Characteristics of animal hoarding cases referred to the RSPCA in New South Wales, Australia.

OBJECTIVE: To describe the characteristics of animal hoarding in New South Wales, Australia. DESIGN: Cross sectional study of consecutive referred cases. METHODS: Files of animal hoarding cases referred to RSPCA NSW in 2013-15 were examined. Details concerning animal hoarding cases and supportive services, living conditions and factors believed to have contributed to animal accumulation were recorded. Data were analysed. RESULTS: Data were available regarding 48 properties where 50 persons (78% female) were found to be hoarding animals. Most were over 50 years of age; 40% lived alone; 15 (30%) had contact with mental health services and/or community social services. Animal hoarders were categorised as 'breeders' (30%), 'overwhelmed caregiver' (24%), 'rescuers' (22%), 'exploiters' (10%) or 'incipient hoarders' (14%); 24% were associated with animal rescue networks. Accumulation of animals was attributed most commonly to unplanned breeding (60% of properties) and collecting strays (38%). Other reasons for accumulation included receiving donations of animals and planned breeding; in 38% of cases there was only one identified reason. The median number of animals was 35 (range, 6-300), with cats hoarded on 75% of properties and dogs on 52%. In 75% of cases, the living conditions of animals were rated as 'very unsanitary' or 'filthy'. CONCLUSIONS: This study provides reasons for recommending increased regulatory control of companion animal breeding and management, and training and support for veterinarians to help reduce the human and animal suffering caused by animal hoarding. There is widespread agreement that psychiatric and personality problems underlie cases of animal hoarding. Closer links between animal welfare organisations and mental health services are desirable.

Investigation of Alzheimer's disease-related pathology in community dwelling older subjects who committed suicide.

BACKGROUND: Older people have a higher risk of completed suicide than any other age group worldwide. The contribution of neurodegenerative disease to this risk remains controversial. AIMS: To investigate prevalence of Alzheimer's disease-related (AD) pathology in older suicide victims. METHODS: Ratings of AD pathology using Braak and CERAD protocols were compared in 143 community-dwelling suicide victims aged 65 years or more and 59 motor vehicle accident victims autopsied at the request of an Australian Coroner's Court. RESULTS: There were no significant differences in plaque score or neurofibrillary tangle staging between suicide and control groups. None of the subjects with a history of dementia had neuropathologically confirmed AD. CONCLUSIONS: Our study is the second and largest investigation of the prevalence of AD neuropathology in the elderly suicide population. Unlike the previous study, we did not find an increased prevalence of AD neuropathology despite a history of dementia in 6.3%, implicating other pathologies such as Lewy Body or Vascular dementia in the aetiology of dementia in elderly suicide victims.

A comparison of the efficacy and safety of olanzapine and risperidone in the treatment of elderly patients with schizophrenia: an open study of six months duration.

BACKGROUND: Following an earlier study in which elderly patients with schizophrenia had their typical antipsychotic medication changed to olanzapine or risperidone, the 61 patients were followed for up to a further six months to see if either treatment was superior in terms of efficacy or side effects. AIMS: To determine whether either olanzapine or risperidone was superior in terms of efficacy or side effects when treating schizophrenia in late life. METHODS: Psychiatric symptoms, side effects and quality of life were rated every six weeks for 24 weeks of open label comparative treatment using standard measures. Group differences were examined using analysis of covariance and within-group changes over time were assessed using paired t-tests. RESULTS: There were 34 olanzapine and 32 risperidone patients who entered the study, but intention to treat data was only available for 61 of the 66 patients. There were no clinical or demographic differences between the groups. Parkinsonism, positive and negative symptoms of schizophrenia improved in both groups both from baseline switch to olanzapine or risperidone and during the six month follow-up after completion of crossover. No significant differences were seen between groups on most measures. However, patients treated with olanzapine showed a significantly greater improvement in quality of life from baseline compared to risperidone patients. CONCLUSIONS: Both drugs were well tolerated and their use was associated with fewer symptoms of schizophrenia and less adverse effects than were seen when the patients were taking a typical antipsychotic at baseline. Olanzapine appears to have particular benefit with regard to quality of life.

A neural-network packet switch controller: scalability, performance, and network optimization.

We examine a novel combination of architecture and algorithm for a packet switch controller that incorporates an experimentally implemented optically interconnected neural network. The network performs scheduling decisions based on incoming packet requests and priorities. We show how and why, by means of simulation, the move from a continuous to a discrete algorithm has improved both network performance and scalability. The system's limitations are examined and conclusions drawn as to its maximum scalability and throughput based on today's technologies.

Age, period and cohort effects on suicide rates in Australia, 1919-1999.

OBJECTIVE: To examine age, period and cohort effects on Australian suicide rates. METHOD: Male suicide rates for successive 5-year periods between 1919 and 1998, and for 1999 were displayed graphically to examine interactions between age, period and cohort effects. RESULTS: There has been a pronounced period effect on male suicide rates in all age groups over the last few decades, with lower rates in wartime and peak rates for most cohorts in the 1960s. Peak rates of all adult female 5-year age cohorts occurred in the 1960s or early 1970s. CONCLUSION: Most so-called cohort effects appear to be associated with environmental changes that may not be a function of the cohort itself. While much attention has focused on the rising suicide rates in young males in Australia, local media and health authorities have given little emphasis to the high rates found in elderly males.

Pharmacological treatment of cognitive deficits in Alzheimer's disease.

Clinical trials and independent reviews support the use of cholinesterase inhibitors for treating the symptoms of patients with mild to moderate Alzheimer's disease (AD). Before initiating cholinesterase inhibitor therapy, patients should be thoroughly assessed, and the diagnosis confirmed, preferably by a specialist. Compliance with cholinesterase inhibitor therapy should be monitored and the response (in global, cognitive, functional and behavioural domains) reassessed after 2-3 months of treatment. Vitamin E may be protective against AD, and therapy with 1000 IU twice daily may be considered. There is insufficient evidence to support the use of other antioxidant agents, anti-inflammatory agents, monoamine oxidase B inhibitors, folate/homocysteine or antihypertensive drugs in patients with AD, or hormone replacement therapy in affected women.

The prevalence and outcome of depression and dementia in Botany's elderly population.

BACKGROUND: Large epidemiological studies of adult populations have reported depression to be less prevalent in old age than among younger adults, whereas studies limited to older persons have reported rates that vary considerably, some showing high rates of depression. There was, therefore, reason to check data from a study that reported high rates, and to review evidence in relation to diagnosis and outcome. METHOD: Re-examination of data from a 1985 survey of elderly people living at home (n = 146). Depression and cognitive impairment were also assessed in a local hostel (n = 42) and nursing home (n = 74). DSM diagnoses were made by an old age psychiatrist. In the nursing home, 23 other residents could not respond to interview questions but were considered to have severe dementia. Subjects in all three settings were followed up after 4 years. RESULTS: Seven community subjects (4.5%; confidence interval 1.3-8.3%) and three in residential care fulfilled criteria for major depression. The estimated total prevalence of depressive disorders among elderly in Botany was between 13.0 and 13.6% (4.6% major depression, 3.6% dementia with depression, 5.4% other depressive disorders). In 1985, the prevalence of dementia among those living at home was 11%. Four-year mortality in the dementia cases was 60%. CONCLUSIONS: Botany has a high prevalence of dementia and depression among elderly people. The recent cross-age. Australian study of mental health and well-being provided an inaccurate report concerning the pattern of mental disorders in old age.

Is depression more prevalent in old age?

OBJECTIVE: To examine the prevalence of depression in old age and to review cross-age studies that reported age-related differences in prevalence. METHOD: Reports of studies that included data on the prevalence of depression in old age were reviewed, and conclusions from review articles were considered. RESULTS: Findings have been inconsistent, but majority opinion holds that depression (especially 'subsyndromal') is common in old age. There may be two peaks in the prevalence rate of major depression, one in late old age and the other in middle age or earlier. CONCLUSIONS: The allocation of health care resources should not be determined by survey findings concerning the prevalence of major depression and dysthymia.

How to help depressed older people living in residential care: a multifaceted shared-care intervention for late-life depression.

OBJECTIVE: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. SETTING: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). PARTICIPANTS: The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents whowere eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. INTERVENTION DESCRIPTION: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) training for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. CONCLUSIONS: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed residents are substantial.

Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior.

The aim of this study was to identify factors associated with vocally disruptive behavior (VDB) in nursing home patients referred to aged care services for treatment, using a case-control methodology. Characteristics of the VDB, reasons for referral, perceived causal factors, and psychotropic use were noted. Twenty-five subjects and controls were examined with the Screaming Behavior Mapping Instrument, the Cornell Scale for Depression in Dementia, the Dementia Behavior Disturbance Scale, and measures of cognition, functional capacity, social activities, and emotional reactions of nursing staff. VDB was associated with other disturbed behaviors, depression, anxiety, severe dementia, functional impairment, communication difficulties, use of psychotropic medication, social isolation, and emotional distress in the nursing staff. Reasons for referral may relate more to the stress experienced by nursing home staff in managing VDB than to specific attributes of the VDB itself.

Subtyping depression by clinical features: the Australasian database.

OBJECTIVE: To distinguish psychotic, melancholic and a residual non-melancholic class on the basis of clinical features alone. Previous studies at our Mood Disorders Unit (MDU) favour a hierarchical model, with the classes able to be distinguished by two specific clinical features, but any such intramural study risks rater bias and requires external replication. METHOD: This replication study involved 27 Australasian psychiatrist raters, thus extending the sample and raters beyond the MDU facility. They collected clinical feature data using a standardized assessment with precoded rating options. A psychotic depression (PD) class was derived by respecting DSM-IV decision rules while a cluster analysis distinguished melancholic (MEL) and non-melancholic classes. RESULTS: The MELs were distinguished virtually entirely by the presence of significant psychomotor disturbance (PMD), as rated by the observationally based CORE measure, with over-representation on only three of an extensive set of 'endogeneity symptoms'. CONCLUSION: In comparison to PMD, endogeneity symptoms appear to be poor indicators of 'melancholic' type, confounding typology with severity. Results again support the hierarchical model.

How long does it take for antidepressant therapies to act?

OBJECTIVE: To review the proposition that antidepressants have a delayed onset of action by employing measurement and analytic strategies that overcome problems confounding interpretation of many efficacy studies. METHOD: A subset of patients was recruited to the longitudinal component of the Australasian database study, was assessed at baseline, and then completed measures of depression and anxiety when treatment commenced, and every 3 days over the next 4 weeks. The trajectories of defined 4-week outcome responders and non-responders were compared. RESULTS: Both groups showed a similar decrease in depression (and anxiety) over the first 3 days. A clear trend break then occurred, with little further improvement in the non-responders, as against distinct and progressive improvement in the responders. Ongoing early improvement (across days 3-6) was a strong predictor of responder status. CONCLUSIONS: The small sample size limits firm interpretation, although distinct interpretive advantages to the study design are evident. Findings are compatible with a number of recent studies arguing against any extensive delayed onset of action for the antidepressant drugs, but argue for caution in interpreting immediate improvement as predicting likely responder status, and more for examining early and sustained improvement as such a marker.

Optoelectronic neural-network scheduler for packet switches.

A novel, to our knowledge, type of packet scheduler that could significantly outperform current state-of-the-art schedulers is presented. The operation and the design of such a scheduler are discussed, and a fully operational experimental implementation is described. The scheduler uses a neural network in a winner-take-all strategy to optimize decisions on the throughput of both a crossbar and a banyan switching fabric. The problems of high interconnection density are solved by use of a free-space optical interconnect that exploits diffractive optical techniques to generate the required interconnection patterns and weights.

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. DESIGN: Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. SETTING: Population of residential facility in Sydney living in self care units and hostels. PARTICIPANTS: 220 depressed residents aged >/=65 without severe cognitive impairment. INTERVENTION: The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. MAIN OUTCOME MEASURE: Geriatric depression scale. RESULTS: Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011). CONCLUSIONS: The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

A follow-up survey of psychotropic drug use in Sydney nursing homes.

OBJECTIVE: To review the pattern of use of psychotropic drugs in Sydney nursing homes. DESIGN: Repeat survey of data from medication cards. SETTING: Central Sydney Health Area, February to June 1998. SUBJECTS: All residents of 38 of the 39 nursing homes in the western sector of the health area. MAIN OUTCOME MEASURES: Psychotropic drugs used regularly or as required. RESULTS: In 1998, 48.5% of residents (95% confidence interval [CI], 46.3%-50.7%) were taking one or more psychotropic drugs regularly and another 4.5% (95% CI, 3.6%-5.4%) had been given "as required" doses at least once in the preceding 4 weeks. Corresponding figures in 1993 were 58.9% (95% CI, 56.9%-60.9%) and 7.0% (95% CI, 6.0%-8.0%). A significantly smaller proportion of residents were taking regular doses of neuroleptics (22.6%), hypnotics (17.0%) and anxiolytics (6.2%) than in 1993. Moreover, dosages of conventional neuroleptics (particularly haloperidol) tended to be lower than in 1993, and 2.4% were prescribed new-generation neuroleptics. The proportion prescribed antidepressants was similar to that in 1993, but fewer (40% v. 64%) were given doses regarded as inadequate for treatment of depression; about half were taking the newer antidepressants. Some 13% were taking anticonvulsants, but these were not categorised as psychotropic in the 1993 or 1998 surveys. CONCLUSIONS: There have been considerable reductions in prescribing of neuroleptic, hypnotic and anxiolytic medication in central Sydney nursing homes. Changes may be attributable to educational initiatives and publicity about perceived overuse.

Psychiatry of old age: from section to faculty.

OBJECTIVE: To describe the processes that led to formation of the RANZCP Faculty of Psychiatry of Old Age (FPOA). METHOD AND RESULTS: Two criteria needed to be fulfilled before Faculty status could be approved. One was to demonstrate a recognised body of knowledge concerning psychiatry of old age, and the other was to be able to offer a comprehensive training program in this subspecialty. CONCLUSIONS: On 1 January 1999, FPOA came into existence.

Are the newer antidepressant drugs as effective as established physical treatments? Results from an Australasian clinical panel review.

OBJECTIVE: The aim of this study was to determine, in a clinical panel sample, the extent to which patients with depression (and melancholic and non-melancholic subtypes) judged the effectiveness of previously received antidepressant treatments, particularly the comparative effectiveness of the older and newer antidepressant drugs. METHOD: Twenty-seven Australasian psychiatrists assessed 341 non-psychotic depressed patients and rated the extent to which previous antidepressant treatments had been effective. Patients were assigned to 'melancholic' and residual 'non-melancholic' categories by two processes (DSM-IV decision rules, and a cluster analysis-derived allocation) and treatment effectiveness examined within each category. RESULTS: Electroconvulsive therapy (both bilateral and unilateral) was judged as highly effective by both melancholic and non-melancholic patients. Antipsychotic medication similarly rated highly (but was judged as more effective by the non-melancholic than melancholic patients). The tricyclics and irreversible monoamine oxidase inhibitors (MAOIs) were rated as more effective by the whole sample than several newer antidepressant classes (including the selective serotonin re-uptake inhibitors [SSRIs], venlafaxine, mianserin and moclobemide), whether effectiveness was examined dimensionally or categorically. Comparison of the overall tricyclic and SSRI classes indicated that any superior tricyclic effectiveness was specific to the melancholic subjects. CONCLUSIONS: Despite methodological limitations intrinsic to such clinical panel data, the judged greater effectiveness of the older antidepressants (tricyclics and irreversible MAOIs) for melancholic depression is of importance. If valid, such data are of intrinsic clinical relevance but also have the potential to inform us about the neurobiological determinants of 'melancholia' and pharmacological actions which contribute to its effective treatment.