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Robin Jacoby

Publications and source records attributed to Robin Jacoby.

18 recordsLinked to original sources
PubMed2006

Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study.

BACKGROUND: The role of physical illness and life problems in contributing to suicide in older people is potentially important with regard to suicide prevention. METHOD: The aim of the study was to determine the life problems other than psychiatric illness contributing to suicide in older people. Semi-structured psychological autopsy interviews, covering life problems and physical illness prior to death, were conducted with informants for 100 people aged 60 years old and over who died through suicide in five English counties. Interviews were completed with informants for 54 age- and sex-matched control subjects who died through natural causes. RESULTS: The three most frequent life problems associated with suicide were physical illness, interpersonal problems, and bereavement. Physical health problems were present in 82% and felt to be contributory to death in 62%. Pain, breathlessness and functional limitation were the most frequent symptoms. Interpersonal problems were present in 55% of the sample and contributory in 31%. The corresponding figures for bereavement-related problems were 47% and 25%. In the case-control analysis, the problems found to be risk factors for suicide were problems related to a bereavement over 1 year before death (OR 3.5, 95% CI 1.2-10.6), and problems with accommodation (OR 5.0, 95% CI 1.1-22.8), finances (p=0.01), and retirement (p=0.02). CONCLUSION: Physical illness, interpersonal problems and bereavement are commonly associated with suicide in older people, but financial, accommodation, retirement and long- term bereavement-related problems may be more specific risk factors.

Aged↗
PubMed2006

Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial.

OBJECTIVE: To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics. DESIGN: Cluster randomised controlled trial with blinded assessment of outcome. SETTING: 12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford. PARTICIPANTS: Residents of the 12 nursing homes; numbers varied during the study period. INTERVENTION: Training and support intervention delivered to nursing home staff over 10 months, focusing on alternatives to drugs for the management of agitated behaviour in dementia. MAIN OUTCOME MEASURES: Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour (Cohen-Mansfield agitation inventory) in each home at 12 months. RESULTS: At 12 months the proportion of residents taking neuroleptics in the intervention homes (23.0%) was significantly lower than that in the control homes (42.1%): average reduction in neuroleptic use 19.1% (95% confidence interval 0.5% to 37.7%). No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes. CONCLUSIONS: Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics.

Accidental Falls↗
PubMed2006

Suicide in older people without psychiatric disorder.

OBJECTIVE: To determine the psychological characteristics and nature of life problems, including physical illness, in people 60 years and over dying through suicide in the absence of psychiatric disorder. METHODS: Psychological autopsy interviews with relatives and friends for 23 people aged 60 years or over who had died through suicide and did not have a psychiatric disorder at the time of death. RESULTS: Three (13%) of the sample had significant psychiatric symptoms, one had a diagnosis of personality disorder, and ten (43.5%) had significantly abnormal personality traits. Physical illness and recent bereavement were the commonest life problems associated with suicide. Five (21.7%) of the sample were suffering from severe physical illness at the time of death. CONCLUSION: Sub-syndromal psychiatric disorder may be less important than personality factors, physical illness, and recent bereavement as important contributory factors to suicide in older people not suffering from psychiatric illness at the time of death.

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PubMed2005

Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial.

OBJECTIVES: To determine the respective efficacy of quetiapine and rivastigmine for agitation in people with dementia in institutional care and to evaluate these treatments with respect to change in cognitive performance. DESIGN: Randomised double blind (clinician, patient, outcomes assessor) placebo controlled trial. SETTING: Care facilities in the north east of England. PARTICIPANTS: 93 patients with Alzheimer's disease, dementia, and clinically significant agitation. INTERVENTION: Atypical antipsychotic (quetiapine), cholinesterase inhibitor (rivastigmine), or placebo (double dummy). MAIN OUTCOME MEASURES: Agitation (Cohen-Mansfield agitation inventory) and cognition (severe impairment battery) at baseline and at six weeks and 26 weeks. The primary outcome was agitation inventory at six weeks. RESULTS: 31 patients were randomised to each group, and 80 (86%) started treatment (25 rivastigmine, 26 quetiapine, 29 placebo), of whom 71 (89%) tolerated the maximum protocol dose (22 rivastigmine, 23 quetiapine, 26 placebo). Compared with placebo, neither group showed significant differences in improvement on the agitation inventory either at six weeks or 26 weeks. Fifty six patients scored > 10 on the severe impairment battery at baseline, 46 (82%) of whom were included in the analysis at six week follow up (14 rivastigmine, 14 quetiapine, 18 placebo). For quetiapine the change in severe impairment battery score from baseline was estimated as an average of -14.6 points (95% confidence interval -25.3 to -4.0) lower (that is, worse) than in the placebo group at six weeks (P = 0.009) and -15.4 points (-27.0 to -3.8) lower at 26 weeks (P = 0.01). The corresponding changes with rivastigmine were -3.5 points (-13.1 to 6.2) lower at six weeks (P = 0.5) and -7.5 points (-21.0 to 6.0) lower at 26 weeks (P = 0.3). CONCLUSIONS: Neither quetiapine nor rivastigmine are effective in the treatment of agitation in people with dementia in institutional care. Compared with placebo, quetiapine is associated with significantly greater cognitive decline.

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PubMed2004

Unmet treatment needs of older prisoners: a primary care survey.

BACKGROUND: little is known about the treatment needs of older prisoners and to what extent they are being met. SUBJECTS: representative sample of 203 sentenced prisoners aged 60 and over in 15 prisons in England and Wales. DESIGN: case notes were surveyed using a standardised proforma and information on current medication was collected. RESULTS: three-quarters of older prisoners were prescribed medication. Those with cardiovascular, respiratory and endocrine health problems were prescribed medication that was mostly appropriately targeted. In contrast, only 18% of inmates with recorded psychiatric morbidity were prescribed psychotropic medication. CONCLUSIONS: reviewing the medical records of older prisoners and considering the appropriateness of their current medication regime would be a primary care intervention that could significantly improve the health of this marginalized group.

Aged↗
PubMed2004

Do general practitioners believe that their older patients physical symptoms are somatized?

OBJECTIVE: To establish general practitioner (GP) ratings of the origins of their older patients' physical symptoms, and to test the hypothesis that those older patients rated as somatizing would have similar clinical characteristics to those found in studies of younger attenders. METHODS: A prospective study among older primary care attenders in two UK practices. All were rated for psychiatric disorder, physical illness, frequency of attendance and demographics. GPs rated degree of somatization on a 5-point scale. RESULTS: Almost three quarters of attenders were considered to have some psychological component to physical presentations, with 13.3% rated as primarily or entirely psychological. Frequent attendance, female gender and antidepressant prescription were associated with high somatization ratings, but depressive disorder was not. CONCLUSION: GPs consider somatization to be an important cause of physical presentations among older patients, especially among female frequent attenders.

Age Distribution↗
PubMed2004

Neuropathological substrates of psychiatric symptoms in prospectively studied patients with autopsy-confirmed dementia with lewy bodies.

OBJECTIVE: This investigation was undertaken to clarify the neuropathological substrates of key psychiatric symptoms in dementia with Lewy bodies. METHOD: The authors studied 112 autopsy-confirmed cases of dementia with Lewy bodies in patients who had had annual standardized clinical evaluations until their death. The relationships of persistent psychiatric symptoms (visual hallucinations, delusions, depression) to plaques (Consortium to Establish a Registry for Alzheimer's Disease protocol), tangles (Braak staging), and Lewy bodies (consensus Lewy body staging) were evaluated. In addition, symptom frequency and persistent symptoms were compared in the patients with Lewy body dementia and 90 patients with autopsy-confirmed Alzheimer's disease studied prospectively during life. RESULTS: The main neuropathological correlate of persistent visual hallucinations was the presence of less severe tangle pathology, but there was no significant association between tangle pathology and persistent delusions. Lewy body staging was associated with the presence of persistent visual hallucinations and persistent delusions. All baseline psychiatric features were significantly more frequent in dementia with Lewy bodies than in Alzheimer's disease, as were persistent visual hallucinations, but patients who had dementia with Lewy bodies and severe tangle pathology had a clinical symptom profile more similar to that of Alzheimer's disease patients and were less likely to have neocortical Lewy bodies. CONCLUSIONS: The modest proportion of patients with Lewy body dementia and more severe tangle pathology resembled Alzheimer's disease patients clinically. Unlike Alzheimer's disease, dementia with Lewy bodies showed a significant inverse association between tangle burden and psychosis.

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PubMed2004

A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the neuropsychiatric inventory median cutoff is a predictor of clinical outcome.

BACKGROUND: Although few placebo-controlled neuroleptic discontinuation studies have been conducted in people with dementia, such studies are essential to inform key clinical decisions. METHOD: A 3-month, double-blind, placebo-controlled, neuroleptic discontinuation study (June 2000 to June 2002) was completed in 100 care-facility residents with probable or possible Alzheimer's disease (according to National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria) who had no severe behavioral disturbances and had been taking neuroleptics for longer than 3 months. The Neuropsychiatric Inventory (NPI) was used to measure changes in behavioral and psychiatric symptoms. Quality of life was evaluated using Dementia Care Mapping. RESULTS: Eighty-two patients completed the 1-month assessment (36 placebo, 46 active). The number of participants withdrawing overall (N = 14 [30%] placebo, N = 14 [26%] active treatment) and because of exacerbation of behavioral symptoms (N = 6 [13%] placebo, N = 5 [9%] active treatment) was similar in the neuroleptic- and placebo-treated patients. As hypothesized, patients with baseline NPI scores at or below the median (< or = 14) had a particularly good outcome, with a significantly greater reduction of agitation in the patients receiving placebo (Mann-Whitney U test, z = 2.4, p =.018), while patients with higher baseline NPI scores were significantly more likely to develop marked behavioral problems if discontinued from neuroleptics (chi(2) = 6.8, p =.009). There was no overall difference in the change of quality of life parameters between groups. DISCUSSION: A standardized evaluation with an instrument such as the NPI may be a clinical indicator of which people with dementia are likely to benefit from discontinuation of neuroleptic treatment.

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PubMed2003

Ethics and dementia: mapping the literature by bibliometric analysis.

OBJECTIVES: This paper reports on a bibliometric analysis of keywords in the literature on ethics and dementia during the period 1980-2000. METHODS: Keywords were drawn from titles, abstracts and keyword fields of 14 bibliographic databases and clustered in to 19 categories. These categories were then examined for their frequency and co-occurrences. The strength of relationships between these categories is mapped using the metaphor of the 'night sky' showing constellations of issues and changes over time. RESULTS: Four categories appear consistently and frequently in the literature: professional care, end-of-life issues, decision-making and treatment. Other issues come and go (such as quality-of-life issues) while others appear to respond to outside events (e.g. feeding issues). The research literature is based predominantly on surveys or studies soliciting responses to predefined issues. Little research has been undertaken to establish the range of ethical issues for either family members or professionals. DISCUSSION: We discuss the domination of the literature by four categories of ethical issues, the new and emerging areas of ethical interest and those areas that are triggered by external events such as legal cases. We also discuss some of the limitations of the study and note some omissions in the literature. CONCLUSION: During the period 1980-2000 the research literature has been dominated by surveys and studies soliciting views on predefined issues with relatively few in-depth, open-ended qualitative studies.

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PubMed2002

The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study.

BACKGROUND: Little is known about grief experiences of individuals bereaved through suicide of older people. Legal procedures may be one source of distress. Studies have suggested that guilt feelings, and a sense of rejection, shame or stigma, are probably more frequent in relatives bereaved through suicide than in those bereaved through other modes of death. METHODS: We examined (a) problems experienced during legal procedures after death and (b) grief experiences, in 85 relatives and friends bereaved through the suicide of person 60 years old or over. In a case-control study the bereavement reactions in a subgroup of 46 people were compared with those of a control group bereaved by the natural death of an older person. Interviews, carried out 6-21 months after the deaths, included a semi-structured assessment of problems following the death, the Grief Experience Questionnaire (GEQ) and the Montgomery and Asberg Depression Rating Scale (MADRS). RESULTS: Thirty-six (42.4%) of those bereaved through suicide reported problems in their dealings with the coroner's office, and 33 (38.8%) described distress caused by media reporting of the inquest. Depression scores were similar in the group of individuals bereaved through suicide and those bereaved through natural causes. The former scored higher on subscales of the GEQ measuring stigmatisation, shame, sense of rejection and "unique reactions" compared with those bereaved through natural death. LIMITATIONS: The participation rate of potential subjects was somewhat low, especially in the control group. Proportions of different kinships to the deceased differed in the study and control groups. CONCLUSIONS: Problems in the media reporting of coroners' inquests and in inquest procedures are a frequent source of distress for bereaved relatives. The common themes of stigma, shame, and sense of rejection in bereavement after suicide suggest that these areas should be specifically addressed in the counselling of relatives bereaved in this way.

Adult↗
PubMed2002

Old age psychiatry and the law.

BACKGROUND: Old age psychiatry is no less subject to increasing legal and quasilegal restraint than other branches of the profession, but the emphases are different. Two themes predominate: first, that of capacity or competence; and second, to what extent formal legal measures should be implemented in cases where incapacitated patients do not dissent from, as opposed to giving active consent to, admission to hospital or receiving treatment. AIMS: To discuss the issues of capacity or competence, especially in relation to recent legislation and judgements and to proposed legislation in England and Wales. METHOD: Selective review and discussion of recent case law and current and proposed statute law. RESULTS AND CONCLUSIONS: The Bournewood case threatened but ultimately failed to upset the status quo. However, the European Convention on Human Rights and the British Human Rights Act 1998 may yet do so.

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