Atypical EEG abnormalities in children with benign partial (Rolandic) epilepsy.

In order to determine the borderlines of the benign partial epilepsy of children with centrotemporal spike foci ('Rolandic epilepsy') 43 patients with epilepsy and spike foci in the centrotemporal region or elsewhere drawn from the EEG files were re-evaluated as adults. The prognosis was equally good whether the spike focus was in the centrotemporal region or elsewhere, and synchronous paroxystic activity did not make the prognosis worse, but focal temporal low frequency activity did. It is suggested that borderline cases exist between 'Rolandic epilepsy' and other age dependent epilepsies.

Alteration of interhemisphere conduction through corpus callosum in chronic schizophrenia.

The contralateral and ipsilateral somatosensory evoked potentials (SEP) after stimulation of the right and left median nerve were recorded in 10 patients with chronic schizophrenia and in 10 normal subjects. The ipsilateral SEP depends on the function of the corpus callosum. The latency-delay from peak 5 in the contralateral SEP to the analogous peak in the ipsilateral SEP was significantly reduced in the patients, but only from the left to the right hemisphere. This peak presumably represents interhemisphere transfer and function of corpus callosum. The amount of synaptic activity--measured by the mean amplitude of the SEP--in the right hemisphere, relative to the activity in the left hemisphere after stimulation of the right median nerve, was also greater in the patients. These differences could be interpreted as an abnormal function of the corpus callosum and as a breakdown of the lateral specialization of the left cerebral hemisphere in schizophrenia.

[Psychopharmacological treatment of elderly patients with dementia. Recommendations and guidelines]. / Psykofarmakologisk behandling af demente aeldre. Forslag og retningslinier.

Behavioral-disturbed elderly patients with dementia are often treated with psychotropic drugs, frequently by doctors who only have sporadic contact with such cases. Knowledge concerning psychotic symptoms and behavioural disturbances in dementia has increased over the past years, as to a certain extent has the number of investigations of psychopharmacological therapy in demented patients. Based on results of controlled drug trials and empiric consensus among psychogeriatricians, recommendations and guidelines regarding indications for drug therapy and type of psychotropic drug suitable for the treatment of psychiatric problems in dementia are given.

[Inappropriate psychopharmacological treatment of the elderly. A 1-year study]. / Uhensigtsmaessig psykofarmakologisk behandling af aeldre. En årsopgørelse.

The psychogeriatric department in the county of Arhus is in a unique position to collect cases of old people treated with psychotropics in various inappropriate ways in hospital wards or by general practitioners. In 1991 the department was in contact with 768 elderly people mostly on an outpatient basis among whom 40 patients exhibited accumulated errors of psychopharmacologic treatment. The treatment episodes were analysed. The patients were very old (mean 80.8 years) with severe somatic morbidity. A majority were demented or delirious. 75% were living in nursing homes. The treatment episodes exhibited polypharmacy and large doses of neuroleptics (mean 0.7 DDD/day) or benzodiazepines (mean 1.41 DDD/day). Psychotropics not suitable for elderly patients were used in 34 patients. Indications for treatment were mostly unspecified behavioural disturbances, sometimes reflecting inappropriate social support. The majority of patients had side effects, sometimes rendering the patient more acceptable to staff and other residents.

[Use of psychopharmaceuticals in municipal nursing homes. A nationwide survey]. / Brug af psykofarmaka på kommunale plejehjem. En landsdoekkende undersøgelse.

In 32 nursing homes selected at random in the 16 counties in Denmark, the use of psychotropic medication was studied in all residents aged over 65 years (1454 persons) by interview of nursing staff and review of treatment records regarding drug group, dose, duration of treatment and target symptoms. Psychotropic prescriptions were recorded in 56% of the elderly. The frequency of residents receiving daily treatment with neuroleptics was 20% and for anxiolytics, hypnotics and antidepressants 13%, 33% and 11%, respectively. The duration of treatment was two to three years. The indications were mostly unspecified behavioural disturbances. The use reflects the high psychiatric morbidity in nursing home residents, especially regarding dementia. From what is known of therapeutic efficacy and side-effects, it is concluded that the prescription rate is too high, duration of treatment much longer than necessary and that drugs inappropriate for elderly are often used.

[Treatment of delirium in a psychogeriatric university hospital department. Etiology, treatment concept and outcome]. / Behandling af delirium på en gerontopsykiatrisk universitetsafdeling. Aetiologi, behandlingskoncept og behandlingsresultater.

The purposes of the study were to account for aetiology, treatment concept, outcome of treatment, and discharge destination of delirious elderly inpatients. During one year all patients in a psychogeriatric university department were assessed on admission and at discharge with a selection of assessments measuring psychopathology, behavioural disorders, depressive symptoms, intellectual functioning, activities of daily living, and gait. Diagnoses were made according to the ICD-10 criteria for research. All patients with a principal diagnosis of delirium (n = 26) are accounted for. Delirious patients improved their health status significantly in all the assessments, and 86% of patients admitted from independent living were discharged to independent living. It is concluded that elderly inpatients with severe or prolonged delirium profit significantly from the treatment concept in all of the rated health aspects.

[The admission and discharge patterns of patients with dementia in psychiatric hospitals]. / Demente patienters indlaeggelses- og udskrivningsmønster på psykiatriske hospitaler.

This paper describes the admission and discharge pattern in a psychiatric hospital for 315 senile and arteriosclerotic demented patients (290.09, 293.09 ICD-8) aged 65 years and over and admitted for the first time. 47% (149) of the patients were admitted from other hospitals and temporary stays in nursing homes. A total of 203 (65%) of the patients experienced one or more changes of residence during the three months prior to admission to the psychiatric hospital. A Kaplan-Meier analysis showed that 25% of the patients were still hospitalized 48 weeks after admission. A total of 62 patients died in the psychiatric hospital, one patient was still hospitalized when the investigation ceased. Of those discharged alive 201, (80%) were discharged to nursing homes 26 (10%) to their own homes and 25 (10%) to hospitals. Of those who had their own home at the time of admission and were discharged alive only 16% were discharged to their own homes, the remainder were discharged to nursing homes and hospitals. On account of the many changes of environment the demented patients experience prior to admission to the psychiatric hospital, they risk developing confusional psychoses which may be disastrous to their physical and mental health.

[Use of psychopharmaceuticals and commitment in psychiatric admissions of elderly patients with dementia]. / Brug af psykofarmaka og tvang ved psykiatriske indlaeggelser af aeldre demente.

Case records of 404 elderly patients (aged 65 years or more) who were admitted for the first time to the Psychiatric Hospital in Aarhus were investigated retrospectively. In 315 patients the diagnoses were senile dementia (290.09) and arteriosclerotic dementia (293.09) according to ICD-8. Information about use of psychotropic drugs before admission and on discharge alive was obtained from the patient case records. In the present study, the use of drugs was not found to be correlated with age, sex and degree of dementia. Significantly fewer committed patients were treated with psychoactive drugs and significantly fewer lived independently in their own homes. Only 42 (13%) patients had a crude psychiatric disorder while 251 (80%) were admitted on account of unacceptable behaviour. 90% of the latter group of patients had been treated with one or more psychoactive drugs on admission. The risks involved in the use of psychoactive drugs are discussed. On account of demographic changes in the Danish population and the recent decrease in psychiatric hospital beds and nursing home beds, it is recommended that the patterns of committed admissions of demented patients to psychiatric hospitals should be followed closely.

[Improvement of functional abilities after treatment of depression in the elderly]. / Funktionsforbedring ved behandling af depression hos aeldre.

During one year all patients with a diagnosis of depression in accordance with ICD-10, referred to a psychogeriatric department, were assessed at admission and discharge with a number of rating scales: The Brief Geriatric Depression Scale, Katz' ADL-index, the Multidimensional Dementia Assessment Scale, the Mini-Mental State Examination and the Functional Ambulation Classification. The department has an active stepwise treatment strategy: SSRI (selective serotonin reuptake inhibitor), potentiation with mianserin, lithium potentiation, ECT. The 87 depressive patients had a median age of 79 and most had one or more severe somatic conditions. Fifty-nine were severely depressed at admission, 19 at discharge; the number of functionally disabled dropped from 22 to seven and the number of cognitively impaired from 35 to 19. In conclusion, a nihilistic approach to treatment in the very old is unfounded.

[A symptom profile of hospitalization-requiring depression among the elderly related to clinical subgroups. A way to improve diagnostics]. / Symptomprofil ved indlaeggelseskraevende depression hos aeldre, relateret til kliniske undergrupper. En genvej til forbedret diagnostik.

UNLABELLED: The objectives were to study clinical symptoms of major depression in later life by using relevant assessment scales of psychopathology, behavioural disorders, and physical functioning. The evaluations on admission and at discharge were based on interdisciplinary observations and interview of patients. The study was carried out during twelve months in a psychogeriatric university department and encompassed 202 patients. All (N = 80) (40%) patients who had a principal diagnosis of major depression are accounted for. Mean age was 79.5 years. Results of the assessments all showed significant improvements (p = 0.0000-0.0024). The overall results of the assessments show that the key symptom of sadness is often missing, muted, or overshadowed by other symptoms, and that behavioural disturbancies and functional disability may be important symptoms in geriatric depression. IN CONCLUSION: adequate treatment of major depression in the elderly significantly improves psychopathology, behavioural disorders and physical functioning. When dealing with mental disorders in this age group, awareness of the five clinical presentations in major geriatric depression, i.e. dementoform, somatoform neurotiform, eretic and classic geriatric depression, may target the diagnostic procedure.

[Nursing home residents in Northern Jutland]. / Plejehjemsbeboere i Nordjylland.

The purpose of the study was to describe a Danish nursing home population. The study consists of 288 nursing home residents (median age 84.6 years, 68% females). The psychiatric morbidity of the residents was diagnosed with the GMS-AGECAT. The staff was interviewed about the residents' ADL, disturbing behaviour and therapeutic measures. Seventy-one percent had a psychiatric disorder, with organic disorder as the most frequent (61%). Demented residents received significantly less hypnotics, were more often physically restrained and had lower ADL levels compared to other residents. The situation in Denmark can be seen as a paradox. While substantial effort has been made to increase the possibility of choice and to "deinstitutionalize" nursing homes, the majority of the residents are demented and thus not capable of making valid choices.

[A clinic for the study of dementia--110 consecutive patients]. / Klinik for demensudredning--110 konsekutive patienter.

Case reports of 110 patients referred to a neurological dementia clinic were reviewed to evaluate a standardized diagnostic program. The patients were evaluated by a neurologist, a gerontopsychiatrist, and a neuropsychologist. ICD-10 criteria were used. Fifty-two patients had dementia while 58 had not; of these, 27 suffered from other non-dementia diseases and 31 were without dementia or other psychiatric or neurological disease. Thirteen patients with Alzheimer's disease were treated with tacrine. Four patients underwent cobalamin substitution treatment and seven started antidepressant medication. Ten patients received acetylsalicylic acid (150 mg Q.D.) and two a levo-dopa-type drug. Twenty-six patients were followed by gerontopsychiatric district care. Because only 47% of the patients suspected of dementia actually fulfilled dementia criteria, the evaluation suggests that patients suspected of dementia benefit from a standardized diagnostic program in a specialist setting.

[Prevalence of depressive disorders among frail elderly, assessed by psychogeriatricians, general practitioners and geriatricians]. / Praevalens af depressionssygdom blandt svage aeldre, vurderet ved gerontopsykiater, praktiserende laeger og geriater.

UNLABELLED: The prevalence of depressive disorders (D) in 70 years of age or older frail elderly was studied. Two hundred and eleven (81%) recipients of Municipal Home Help Service (frail elderly) in a rural area of Jutland were included and screened by the Geriatric Depression Scale-15 (GDS). If participants had: a) a GDS-score > or = 5 points or/and b) a history of depression, further evaluation was given by: 1) general practitioners (GPs) (implicit criteria), 2) a psycho-geriatrician (ICD-10 criteria), and 3) a geriatrician with the Hamilton Test for Depression. Prevalence rates for D among the evaluators: 15-18%. The diagnostic agreement was only fair. IN CONCLUSION: 18% of the studied population fulfilled the ICD-10 research criteria for depression. The GDS may help GPs in diagnosing depression among frail elderly. False GDS negatives, found among GDS negatives with a history of depression, should be evaluated thoroughly when identifying depression in the target group.