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PubMed1975

Information leading to accurate diagnosis in the elderly.

Psychiatric diagnosis in the elderly has been examined in order to extract the information which leads to later modification of the diagnosis. Initial diagnoses of neuroses and toxic states were least stable, 14 out of 29 changing to a different category. Information from relatives and further interviews contributed most to the modification of the initial diagnosis, though affective and neurotic syndromes were particularly susceptible to change resulting from conceptual differences, and dementia to change consequent on physical examination. It is concluded that an adequate initial interview of a patient and his next of kin will achieve a diagnosis which is correct in its major category on 95 per cent of occasions.

Age Factors↗
PubMed1975

The assessment and progress of long-stay and elderly psychiatric patients: the predictive validity of a ward behaviour questionnaire.

This paper describes an attempt to validate a behaviour rating scale used to predict the likelihood of discharge among elderly and long-stay patients in a psychiatric hospital. The scale measured behaviour on the ward as rated by nursing staff. The scale was a sensitive predictor of discharge among those with a low score (indicating least disability), except for patients with organic psychoses. However, many patients with low scores were not discharged. In order to improve the scale's use as a screening technique additional information was considered. The significance of the findings is discussed.

Activities of Daily Living↗
PubMed1977

Diagnosis 'uncertain': a follow-up study.

During a ten year study, 10% of patients at a general hospital in-patient unit had unsolved diagnostic problems at the time of discharge from hospital. These 132 cases were designated 'uncertain' and were followed up. Eighty-three patients were ultimately diagnosed, and 300 consecutive in-patients discharged from the same unit with a definite diagnosis were also studied. The clinical features and diagnoses of the two groups were compared. Special features associated with uncertainty were: a presenting complaint of pain; apathy without apparent mental or physical cause; hallucinosis or major paranoid symptoms without other good evidence of psychosis. Age was found to be relevant; compared with patients receiving confident diagnoses, those with uncertain diagnosis due to depressive psychosis were more often younger, while those due to neurosis or personality disorder tended to be older. Atypical psychotic depression was the condition most commonly associated with diagnostic doubt.

Age Factors↗
PubMed1982

Psychiatric morbidity and time zone changes: a study of patients from Heathrow airport.

In a two-year period, 186 patients were admitted from Heathrow Airport to the nearest psychiatric hospital. Affective illness was related to time zone change. Depression was diagnosed significantly more often on flights from east to west (P less than 0.012 east to west versus west to east; P less than 0.015 north to south combined with south to north versus east to west, Fisher's exact probability test, two tailed). Hypomania was inversely related to depression in an east to west comparison (P less than 0.025). No other associations with direction of travel were seen in other diagnoses. Ninety-three (50 per cent) were diagnosed as schizophrenic; 24 of these had been aimlessly wandering. Twenty patients had been admitted at least once before under similar circumstances. Schizophrenic patients from Heathrow constituted 20 per cent of the total number of schizophrenic patients admitted to the hospital during that period.

Aircraft↗
PubMed1982

Evaluation of different forms of community meeting in a psychiatric unit in Hong Kong.

In an in-patient psychiatric unit attached to a teaching general hospital in Hong Kong, community meetings went through doctor-directed and nurse-directed forms to develop into a non-directive one. The therapeutic value of these different forms was tested by retrospective and prospective studies. In the retrospective study the rates of ward incidents and discharge rates of in-patients before and during the three stages were compared. In the prospective study an ABA design was used with ten-week blocks of regular non-directive meetings, cessation of meetings and then resumption; ward incidents, discharge rates and ward atmosphere during these blocks were compared. Both the non-directive and nurse-directed forms were equally associated with a reduction in ward incidents, aggressive incidents showing the greatest tendency to change; ward atmosphere and patient discharge rates did not change with community meetings.

Evaluation Studies as Topic↗
PubMed1984

Clinical use of the DST in a psychogeriatric population.

The dexamethasone suppression test (DST) was administered to 95 patients referred to a psychogeriatric assessment service. Non-suppression of plasma cortisol was found in 28 out of 48 patients (58%) with senile dementia and all patients with arteriosclerotic dementia or acute confusional states. Non-suppression could not be explained by associated depressive symptoms. The DST was confirmed as a valid diagnostic test for endogenous depression in the elderly, but its value in distinguishing true dementing illnesses from depressive pseudodementia was not supported. The clinical implications of these findings for interpreting DST results in the elderly are discussed.

Aged↗
PubMed1986

Mortality and facial dyskinesia.

In 1965 a psychiatric in-patient population was surveyed for the prevalence of facial dyskinesia. The present investigation reports on their survival time. Among male and female patients with functional disorders (mostly schizophrenia) there was a strong association between moderate or severe facial dyskinesia and shortened survival, but no clinical factors were found to explain this. Mild facial dyskinesia in functional disorders was not associated with reduced life expectancy and may be attributable to the general effects of ageing rather than to a specific pathological process. Among patients with primary organic brain syndromes, dyskinesia was not associated with reduced life expectancy.

Aged↗