Biomedical subjects
Publications and source records attributed to R Pasternak.
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This study compares the demographic and clinical characteristics of homebound (HB) elders referred for psychiatric services (N = 251) with those of inpatients (IP) admitted to a geriatric psychiatry unit (N = 594). Demographically, HB patients were older (78.8 vs 74.7 years), were more likely to be women (83% vs 68%), were widowed (54% vs. 44%), and had fewer years of education (10.3 vs. 11.1), but were similar in race, income, and proportion living alone. Clinically, HB patients had less functional disability, less severe depression, less cognitive impairment, and fewer medical problems. However, they were similar in the distribution of most psychiatric diagnoses except dementia (higher in the IP group) and dementia with depression (higher in the HB group). Outcome data for the HB group over 15 (range, 1 to 38) months revealed medical hospitalization in 20.7%, psychiatric hospitalization in 16.3%, nursing home placement in 9.2% and mortality in 8.4%. These preliminary data show that the HB group had psychiatric problems that were comparable to those of the IP group but were not as severely impaired.
The authors studied 61 geropsychiatric patients with delirium from a cohort of 843 consecutive admissions to a geriatric clinical research unit. A central study goal was to assess how the presence of dementia affected the presentation of delirium. Eighteen delirious (D) and 43 delirious-demented (D-D) patients were compared on the Delirium Rating Scale (DRS), Mini-Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS), and EEG. D-D patients had lower MMSE scores, but no differences were found in total DRS or BPRS scores or in EEG grade. DRS items were similar in the two groups except that D-D had more cognitive impairment than D. An exploratory principal components analysis of DRS items identified two core factors. The authors conclude that the presentation of delirium in the setting of concurrent dementia is very similar to delirium without dementia, with subtle differences probably attributable to dementia.
The aim of this pilot study was to compare cerebral changes on magnetic resonance imaging (MRI) scans in elderly schizophrenic subjects with those in psychiatric and normal control subjects. We compared the MRIs of 19 subjects with schizophrenia, 19 age- and gender-matched subjects with recurrent major depression, and 19 age- and gender-matched nonpsychiatric control subjects. Deep white matter hyperintensities (DWMH) in right posterior regions were significantly more prominent in the schizophrenic group than in the two comparison groups. Total ratings of MRI abnormalities were significantly related to age in both the normal control and schizophrenic groups, but not in the depressive group. Age of onset was positively associated with total ratings in the depressive group, but not in the schizophrenic group. Thus, a subset of elderly patients with schizophrenia appear to have cerebral white matter abnormalities; such abnormalities may not be confined to late-onset schizophrenia. Systematic MRI studies of early- and late-onset schizophrenia in late life are needed to resolve this question.
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This study analyzes the effect of ethnicity, classified as African-American and Anglo-European, on diagnosis, symptomatology, and response to inpatient treatment in a sample of geriatric patients of a research unit of a tertiary care facility. Variables that might confound the effects of ethnicity, such as age, gender, education, and associated diagnoses, were statistically controlled. Psychotic diagnoses were significantly associated with ethnicity, being higher in African-Americans, weakening the claim that such an association stems from the confounding effects of social class. Variability in the ratings on the Brief Psychiatric Rating Scale and Hamilton Depression Scale was significantly associated with ethnicity in several instances. African-Americans appeared to obtain comparatively higher therapeutic benefits from hospitalization. Results are discussed using knowledge of the field of cultural and social psychiatry.
Among 547 elderly inpatients grouped by DSM-III-R axis I diagnoses, the diagnostic rate of comorbid personality disorder varied four-fold, from 6% in patients with an organic mental disorder to 24% in those with major depression. The previously reported low prevalence of comorbid personality disorder in geriatric patients may be due to its lower rate of diagnosis among patients with organic mental disorders.
The Delirium Rating Scale (DRS) has been shown to be a valid instrument for identifying and grading the severity of delirium in patients admitted to a general hospital for medical or surgical treatment. However, its accuracy in identifying delirium among elderly patients admitted to a psychiatric hospital for evaluation and treatment of psychiatric illness has not been previously addressed. The DRS was administered to 791 elderly patients who were consecutively admitted to a psychogeriatric unit; 70 met DSM-III-R criteria for delirium. A DRS threshold score of > or = 10 correctly identified delirious patients with a sensitivity of 94% and a specificity of 82%. Both psychosis and cognitive impairment appeared to falsely elevate the DRS score in this population.
Although a considerable body of biological and clinical data has been accumulated on the mood disorders and organic disorders of late life, only a handful of studies have focused on aging schizophrenia patients. Using the results of a comprehensive evaluation of all elderly patients admitted over a 30-month period to a 26-bed acute care geriatric unit, we compared the demographic, social, and clinical characteristics of schizophrenia patients, patients with recurrent major depression with and without psychotic features, and patients with primary degenerative dementia of the Alzheimer's type with and without delusions. The main findings of this study are that elderly schizophrenia patients were younger, more often African-American, more often single, and poorer than the other groups. A concomitant history of substance abuse and institutionalization as an outcome were more frequent among schizophrenia patients. Like the older depressed and demented patients, schizophrenia patients were predominantly female and commonly presented with several medical disorders. The potential significance of these findings is discussed in the context of the literature on the long-term outcome of schizophrenia.
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Three city data sources (CDSs)--police reports, ambulance reports, and medica examiner (ME) logs--were evaluated for their usefulness in epidemiologic studies of trauma. The CDSs were employed to identify all cases of penetrating injury to the chest and/or abdomen severe enough to require care in a medical institution during 1979 and 1980 in Baltimore city. The percent of cases identified by source was: police, 66.8%; ambulance, 47.9%; ME, 16.6%; police plus ambulance, 89.4%; police plus ME, 82.9%; and ambulance plus ME, 50.1%. Hospital admissions to six study hospitals due to chest and/or abdomen penetrating injury were located and matched to the CDS reports: 89.2% of the hospitalized cases were reported in one or more CDS, and 34.7% of the cases identified by one or more CDS could not be located in the hospital records. Using hospital records as the standard, each source was determined to have the following completeness of case reporting: police, 66.2%; ambulance, 72.9%; and ME, 92.2%. The authors conclude that existing CDSs should be used with caution, and that the usefulness of data from multiple sources far outweighs that from any single source.