been undertaken in nursing home settings. The small amount of quantitative, empirical research that has been published has suffered from research design, method, and analytic shortcomings. Nursing home research in at least one federal agency has experienced worse than average funding and disapproval rates. The implications of this review are discussed, and recommendations are made for advancing this important area of study.
The late-onset psychoses. Possible risk factors.
Schizophrenia and depressive illness can manifest for the first time in late life. Similarities to the early-life forms of the illnesses appear to outweigh the differences. Disparities in symptoms and risk factors in the elderly likely stem from biologic and social changes that are part of the aging process.
Late-onset schizophrenia. Studying clinical validity.
The authors compared clinical characteristics of 36 late-onset schizophrenic patients from four centers (hospitals in San Diego, Baltimore, Los Angeles, and Montreal). There was a preponderance of the paranoid type with bizarre delusions and auditory hallucinations, chronic course of illness, and response to relatively low doses of neuroleptics. A comparison of late-onset and younger schizophrenic patients revealed both similarities and differences between the two groups. The authors reviewed the relevant literature and discussed the implications for assessing the validity of the concept of late-onset schizophrenia. They believe that, although less common, late-onset schizophrenia is probably as valid an entity (or group of entities) as schizophrenia with onset before age 45.
Psychiatry and the nursing home.
In the last two decades, nursing homes have become major providers of health services for the frail elderly. Despite ample evidence of need for specialized psychiatric services in the nursing home setting, the majority of patients who could benefit from such care do not receive it. The authors propose a fourfold role for the psychiatrist, encompassing clinical care, consultation, teaching, and research. Features of this role can be adapted to fee-for-service, community mental health center, and academic models of psychiatric practice.
Increased ventricle-to-brain ratio in late-onset schizophrenia.
For 29 patients with schizophrenia that began after age 44, the mean ventricle-to-brain ratio was significantly higher than for 23 age-matched normal subjects but significantly smaller than for 23 patients with Alzheimer's disease and hallucinations or delusions.
Caregivers for dementia patients: a comparison of husbands and wives.
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Families, informal supports, and Alzheimer's disease. Current research and future agendas.
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Mania in the elderly.
Forty-two patients 60 years old and older who fulfilled DSM-III criteria for mania were retrospectively identified. Symptom profiles and treatment response were similar to those of younger patients. No evidence was obtained to support physical illness as a common precipitant of late-life mania.
Utilization of psychiatric consultation for elderly patients.
Six hundred fifty-one psychiatric consultations performed during a one-year period were reviewed retrospectively. Cognitive impairment was present in 54 per cent and depression in 27 per cent of the elderly patients in the population studied. A second study of the point prevalence of cognitive and emotional disorders in the hospital was carried out using the Mini-Mental State Exam and the General Health Questionnaire. Emotional disorders had similar prevalences in all age groups but cognitive disorders were more common in the elderly. Twenty-one per cent of consultations were done on patients over the age of 60, although elderly patients occupied 28.5 per cent of hospital beds. Thus, elderly patients were less often referred for psychiatric consultation than younger patients, although the incidence of psychiatric disorders increases with age.
Distribution of focal signs in a group of demented men.
The distribution of signs indicative of localized brain damage important in the diagnosis of multi-infarct dementia (MD) has not been specified. The demented members of a longitudinally examined research panel (n = 519) were identified. Differential diagnosis of the probable causes of the dementias was made. Focal signs were found to occur in both the cases diagnosed as MID (n = 13) and the case diagnosed as senile dementia - Alzheimer's type (n = 27). It is important for the clinician in the evaluation of focal signs in dementing illness to consider the developmental sequence and the total clinical context of the disorder.
Familial manic-depressive illness and familial Parkinson's disease: a case report.
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Serum haloperidol levels in Gilles de la Tourette syndrome.
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