Biomedical subjects
P V Rabins
Publications and source records attributed to P V Rabins.
Psychiatric consultation to a continuing care retirement community.
Life care communities provide a continuum of residential services to the elderly. This report describes the provision of on-site psychiatric consultations to 82 individuals residing in one such community. Dementia and major depression were the most common diagnoses made.
Quality of life and dementia.
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Prevention of mental disorder in the elderly: current perspectives and future prospects.
This article reviews primary, secondary, and tertiary preventive strategies in the mental health field. Primary prevention is currently restricted to some forms of dementia, but secondary and tertiary prevention can significantly diminish both short-term and long-term morbidity. Improved professional and lay education, better use of existing knowledge and resources, and improved communication among practitioners in the medical, psychosocial, and mental health fields can all lead to improved care at the present time.
Visual hallucinations in patients with macular degeneration.
OBJECTIVE: This study was undertaken to determine the prevalence of visual hallucinations in patients with macular degeneration, describe such hallucinations phenomenologically, and possibly determine factors predisposing to their development. METHOD: Using a case-control design, the authors screened 100 consecutive patients with age-related macular degeneration for visual hallucinations. Each patient with visual hallucinations was matched to the next three patients without hallucinations. The patients and comparison subjects were compared in terms of scores on the Beck Depression Inventory, Eysenck Personality Questionnaire, Telephone Interview for Cognitive Status, and a structured questionnaire including demographic characteristics, family history, and medical and psychiatric history. Ophthalmologic data were obtained by chart review. RESULTS: Of the 100 patients, 13 experienced visual hallucinations. Four variables were significantly associated with having hallucinations: living alone, lower cognition score, history of stroke, and bilaterally worse visual acuity. Hallucinations were not associated with family or personal history of psychiatric disorder or with personality traits. In 11 (84.6%) of the 13 patients, the hallucinations had begun in association with an acute change in vision. CONCLUSION: These results indicate that visual hallucinations are prevalent among patients with macular degeneration. They appear unrelated to primary psychiatric disorder. The predisposing factors of bilaterally worse vision and living alone support an association with sensory deprivation, while history of stroke and worse cognition support a decreased cortical inhibition theory.
Centrum semiovale white matter CT changes associated with normal ageing, Alzheimer's disease and late life depression with and without reversible dementia.
A standardized, reliable means of assessing CT attenuation numbers in the centrum semiovale and surrounding grey matter was developed. This was applied to cranial CT scans of 60 normal controls (36 aged greater than 60 years), 25 elderly patients with major depression (14 of whom had the dementia syndrome of depression), and 10 patients with Alzheimer's disease (AD). Subjects received neuropsychological evaluation. Centrum semiovale (CSO) CT attenuation numbers decreased with increasing age for both white and grey matter. White matter attenuation values best discriminated elderly controls from the three patient groups. Both white and grey matter CSO attenuation values correlated with performance on a number of cognitive tasks.
Psychosocial and management aspects of delirium.
Data to demonstrate that psychosocial factors, sensory deprivation, or sleep deprivation alone can cause delirium are few. Nonetheless, these factors or conditions may contribute to the development or symptom presentation of a delirium when other metabolic or toxic etiologies are present. There is likewise little research on the appropriate treatment of the delirious patient. Clinical experience suggests that attention to the patient's psychological state through frequent orientation, emotional support, and frequent explanation can help. Low-dose neuroleptic drugs are occasionally useful and necessary.
Mania in the elderly: a 5-7 year follow-up.
A 5-7 year follow-up study of elderly individuals hospitalized on an acute psychiatric inpatient service for bipolar disorder, manic phase, demonstrates that the prognosis of mania has improved in the past 30 years. A majority of those hospitalized for mania are alive and living independently 5 years after hospitalization. However, eight of 25 (32%) patients have experienced a decline in Mini-Mental State Exam score to below 24, suggesting a clinically significant cognitive disorder. Mortality rates were higher in the manic group than expected from population norms. Compared to a group of similarly aged individuals hospitalized for unipolar depression, patients with bipolar disorder had an earlier age of onset and a lesser likelihood of being rehospitalized.
Cortical magnetic resonance imaging changes in elderly inpatients with major depression.
OBJECTIVE: The purpose of the study was to determine if magnetic resonance imaging (MRI) scans of elderly depressed patients differ from MRI scans of age-matched control subjects and age-matched patients with Alzheimer's disease. METHOD: The authors studied 21 patients 60 years or older with major depression, 16 patients with Alzheimer's disease, and 14 age-matched control subjects. RESULTS: Compared to control subjects, depressed patients had greater cerebral sulcal and temporal sulcal atrophy; larger sylvian fissures, lateral ventricles, third ventricles, and temporal horns; and greater severity of subcortical white matter lesions. Depressed patients also had more basal ganglia lesions but similar levels of periventricular hyperintensity. There were no differences between depressed patients with and without delusions on any MRI measure. Depressed patients who received ECT had more temporal horn atrophy and greater subcortical abnormality summary scores than normal subjects. Cortical sulcal atrophy correlated with age at onset of depression. CONCLUSIONS: The findings suggest that elderly hospitalized depressed patients have greater cortical as well as subcortical atrophy and more basal ganglia lesions than age-matched normal control subjects. The correlation of these abnormalities with outcome remains unknown.
Problems in the treatment of depressed elderly persons in an outreach program.
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The emotional impact of caring for the chronically ill.
Thirty-two family caregivers of persons with Alzheimer's disease and 30 caregivers of persons with cancer were compared cross-sectionally to determine whether the type of illness cared for affected the emotional state of the caregiver and to identify correlates of both undesirable and desirable emotional outcomes. No prominent differences in negative or positive emotional states were found between the two groups. Correlates of negative and positive emotional status were identified. They include caregiver personality variables, the feeling that one is supported by one's religious faith, and the number of social supports.
Emotional adaptation over time in care-givers for chronically ill elderly people.
Thirty-two care-givers of persons with Alzheimer's disease and 30 care-givers of persons with recurrent metastatic cancer were interviewed three times over a 2-year period. Both groups showed a decline in anxiety and negative mood while dementia care-givers also experienced a decline in anger. A multiple regression analysis revealed that care-giver neuroticism, self-reported low strength of religious beliefs and anger explained 54% of the variance of the negative affect balance score at 2-year follow-up while higher number of social contacts at index interview and strong self-reported religious faith explained 43% of the variance of positive affect balance.
Psychogeriatric assessment and treatment in urban public housing.
A psychogeriatric outreach team provides in-home evaluation and treatment for elderly persons living in high-rise public housing in Baltimore. During the first ten months of the team's operation, housing staff referred 9.5 percent of the elderly residents of four public housing sites for evaluation. Evaluations were completed for 85 residents, 25 percent of whom were age 80 or older. Twenty-one percent of the residents evaluated were unable to perform at least one basic activity of daily living such as eating, bathing, or dressing without assistance, and 54 percent needed help with cooking, cleaning, and other instrumental activities of daily living. Eighty-nine percent of the residents who were evaluated by the team met criteria for at least one DSM-III-R diagnosis; 63 percent of the disorders had not been previously diagnosed. The most prevalent diagnoses were dementia, depressive syndromes, schizophrenic and delusional disorders, and alcohol abuse or dependence.
Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia ('pseudodementia').
Twenty-six elderly (greater than 60 yrs) patients with DSM-III major depression were compared to 13 patients with NINCDS/ADRDA probable Alzheimer's disease (AD), and to 31 screened normal controls. Subjects were matched on age and sex. Fifteen of the 26 depressed patients were cognitively impaired on the Mini-Mental State Examination (MMSE) upon admission, but after treatment returned to the normal range. These 15 patients were defined as having the dementia syndrome of depression (DOD). The remaining 11 depressed patients were termed depressed, cognitively normal (DCN). All subjects received standardized cranial CT scans for assessment of ventricular brain ratio (VBR) and CT attenuation numbers. Subjects also received neuropsychological evaluation. CT values for the 26 depressed patients lay between those of AD patients and normal controls. CT values for the DOD subgroup clustered near those of AD patients. Patterns of cognitive deficits and correlations of CT attenuation values with cognitive measures were also similar in AD and DOD. Most patients were reassessed at a mean of two years after initial testing; of the 11 of the 15 DOD re-examined, only one had undergone cognitive decline. By contrast, all AD patients retested had declined significantly. Episodes of DOD and DCN tended to 'breed true'. This study suggests that while patients with DOD may have underlying structural brain abnormalities, obvious short-term progression to AD does not commonly occur.
A chart review study of late-onset and early-onset schizophrenia.
This chart review study compared 54 schizophrenic patients with onset of illness after age 45 years to 54 young and 22 elderly patients with early-onset schizophrenia (before age 45). The index group was more likely to have visual, tactile, and olfactory hallucinations; a greater number of different types of hallucinations; persecutory delusions; and premorbid schizoid personality traits, and was less likely to have thought disorder and affective flattening, than was either comparison group. Among the two elderly groups, index patients had more auditory and visual sensory impairment. Nearly half (48.1%) of the index patients responded to neuroleptic treatment with complete remission.
Dementia of depression among patients with neurological disorders and functional depression.
Cognitive performance on the Mini-Mental State Examination (MMSE) was assessed in depressed patients (diagnosis of major depression) with cerebrovascular lesions, with Parkinson's disease, or with functional depression (no known brain lesions). Controls for patients with brain lesions or Parkinson's disease were nondepressed patients with the same conditions. Controls for functionally depressed patients were age-matched normal individuals. Depressed patients had significantly lower total MMSE scores than their nondepressed counterparts, but depression did not have an effect on cognitive performance across the three disease groups. The only significant difference between depressed and nondepressed patients shared by all three groups was poorer performance by depressed patients on the delayed-recall task. The findings suggest that major depression may lead to a specific pattern of cognitive deficits independent of coexisting brain pathology.
Coexisting depression and dementia.
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Dementia. Helping family caregivers cope.
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