Mental illness, physical abuse and burden of care on relatives: a study of acute psychiatric admission patients.

As mental health care policies increasingly emphasize treatment and care in community settings, there has been concern over the burden that families of mentally ill people might suffer as a result. We conducted a study of the prevalence of abuse faced by relatives of patients admitted during a 6-month period to the acute psychiatric unit of a busy general hospital, who had previously been living with a relative. Patients and their relatives were assessed using semi-structured interview schedules. The experience of burden and the specific experiences of abuse since the onset of their relative's illness were recorded. In total, 32 (32%) of the 101 relatives had been struck on at least one or two occasions. Verbal abuse, threats and temper outbursts were reported by over 50% of the relatives. Principal correlates of abuse were diagnosis, concurrent drug misuse and a poor pre-morbid relationship between carer and patient.

Patterns of neuropsychological impairment in dementia of the Alzheimer type and multi-infarct dementia.

Patterns of performance on 22 neuropsychological tests were examined in 58 patients with presumed dementia of the Alzheimer type (DAT) and 58 patients with presumed multi-infarct dementia (MID). Few differences between patterns of performance in DAT and MID were found when overall level of performance was taken into account. Within the DAT group, there were some age-related differences in performance that in themselves might support other studies suggesting clinical and neuropathological differences between subtypes of DAT that are related in part to the age at which the condition occurs. However, similar age-related patterns were found in the MID group and the DAT and MID groups did not differ significantly in this respect. Considerable inter-individual variability in pattern of performance was apparent within each group. A proportion of patients were re-assessed 10 months after initial assessment: the extent of decline over time was not predictable from patients' characteristics or test performances at initial assessment. 'De-differentiation' in patterns of impairment, over time or with increasing severity of impairment, was not observed.

Schizophrenia, tardive dyskinesia and essential fatty acids.

Several reports have indicated that people suffering from schizophrenia show an associated abnormality in levels of certain essential fatty acids (EFAs) in blood cells. Similar abnormalities have also been noted in association with the presence of tardive dyskinesia (TD). In order to study this further, 72 patients with the diagnosis of schizophrenia or schizoaffective disorder were examined to assess the relationship between psychiatric status, movement disorder (TD) and relative levels of the n-3 and n-6 essential fatty acids in red blood cell membranes and plasma. Patients were followed up over the next 4.5 years to determine whether or not changes in clinical state showed any systematic relationship to changes in essential fatty acid levels. We hypothesised that patients with schizophrenia would show persistently lowered levels of n-6 and n-3 series essential fatty acids, compared with normal controls. We further hypothesised that this abnormality would be greater in the presence versus absence of TD and the dominance of negative rather than positive symptoms. The only consistent findings were that lower levels of linoleic acid and higher levels of dihomogamma-linolenic acid characterised the patient population compared with control subjects but there was considerable variability in patients' EFA profile.

The effect of inpatient respite care on elderly patients and their carers.

Fifty-eight carers and their dependents who received inpatient respite care were studied before and during the admission period. Although there was no observable improvement in the carers' emotional well-being the majority of the patients showed an improvement in functioning, particularly those who were being looked after by highly stressed carers. Many carers expressed a wish for more respite than they were currently offered, and some would have preferred a more flexible type of service.

The St. George's dementia bed investigation study: cardiovascular, neurological and neuropsychological correlates.

The results of the cardiovascular, neurological and neuropsychological examination of a series of patients admitted to the St. George's dementia investigation bed and who later came to postmortem are compared in relation to their pathological diagnosis. Individual clinical signs were not found to differentiate between cases of dementia with vascular versus those with Alzheimer's disease pathology, although multivariate analysis suggested that there was a pattern of signs associated with cerebrovascular disease. A vascularity index was constructed from these signs; it achieved a useful level of discrimination between vascular and nonvascular causes of dementia.

The St. George's dementia bed investigation study: a comparison of clinical and pathological diagnosis.

Sixty-four elderly patients who had been admitted to the St. George's Hospital Alzheimer's disease evaluation project during 1981-1989 were followed up to postmortem examination. Comparison between clinical diagnoses and neuropathological diagnoses indicated positive predictive values for the antemortem diagnoses of 50-67%. Existing clinical criteria may not be accurate enough to permit firm antemortem diagnosis of older people for either research or clinical purposes.

Signal-detection analysis of nonverbal recognition memory in dementia.

A signal-detection analysis was applied to performance on two non-verbal recognition memory tasks for 21 subjects with presumed dementia of the Alzheimer type, 19 subjects with presumed multi-infarct dementia, and 19 elderly depressed subjects. Performance was best for the depressed and worst for the Alzheimer subjects. Response bias did not differ significantly among groups. Within the depressed group, more impaired and older subjects were more conservative on one test. Correlations suggested that the sensitivity and response-bias measures may depend on the type of material used and so have limited generality.

Encoding preferences in memory in dementia.

Encoding preferences in memory were examined in 22 subjects with presumed dementia of the Alzheimer type (DAT), 22 subjects with presumed multi-infarct dementia (MID), and 19 elderly depressed subjects by means of multiple-choice recognition testing of memory for word lists where target words appeared in choice arrays amongst semantic, acoustic and unrelated distractor words. Performance was worse in dementia than in depression. Subjects with dementia tended to make many unrelated error choices, and in DAT this tendency was stronger in more impaired subjects; but there were no significant differences between groups in the proportions of different types of errors made.

A double-blind trial of essential fatty acid supplementation in patients with tardive dyskinesia.

This study reports the results of a trial of essential fatty acid (EFA) supplementation in psychiatric patients (predominantly schizophrenics) with movement disorders. Evidence of EFA deficiency in these patients was observed. The antidyskinetic effect of EFA supplementation was marginally significant but not clinically important. However, active treatment produced highly significant improvements in total psychopathology scores and schizophrenia subscale scores, and a significant improvement in memory.

Socioeconomic development and the status of elderly men in Turkey: a test of modernization theory.

The aim of this study was to test the predictions of modernization theory concerning the relationship between socioeconomic development and the status of elderly men in Turkish society. Using data derived from Turkish provincial census returns for 1980 and related material, we performed a series of principal component (PC) regression analyses on the data. The results indicated that a greater proportion of elderly men were classified as "head of household" in provinces characterized by low levels of urbanization and industrialization and with high village populations. Labor force participation rates of elderly men also demonstrated a negative relationship to the modernization variables. In contrast, measures of educational and high-level employment status showed a positive relationship with these indexes. These latter variables may reflect historical processes of development and achievements gained earlier in life rather than the current status of elderly men in Turkey. Thus, the study provides strong support for the major tenets of modernization theory.

Influence of emotional distress among supporters on the outcome of psychogeriatric day care.

From a sample of consecutive referrals for psychogeriatric day care, the influence of the supporters' emotional distress and self-reported strain, together with the number of problems presented by the patient, was examined in relation to outcome, 6-7 months after initial attendance. A higher level of problems and the failure to achieve any reduction in reported distress were both found to contribute to the breakdown of community care and to the subsequent institutionalisation of the patient. Day hospital care was associated with a significant reduction in emotional distress for the majority of relatives, although for relatives whose distress was not alleviated by their dependents' attendance, admission to long-term care did produce such a reduction.

Senile dementia and parietal lobe dysfunction.

Two samples of patients suffering from senile dementia were administered the Kew tests for parietal lobe function and aphasia. No evidence emerged of any clinical heterogeneity; parietal lobe test performance was found to be more a function of degree of impairment rather than of age.

Mood, memory, and motor performance and the severity of tardive dyskinesia.

This study tested the hypothesis that the features of tardive dyskinesia were associated with motor slowing, memory impairment, and depressive apathy all of which are considered to characterize the so-called subcortical dementias. In a sample of 48 psychiatric patients all fulfilling research criteria for tardive dyskinesia and without other signs of organic illness age-independent correlations were observed between severity of orofacial dyskinesia and measures of memory, motor performance and mood providing some empirical support for the hypothesis.

Psychometric prediction of psychogeriatric day care outcome.

A comparison was made between sets of psychometric variables [the Clifton Assessment Procedures for the Elderly (CAPE)] and personal socio-demographic variables in predicting the outcome of psychogeriatric day care. Two groups of elderly patients referred for day care were investigated: 40 new admissions to a psychogeriatric day centre and 63 new admissions to psychogeriatric day hospitals. Discriminant function analysis was employed to compare the classification accuracy obtained from the personal socio-demographic variables and the CAPE psychometric data. The results demonstrated the incremental validity of the CAPE in predicting outcome of day care in both settings and support the routine use of such brief measures as appropriate screening procedures in these settings.

Estimation of premorbid intelligence in dementia.

Thirty elderly subjects with dementia were assessed using a neuropsychological test battery. Using four cognitive and behavioural measures of severity of dementia, no significant relationships between National Adult Reading Test (NART) or Mill Hill Vocabulary Scale synonym section (MHVS) scores and severity were observed. The NART and MHVS correlated with each other to a highly significant degree. No differences were observed on any of the measures when patients with Alzheimer's disease were compared with those adjudged to have multi-infarct dementia. These results are discussed in relation to the existing literature on the estimation of premorbid intelligence in dementia.

Family attitudes to caring for the elderly mentally infirm at home.

Attitudes towards care-giving were examined in a sample of 129 supporters of elderly mentally infirm patients referred for psychogeriatric day care. As in previous studies, spouses felt more commitment to care-giving than other relatives. Commitment to care-giving was influenced by different factors in adult children and spouses, but consistently predicted subsequent decisions to institutionalize the dependant. Following institutionalization, most supporters felt relieved. They tended to perceive the decision to have been made by others, and to have resulted from a deterioration in their dependents' mental condition, rather than a failure of the care-giving relationship.

A controlled trial of prostaglandin E1 precursor in chronic neuroleptic resistant schizophrenic patients.

The postulated deficiency of prostaglandin E1 series (PGE1) in schizophrenia has been investigated in a controlled therapeutic trial. Twenty-one inpatients with a schizophrenic illness resistant to neuroleptic drug treatments were randomly assigned to one of three treatment conditions in a blind controlled trial of dihomo-gammalinolenic acid (DHLA), a PGE1 precursor. Patients received depot neuroleptic medication and DHLA capsules, placebo depot medication and DHLA capsules, or placebo depot medication and placebo capsules. No marked treatment effects were noticed on ratings of the patients' behaviour or symptomatology, though some clinical effects were noted in dyskinetic patients. Abnormalities in red blood cell lipids were observed in the patients entering the trial, suggesting that further investigation of an EFA/prostaglandin deficiency hypothesis in schizophrenia is worth pursuing.