A group therapy project with parents of behavior problem children in public schools.
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This study was part of an 8-year follow-up study of the Epidemiological Multicenter Child Psychiatric Study in Finland. The Child Behavior Checklists (CBCLs) were analyzed for 598 15- to 16-year-old adolescents living in the southwestern area of Finland in 1997. The internal consistency of the CBCL syndrome scales was adequate (the alpha coefficient ranged from 0.66 to 0.89). The CBCL scores differentiated between non-referred adolescents and adolescents who had been referred to the mental health service or had severe problems according to the parents. Boys had more externalizing problems than girls in the maladjustment group. Girls had more somatic symptoms in the maladjustment group than boys.
Dementia is the most common reason for nursing home placement, and related behavioral symptoms are the primary factors precipitating the decision. Disruptive behaviors such as depression, sleep disturbance, agitation, aggression, and psychosis can tax family members' abilities to care for a loved one who has reached that stage of the illness. Working with families to institute effective management strategies may help delay institutionalization. In this article, Drs Burke and Morgenlander present a systematic approach to identifying and treating common problems in dementia.
Although a variety of potential alternatives to the neuroleptics in the management of agitated behavior in Alzheimer's disease exist, more large, well-controlled studies are needed. At present, neuroleptics remain the standard treatment for this problem. It is also important for the clinician to investigate thoroughly underlying instigators of behavior change in Alzheimer's patients, such as delirium, anxiety, depression, or environmental factors, and target treatment to these disorders.
Aging pets often suffer a decline in cognitive function (eg, memory,learning, perception, awareness) likely associated with age-dependent brain alterations. Clinically, cognitive dysfunction may result in various behavioral signs, including disorientation; forgetting of previously learned behaviors, such as house training; alterations in the manner in which the pet interacts with people or other pets;onset of new fears and anxiety; decreased recognition of people, places, or pets; and other signs of deteriorating memory and learning ability. Many medical problems, including other forms of brain pathologic conditions, can contribute to these signs. The practitioner must first determine the cause of the behavioral signs and then determine an appropriate course of treatment, bearing in mind the constraints of the aging process. A diagnosis of cognitive dysfunction syndrome is made once other medical and behavioral causes are ruled out.
We studied the sleep characteristics of 108 outpatients with probable Alzheimer's disease and found that sleep disturbance was significantly related to daytime behavioral disturbance but not to cognitive impairment. Possible treatment strategies and neuropathological and neurochemical mechanisms are discussed.
BACKGROUND: In addition to cognitive decline, 30% to 40% of patients with Alzheimer's disease (AD) experience concomitant psychiatric and behavioral complications, such as hallucinations, delusions, and aggression. Atypical antipsychotics (AAs) are used to treat psychosis and aggressive behaviors in these patients; however, data regarding their early effects on cognition are conflicting. Based on a literature search, the cognitive effects of long-term treatment with AAs in outpatients with AD have not been studied. OBJECTIVE: The aim of this study was to describe and compare the rate of cognitive decline with longterm AA use in adult patients with AD receiving concomitant treatment with cholinesterase inhibitors. METHODS: This study was conducted at the Department of Neurology, The Ohio State University, Columbus, Ohio. Data were collected from the charts of adult outpatients who (1) received care at Memory Disorders Clinic, Columbus, Ohio, between April 2003 and June 2005; (2) were aged > or =55 years with a diagnosis of mild to severe definite or probable AD; (3) received an AA for > or =6 months or did not receive any AA; and (4) received a cholinesterase inhibitor during the entire evaluation period. Cognitive function, as measured using the Mini-Mental State Examination (MMSE), was compared between those who received AA treatment and those who did not. The end point was the rate of decline in cognitive function, defined as annualized change in mean MMSE score from baseline to the end of follow-up. RESULTS: Ninety-two outpatients were included in the final analysis (67 women, 25 men; mean age, 72.4 years). Thirty-four patients received treatment with an AA for 6 > or =months (mean duration of treatment, 421 days) and 58 did not receive any AA treatment. Quetiapine (mean dose, 67 mg/d) was prescribed to 28 (82 %) of the patients receiving an AA. The AAs were prescribed for psychosis (15 [44%] patients), psychosis/agitation (11 [32%]), and agitation/aggression (8 [24%]). The baseline mean MMSE scores in patients receiving and not receiving an AA were 14.65 and 17.88, respectively (P = 0.021), with mean (SD) annual rates of cognitive decline of 3.03 (1.84) and 2.24 (1.27), respectively (P = NS). CONCLUSION: The results from this retrospective study of data from a small, selected group of outpatients with AD did not find a significant difference in the rate of cognitive decline between those who received an AA for > or =6 months and those who did not.
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