Characteristics of elderly people using the psychiatric emergency system.

We investigated the differences between elderly and under-65-year-old patients using the psychiatric emergency system. The following characteristics were more common in elderly patients than in younger patients: organic mental disorder, mood disorder, dementia, disturbed consciousness, no excitation, physical complications, no history of visiting a psychiatrist and no history of hospitalization. In addition, significantly more elderly patients with mood disorder attempt suicide.

Moderate hyperventilation prolongs electroencephalogram seizure duration of the first electroconvulsive therapy.

Although it is controversial that seizure duration can influence the efficacy of electroconvulsive therapy (ECT), a missed or brief seizure is considered less effective ECT. Of the background in the practice of ECT, hyperventilation may augment the seizure duration. To elucidate these hypotheses, we performed double-blind randomized controlled trial for 19 patients. They were divided into 2 groups, according to the end-tidal pressure of carbon dioxide (ETCO2): The moderate hyperventilation group with ETCO2 of 30 mm Hg and the normal ventilation group with ETCO2 of 40 mm Hg. ECT was performed under general anesthesia with propofol and suxamethonium. During ECT electroencephalogram (EEG) and electromyogram were recorded. The Global Assessment of Functioning scores were also analyzed before and after 6 sequential ECT. The moderate hyperventilation group showed a significant increase in EEG seizure duration in the first treatment compared with the normal ventilation group (P < 0.05). However, EEG seizure duration in the subsequent treatments and electromyogram seizure duration in all the treatments did not differ between 2 groups. The moderate hyperventilation did not prevent the increase in seizure threshold or shortening of seizure duration. No complications or sever adverse effects were observed after ECT in any of the 6 treatments. The Global Assessment of Functioning scores were not significantly changed with moderate hyperventilation. We conclude that moderate hyperventilation is safe and may be useful for seizure augmentation before the restimulation with higher intensities.

The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment.

BACKGROUND: Cognitive factors associated with drinking behavior such as positive alcohol expectancies, self-efficacy, perception of impaired control over drinking and perception of drinking problems are considered to have a significant influence on treatment effects and outcome in alcohol-dependent patients. However, the development of a rating scale on lack of perception or denial of drinking problems and impaired control over drinking has not been substantial, even though these are important factors in patients under abstinence-oriented treatment as well as participants in self-help groups such as Alcoholics Anonymous (AA). The Drinking-Related Cognitions Scale (DRCS) is a new self-reported rating scale developed to briefly measure cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment, including positive alcohol expectancies, abstinence self-efficacy, perception of impaired control over drinking, and perception of drinking problems. Here, we conducted a prospective cohort study to explore the predictive validity of DRCS. METHODS: Participants in this study were 175 middle-aged and elderly Japanese male patients who met the DSM-IV Diagnostic Criteria for Alcohol Dependence. DRCS scores were recorded before and after the inpatient abstinence-oriented treatment program, and treatment outcome was evaluated one year after discharge. RESULTS: Of the 175 participants, 30 were not available for follow-up; thus the number of subjects for analysis in this study was 145. When the total DRCS score and subscale scores were compared before and after inpatient treatment, a significant increase was seen for both scores. Both the total DRCS score and each subscale score were significantly related to total abstinence, percentage of abstinent days, and the first drinking occasion during the one-year post-treatment period. Therefore, good treatment outcome was significantly predicted by low positive alcohol expectancies, high abstinence self-efficacy, high perception level of impaired control over drinking, and high perception level of drinking problems measured by DRCS. CONCLUSIONS: The DRCS was considered to have satisfactory predictive validity, which further supports our previous findings. It was suggested that DRCS is a promising rating scale for evaluating multidimensional cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment.

Assessing multidimensional cognitions of drinking among alcohol-dependent patients: development and validation of a drinking-related cognitions scale (DRCS).

The aim of this study is to develop and validate the Drinking-Related Cognitions Scale (DRCS). The DRCS is a brief measure designed to assess multidimensional cognitions of drinking, including perception of drinking problems, perception of impaired drinking control, readiness to change, decisional balancing, and self-efficacy in alcohol-dependent patients. This study was carried out in Japan, with 132 alcohol-dependent patients (mean age (SD): 49.4 (7.5) years) admitted to an inpatient treatment program. On the basis of prior studies of the rating scales of drinking-related cognitions, DRCS items were selected. Factor analysis was carried out to assess the selection of DRCS items and the factor structure. The factor analysis of the 15 DRCS items showed three factors, "expectancy and resignation," "perception of impaired control," and "perception of drinking problem." The DRCS showed good reliability (Cronbach's alpha-coefficients for the entire scale and subscales were 0.80 or higher, and the analysis of variance intraclass correlation coefficient for the test-retest method was 0.81 for the total score). The total DRCS and subscale scores predicted abstinence status at a 3-month follow-up, and the DRCS was considered to have satisfactory predictive validity. It was suggested that the DRCS would be useful for the easy measurement of multidimensional cognitions of drinking in alcohol-dependent patients.