RESUMO
AIM: Carbon monoxide (CO) is a colorless, odorless gas and tasteless. CO poisoning (COP) is one of the most frequently encountered inhalation poisonings. The most common cause of morbidity in COP is delayed neurological sequelae (DNS). DNS is the occurrence of neuropsychiatric findings within 2-240â¯days after discharge of patients with COP and there are no definitive diagnostic criteria. The aim of our study is; to determine the risk factors and incidence of DNS. METHOD: Our study is a retrospective, observational study. Patients with the diagnosis of COP in the emergency department between 2015 and 2016 were included in the study. Patients age, gender, findings in the initial physical examination (PE) and neurological examination (NE), blood carboxyhemoglobin (COHb) level, relation between hyperbaric oxygen (HBO) treatment and DNS were assessed. RESULTS: Total of 72 patients were included in the study. Mean age was 33.43⯱â¯20.89. It was determined that pathological findings in the initial NE are a significant predictive factor for DNS (Odds ratio 18.600, p:0.004). Significant relation between NE and HBO treatment was present (p:00.1). There was no statistically significant relationship between initial COHb level and receiving HBO treatment (p:0.9). Median COHb level of patients with DNS was 30 (min:10, max: 43), median COHb level of patients without DNS was 25 (min:10, max:44) and there was no statistically significant relationship between the two groups according to COHb levels (p:0.7). CONCLUSION: Pathological findings in the initial neurological examination had a predictive value for delayed neurological sequelae in patients with carbon monoxide poisoning.
Assuntos
Intoxicação por Monóxido de Carbono/fisiopatologia , Carboxihemoglobina/metabolismo , Doenças do Sistema Nervoso/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atenção , Intoxicação por Monóxido de Carbono/metabolismo , Intoxicação por Monóxido de Carbono/psicologia , Intoxicação por Monóxido de Carbono/terapia , Criança , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Confusão/epidemiologia , Confusão/etiologia , Confusão/fisiopatologia , Confusão/psicologia , Feminino , Hospitalização , Humanos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Hiperfagia/epidemiologia , Hiperfagia/etiologia , Hiperfagia/fisiopatologia , Hiperfagia/psicologia , Lactente , Tempo de Internação , Masculino , Transtornos da Memória/epidemiologia , Transtornos da Memória/etiologia , Transtornos da Memória/fisiopatologia , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Rigidez Muscular/epidemiologia , Rigidez Muscular/etiologia , Rigidez Muscular/fisiopatologia , Rigidez Muscular/psicologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/psicologia , Exame Neurológico , Exame Físico , Equilíbrio Postural , Fatores de Risco , Transtornos de Sensação/epidemiologia , Transtornos de Sensação/etiologia , Transtornos de Sensação/fisiopatologia , Transtornos de Sensação/psicologia , Fatores de TempoRESUMO
BACKGROUND: Health and social care provision for an ageing population is a global priority. Provision for those with dementia and hip fracture has specific and growing importance. Older people who break their hip are recognised as exceptionally vulnerable to experiencing confusion (including but not exclusively, dementia and/or delirium and/or cognitive impairment(s)) before, during or after acute admissions. Older people experiencing hip fracture and confusion risk serious complications, linked to delayed recovery and higher mortality post-operatively. Specific care pathways acknowledging the differences in patient presentation and care needs are proposed to improve clinical and process outcomes. METHODS: This protocol describes a multi-centre, feasibility, cluster-randomised, controlled trial (CRCT) to be undertaken across ten National Health Service hospital trusts in the UK. The trial will explore the feasibility of undertaking a CRCT comparing the multicomponent PERFECTED enhanced recovery intervention (PERFECT-ER), which acknowledges the differences in care needs of confused older patients experiencing hip fracture, with standard care. The trial will also have an integrated process evaluation to explore how PERFECT-ER is implemented and interacts with the local context. The study will recruit 400 hip fracture patients identified as experiencing confusion and will also recruit "suitable informants" (individuals in regular contact with participants who will complete proxy measures). We will also recruit NHS professionals for the process evaluation. This mixed methods design will produce data to inform a definitive evaluation of the intervention via a large-scale pragmatic randomised controlled trial (RCT). DISCUSSION: The trial will provide a preliminary estimate of potential efficacy of PERFECT-ER versus standard care; assess service delivery variation, inform primary and secondary outcome selection, generate estimates of recruitment and retention rates, data collection difficulties, and completeness of outcome data and provide an indication of potential economic benefits. The process evaluation will enhance knowledge of implementation delivery and receipt. TRIAL REGISTRATION: ISRCTN, 99336264 . Registered on 5 September 2016.
Assuntos
Lista de Checagem , Confusão/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Geriatria/organização & administração , Fraturas do Quadril/terapia , Protocolos Clínicos , Confusão/diagnóstico , Confusão/psicologia , Estudos de Viabilidade , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Humanos , Recuperação de Função Fisiológica , Projetos de Pesquisa , Medicina Estatal/organização & administração , Fatores de Tempo , Resultado do Tratamento , Reino UnidoRESUMO
BACKGROUND: Auditory Hallucinations may arise from people confusing their own inner speech with external spoken speech. People with visual hallucinations (VH) may similarly confuse vivid mental imagery with external events. This paper reports two experiments exploring confusion between internal and external visual material. METHOD: Experiment 1 examined reality monitoring in people with psychosis; those with visual hallucinations (n = 16) and those without (n = 15). Experiment 2 used two non-clinical groups of people with high or low predisposition to VH (HVH, n = 26, LVH, n = 21). All participants completed the same reality monitoring task. Participants in Experiment 2 also completed measures of imagery. RESULTS: Psychosis patients with VH demonstrated biased reality monitoring, where they misremembered items that had been presented as words as having been presented as pictures. Patients without VH did not show this bias. In Experiment 2, the HVH group demonstrated the same bias in reality monitoring that psychosis patients with VH had shown. The LVH group did not show this bias. In addition, the HVH group reported more vivid imagery and particularly more negative imagery. CONCLUSIONS: Both studies found that people with visual hallucinations or prone-ness to such experiences confused their inner visual experiences with external images. Vivid imagery was also related to proneness to VH. Hence, vivid imagery and reality monitoring confusion could be contributory factors to understanding VH.
Assuntos
Confusão/psicologia , Alucinações/psicologia , Imaginação , Transtornos Psicóticos/psicologia , Teste de Realidade , Adulto , Estudos de Casos e Controles , Feminino , Alucinações/complicações , Humanos , Masculino , Transtornos Psicóticos/complicações , Adulto JovemRESUMO
There is currently no specific neuropsychological test assessing spatial orientation abilities, despite the fact that navigational deficits are heavily incapacitating in daily life. This lack of a specific test is probably due to theoretical vagueness of concepts in this field and important interindividual differences in spatial cognition. Here we propose a new standardized test assessing a fundamental component of spatial orientation-namely, mental imagery: Adequate mental visualization of the environment is indeed a necessary step in finding one's way. Two conditions of mental imagery were proposed to a group of 58 patients with a right cerebral lesion and to a control group (N = 117). The 1st condition assessed global, categorical imagery; the 2nd evaluated precise, metric imagery. We evaluated performance of the 2 groups in the 2 conditions and the impact of sociodemographic variables (age, gender, education). Results show that the right-lesioned patients presented difficulties in mental imagery, especially in the metric condition. Moreover, the data indicate a global impact of age and a milder effect of education on mental imagery abilities. Although sample sizes are sometimes small, preliminary normative data are given; already in the present form, they are usable and informative in assessing mental imagery, and more generally, spatial orientation, in a clinical practice.
Assuntos
Envelhecimento/psicologia , Confusão/diagnóstico , Imaginação , Testes Neuropsicológicos , Percepção Espacial , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Córtex Cerebral/patologia , Confusão/psicologia , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto JovemRESUMO
CONTEXT: Synthetic cannabinoid use has increased in many states, and medicinal and/or recreational marijuana use has been legalized in some states. These changes present challenges to law enforcement drug recognition experts (DREs) who determine whether drivers are impaired by synthetic cannabinoids or marijuana, as well as to clinical toxicologists who care for patients with complications from synthetic cannabinoids and marijuana. Our goal was to compare what effects synthetic cannabinoids and marijuana had on performance and behavior, including driving impairment, by reviewing records generated by law enforcement DREs who evaluated motorists arrested for impaired driving. METHODS: Data were from a retrospective, convenience sample of de-identified arrest reports from impaired drivers suspected of using synthetic cannabinoids (n = 100) or marijuana (n = 33). Inclusion criteria were arrested drivers who admitted to using either synthetic cannabinoids or marijuana, or who possessed either synthetic cannabinoids or marijuana; who also had a DRE evaluation at the scene; and whose blood screens were negative for alcohol and other drugs. Exclusion criteria were impaired drivers arrested with other intoxicants found in their drug or alcohol blood screens. Blood samples were analyzed for 20 popular synthetic cannabinoids by using liquid chromatography-tandem mass spectrometry. Delta-9-tetrahydrocannabinol (THC) and THC-COOH were quantified by gas chromatography-mass spectrometry. Statistical significance was determined by using Fisher's exact test or Student's t-test, where appropriate, to compare the frequency of characteristics of those in the synthetic cannabinoid group versus those in the marijuana group. RESULTS: 16 synthetic cannabinoid and 25 marijuana records met selection criteria; the drivers of these records were arrested for moving violations. Median age for the synthetic cannabinoid group (n = 16, 15 males) was 20 years (IQR 19-23 years). Median age for the marijuana group (n = 25, 21 males) was 20 years (IQR 19-24 years) (p = 0.46). In the synthetic cannabinoid group, 94% (15/16) admitted to using synthetic cannabinoids. In the marijuana group, 96% (24/25) admitted to using marijuana. Blood was available for testing in 96% (24/25) of the marijuana group; 21 of these 24 had quantitative levels of THC (mean + SD = 10.7 + 5 ng/mL) and THC-COOH (mean + SD = 57.8 + 3 ng/mL). Blood was available for testing in 63% (10/16) of the synthetic cannabinoid group, with 80% (8/10) of these positive for synthetic cannabinoids. Those in the synthetic cannabinoid group were more frequently confused (7/16 [44%] vs. 0/25 [0%], p ≤ 0.003) and disoriented (5/16 [31%] vs. 0/25 [0%], p ≤ 0.003), and more frequently had incoherent, slurred speech (10/16 [63%] vs. 3/25 [12%], p = 0.0014) and horizontal gaze nystagmus (8/16 [50%] vs. 3/25 [12%], p = 0.01) than those in the marijuana group. CONCLUSION: Drivers under the influence of synthetic cannabinoids were more frequently impaired with confusion, disorientation, and incoherent, slurred speech than drivers under the influence of marijuana in this population evaluated by DREs.
Assuntos
Condução de Veículo , Canabinoides/farmacologia , Cannabis , Crime , Abuso de Maconha/psicologia , Fumar Maconha/psicologia , Extratos Vegetais/farmacologia , Psicotrópicos/farmacologia , Detecção do Abuso de Substâncias/métodos , Canabinoides/sangue , Canabinoides/síntese química , Canabinoides/isolamento & purificação , Cromatografia Líquida , Confusão/induzido quimicamente , Confusão/psicologia , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Abuso de Maconha/sangue , Abuso de Maconha/complicações , Abuso de Maconha/diagnóstico , Fumar Maconha/efeitos adversos , Fumar Maconha/sangue , Nistagmo Patológico/induzido quimicamente , Extratos Vegetais/sangue , Extratos Vegetais/isolamento & purificação , Valor Preditivo dos Testes , Psicotrópicos/sangue , Psicotrópicos/síntese química , Psicotrópicos/isolamento & purificação , Estudos Retrospectivos , Percepção Espacial/efeitos dos fármacos , Inteligibilidade da Fala/efeitos dos fármacos , Espectrometria de Massas em Tandem , Adulto JovemRESUMO
Inferential confusion is an under-researched faulty reasoning process in obsessive-compulsive disorder (OCD). Based on an overreliance on imagined possibilities, it shares similarities with the extensively researched construct of thought-action fusion (TAF). While TAF has been proposed as a specific subset of the broader construct of magical thinking, the relationship between inferential confusion and magical thinking is unexplored. The present study investigated this relationship, and hypothesised that magical thinking would partially mediate the relationship between inferential confusion and obsessive-compulsive symptoms. A non-clinical sample of 201 participants (M = 34.94, SD = 15.88) were recruited via convenience sampling. Regression analyses found the hypothesised mediating relationship was supported, as magical thinking did partially mediate the relationship between inferential confusion and OC symptoms. Interestingly, inferential confusion had the stronger relationship with OC symptoms in comparison to the other predictor variables. Results suggest that inferential confusion can both directly and indirectly (via magical thinking) impact on OC symptoms. Future studies with clinical samples should further investigate these constructs to determine whether similar patterns emerge, as this may eventually inform which cognitive errors to target in treatment of OCD.
Assuntos
Confusão/psicologia , Magia/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Pensamento , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Lógica , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
It has been repeatedly demonstrated that mentally performing an action and mentally transforming body-parts entail simulation of one's own body movements, consistent with predictions of embodied cognition theories. However, the involvement of embodied simulation in mental transformation of whole-body images is still disputed. Here, we assessed own body transformation in Parkinson's disease (PD) patients with symptoms most affecting the left or the right body side. PD patients were required to perform left-right judgments on front-facing or back-facing human figures, and a letter rotation task. Results demonstrated that PD patients were selectively impaired in judging the side of back-facing human figures corresponding to their own most affected side, but performed as well as healthy subjects on mental transformation of front-facing bodies and on letter rotation. These findings demonstrate a parallel impairment between motor and mental simulation mechanisms in PD patients, thus highlighting the specific contribution of embodied cognition to mental transformation of whole-body images.
Assuntos
Imagem Corporal/psicologia , Lateralidade Funcional/fisiologia , Imaginação/fisiologia , Orientação/fisiologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Reconhecimento Visual de Modelos/fisiologia , Resolução de Problemas/fisiologia , Adulto , Idoso , Confusão/fisiopatologia , Confusão/psicologia , Discriminação Psicológica/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , RotaçãoRESUMO
BACKGROUND: Older adults in rehabilitation often experience barriers to exercise, which may impede recovery. Patterned sensory enhancement (PSE) is a neurologic music therapy intervention for sensorimotor rehabilitation. The use of live music during patterned sensory enhancement (live-PSE) may be particularly beneficial in meeting patient needs and improving older adults' exercise participation and mood during therapy. OBJECTIVE: To examine the effects of live-PSE on exercise output, exercise adherence, ratings of perceived exertion, and mood for 24 older adult inpatients in a rehabilitation facility attending a group exercise program. METHODS: Using a within-subjects design, results from sessions involving exercise instruction and live-PSE (experimental condition) were compared with sessions of exercise instruction alone (control condition). A logbook documenting participant comments and behaviors was also maintained. RESULTS: There were no significant between condition differences for the exercise outcome measures. Between condition session outcome measures for mood were non-significant for all profiles except confusion, which suggested that some participants might have become more confused during sessions with live-PSE. Unsolicited participant comments and behaviors recorded in the logbook indicated that 21 participants perceived experimental sessions positively, 2 reacted negatively, and 1 did not express any preferences. CONCLUSIONS: Live-PSE did not significantly improve exercise outcomes and there were indications of increased confusion during experimental sessions for some participants. However, participant comments and behaviors also suggested positive experiences during sessions with live-PSE Further research to investigate these discrepant results is warranted, and might best be explored using a mixed methods approach.
Assuntos
Afeto , Doença Crônica/psicologia , Doença Crônica/reabilitação , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Processos Grupais , Musicoterapia/métodos , Idoso , Confusão/psicologia , Feminino , Humanos , Masculino , Satisfação do Paciente , Esforço Físico , Resultado do TratamentoRESUMO
This qualitative study describes midwives' experiences in providing care in both pregnancy termination and childbirth in Japan. Midwives working in the general hospital maternity unit assist in both, which is an ethical issue warranting further exploration. Eleven midwives working in a general hospital were interviewed using a semistructured interview, and responses were coded using thematic analysis. Two major themes emerged: the experience of midwives involved in childbirth and pregnancy termination (three subthemes: confusion about care of the baby and aborted fetus, inability to cater to different mothers' needs, and establishing emotional control) and professional awareness and attitude as a midwife (three subthemes: consistency with professional principles, suppression of feelings in relation to aborted fetus, and previous and current professional identities). We found that midwives are isolated in this important social moral issue and its accompanying professional confusion. Suppressing their feelings remains the most common way of dealing with the ambivalence of the roles they fulfill. Improved working conditions and enhanced training on aspects of professional ethics would assist in reducing professional confusion.
Assuntos
Aborto Induzido/ética , Confusão/psicologia , Ética Profissional , Tocologia/ética , Parto/psicologia , Papel Profissional , Aborto Induzido/psicologia , Adaptação Psicológica , Adulto , Feminino , Humanos , Entrevista Psicológica , Japão , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Identificação Social , Estresse Psicológico , Adulto JovemRESUMO
Chordoid glioma of the third ventricle constitutes a rare, very recently recognized histological entity. Most reports of this neoplasm, focused on its distinct histological features, have hypothesized about a probable origin of the lesion at the third ventricle floor and/or the lamina terminalis. We report on a new case, presenting neuroradiological and intraoperative pictorial evidences of the tumoral attachment, limited to the chiasm-lamina terminalis junction. A 53-year-old woman debuted with acute symptoms of obstructive hydrocephalus, visual disturbances and confusion. MRI investigation showed a large solid-cystic third ventricle mass bulging through the lamina terminalis and ventricular floor. After placing a ventriculoperitoneal shunt, the tumor was completely removed through a trans-lamina terminalis approach. A tight tumoral attachment to the junction of the posterior chiasm to the lamina terminalis was identified and dissected. No other adhesions to the third ventricle boundaries were found. A chordoid glioma was diagnosed on histological examination. One year after the surgical procedure the patient does not present new neurological deficits, and there are no signs of tumoral regrowth on the follow-up postoperative MRI. Chordoid glioma should be included in the differential diagnosis of third ventricle tumors. Preoperative neuroradiological suspicion of this lesion should alert the neurosurgeon about the presence of a tight tumoral adherence at the level of the chiasm-lamina terminalis junction. The trans-lamina terminalis approach provides a suitable route for an early control of this attachment under direct vision, allowing a safe dissection of the mass from the third ventricle.
Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Glioma/cirurgia , Hipotálamo/cirurgia , Procedimentos Neurocirúrgicos , Quiasma Óptico , Neoplasias do Nervo Óptico/cirurgia , Terceiro Ventrículo , Neoplasias do Ventrículo Cerebral/patologia , Neoplasias do Ventrículo Cerebral/psicologia , Confusão/psicologia , Diagnóstico Diferencial , Feminino , Glioma/patologia , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Pessoa de Meia-Idade , Neoplasias do Nervo Óptico/patologia , Neoplasias do Nervo Óptico/psicologia , Derivação Ventriculoperitoneal , Transtornos da Visão/etiologiaAssuntos
Confusão/induzido quimicamente , Confusão/reabilitação , Fosfatidilcolinas/efeitos adversos , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/reabilitação , Adulto , Confusão/psicologia , Feminino , Hospitalização , Humanos , Injeções Subcutâneas , Lipólise , Obesidade/tratamento farmacológico , Fosfatidilcolinas/uso terapêutico , Transtornos Psicóticos/psicologiaRESUMO
INTRODUCTION: Previous source monitoring studies on schizophrenia reported an association between external source misattribution and hallucinations, but this is often not replicated. This inconsistency may be attributable to a failure in accounting for guessing parameters when computing source monitoring biases. METHODS: Fifty-one patients and 20 healthy controls were required to recall the source of items originating from external (computer and experimenter) or internal (the subject) sources. When statistically determined criteria were met, the appropriate counts of false positives were entered as covariates in the statistical analyses (analysis of covariance; ANCOVA) to exclude guessing from source monitoring bias measures. RESULTS: When comparing patients to controls, impairments on item recognition and source discrimination were observed. When comparing patient groups split on hallucinations, a bias towards attributing self-generated items to an external source was observed. A group difference on the externalisation bias was absent when the sample was split on delusions. CONCLUSIONS: A bias towards attributing self-generated items to an external source was associated with hallucinations. This ANCOVA methodology is recommended for source monitoring studies investigating group differences, and suggests that previously reported null results may be attributable to a failure in separating guessing and source monitoring measures.
Assuntos
Cultura , Delusões/psicologia , Alucinações/psicologia , Controle Interno-Externo , Transtornos Psicóticos/psicologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Localização de Som , Estimulação Acústica , Adulto , Confusão/psicologia , Sinais (Psicologia) , Delusões/diagnóstico , Feminino , Alucinações/diagnóstico , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Prisioneiros/psicologia , Resolução de Problemas , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Percepção da FalaRESUMO
The Hmong began arriving to the United States as refugees in the mid 1970s and constitute a growing number of the population. Little is known about the prevalence and care of dementia in Hmong elderly individuals. The purpose of this article is to discuss the traditional beliefs and treatment of tem toob (memory impairment) within the Hmong culture. This includes a discussion of the authors' encounters with Hmong herbalists in open-air markets during a journey in Laos and Thailand. A story cloth is then featured to discuss a shamanic healing ceremony for an elderly woman with tem toob. Nursing implications are discussed.
Assuntos
Demência/etnologia , Demência/enfermagem , Medicina Tradicional , Enfermagem Transcultural , Idoso , Confusão/etnologia , Confusão/enfermagem , Confusão/psicologia , Demência/psicologia , Humanos , Laos , Transtornos da Memória/etnologia , Transtornos da Memória/enfermagem , Transtornos da Memória/psicologia , Tailândia , Estados UnidosAssuntos
Aromaterapia , Transtorno Depressivo Maior/terapia , Massagem , Adulto , Cognição , Confusão/psicologia , Confusão/terapia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Projetos Piloto , Escalas de Graduação Psiquiátrica , Desempenho PsicomotorRESUMO
Several reports suggest a significant correlation between hand preference quotients and Magical Ideation Scale (MIS) scores, such that individuals with mixed preferences have higher MIS scores. In a sample of 156 male and 257 female undergraduate university students no significant correlation was found between MIS scores and hand preference; hand preference being defined in numerous ways, and using short and long hand preference questionnaires to assess handedness. An index of left-right confusion was significantly related to MIS score, but only in females. We suggest that the role of subjects' response style and general approach to filling out questionnaires should be fully explored before "neurological" causes of links between hand preference and other questionnaire-assessed behavioural variables are invoked.
Assuntos
Confusão/psicologia , Lateralidade Funcional , Magia , Pensamento , Adolescente , Adulto , Dominância Cerebral , Feminino , Humanos , Masculino , Orientação , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Psicopatologia , Valores de Referência , Estudantes/psicologiaAssuntos
Apraxias/diagnóstico , Transtorno Bipolar/diagnóstico , Transtornos Cognitivos/diagnóstico , Delírio/diagnóstico , Testes Neuropsicológicos , Encaminhamento e Consulta , Adulto , Apraxias/psicologia , Transtorno Bipolar/psicologia , Transtornos Cognitivos/psicologia , Confusão/psicologia , Delírio/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Three cases of elderly, institutionalised patients with problems relating to dementia and agitation and good response to homeopathic treatment are presented.
Assuntos
Confusão/tratamento farmacológico , Demência/complicações , Eczema/tratamento farmacológico , Homeopatia/métodos , Fitoterapia , Extratos Vegetais/uso terapêutico , Agitação Psicomotora/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Confusão/etiologia , Confusão/psicologia , Eczema/psicologia , Feminino , Humanos , Agitação Psicomotora/etiologia , Agitação Psicomotora/psicologiaRESUMO
OBJECTIVE: To define gender differences in noncognitive behavioral problems of patients with AD and differences in the associated treatment of those problems. DESIGN/METHODS: We performed an observational study using the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE) database, which contains data collected with the Minimum Data Set on a cross-section of nursing home residents in five US states. Behavior problems were documented at the first assessment of 28,367 residents with AD. We evaluated the role of gender differences in behavior as predictors of differences in nonpharmacologic versus specific pharmacologic therapies with psychoactive medications using logistic regression. RESULTS: Men were more likely than women to exhibit behavior problems such as wandering, abusiveness, and social impropriety (59% versus 50% for any behavior problem). Hallucinations and delusions as well as depression were equally prevalent in men and women. Nevertheless, men were more likely to receive psychoactive medications. Among the specific drug categories examined, and controlling for age and degree of cognitive impairment, men were more likely to receive antipsychotic drugs and less likely to be receiving antidepressants. CONCLUSION: Gender appears to play an important role in determining the frequency of behavioral problems in nursing home residents with AD, which may influence choice of treatments as well as the decision whether to treat. The use of more potent tranquilizers in men with problem behaviors has potential implications for morbidity, deserving further investigation.
Assuntos
Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/psicologia , Violência , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/psicologia , Confusão/tratamento farmacológico , Confusão/psicologia , Feminino , Alucinações/tratamento farmacológico , Alucinações/psicologia , Humanos , Masculino , Casas de Saúde , Padrões de Prática Médica , Fatores SexuaisRESUMO
In recent years there has been a growing awareness of the problems people living in rural areas of Australia face in accessing health-care services. In particular, those experiencing a critical illness or major trauma and requiring specialist critical care services, often available only in metropolitan areas, may require inter-hospital transportation, usually by air ambulance. Management of such patients aims at achieving physiological stabilisation, organising the transfer and communicating with the transport team. As critical care nurses espouse a holistic approach to care, it is imperative that nursing practice aim to meet all the needs of these people. Therefore, critical care nurses should be aware of what such patients are experiencing. A qualitative research study, using Heideggerian hermeneutic phenomenology, was undertaken to explore the experiences of a group of people from rural NSW with a critical illness that necessitated their transfer by air ambulance to a metropolitan critical care unit for further management. Data analysis from interviews with the study participants revealed four major themes. This paper discusses the findings from one such theme, the impact of interhospital transportation, and highlights the anxiety and confusion experienced by rural people transferred to a metropolitan critical care unit. Recommendations for nursing care that minimises this anxiety and confusion are discussed.
Assuntos
Atitude Frente a Saúde , Cuidados Críticos/psicologia , Cuidados Críticos/normas , Estado Terminal/psicologia , Hospitais Urbanos/normas , Transferência de Pacientes/normas , População Rural , Transporte de Pacientes/normas , Adulto , Idoso , Resgate Aéreo , Ansiedade/psicologia , Confusão/psicologia , Estado Terminal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Pesquisa Metodológica em Enfermagem , Inquéritos e QuestionáriosRESUMO
The usefulness of cognitive rehabilitative treatment in the acute stages after brain injury seems questionable because patients in severe acute confusional state early after coma clinically seem unable to learn and store new information. Therefore, the capability of patients in acute confusional state to learn and retain associative information was assessed. On two occasions pairs of simple nouns were presented to six patients in severe acute confusional state. Stimuli were presented repeatedly either in written form only or with additional pictorial representations. Immediate and 20 minutes delayed recall was measured. Patients in acute confusional state were able to learn progressively more word pairs across several presentations. They retained some information over an interval of 20 minutes. In addition, they learned and remembered pictorially supported associations better than pure verbal associations. Patients in severe acute confusional state may retain some explicit information and may profit from an imagery mnemonic aid. These results were not expected on the basis of clinical findings alone and they have potential implications for the care of patients in acute confusional state.