Characteristics of domestic violence perpetrators with dementia from police records using text mining.

Aim: Few studies have examined the characteristics of domestic violence (DV) committed by people with dementia. We provide an overview of DV perpetrated by people with dementia in the community based on police reports of attendances at DV events. Method: A text mining method was used on 416,441 New South Wales (NSW) police narratives of DV events from January 2005 to December 2016 to extract information for Persons of Interest (POIs) with mentions of dementia. Results: Events involving those with dementia accounted for a relatively low proportion of total DV events (<1%). Of the 260 DV events with a dementia mention for the POI, the most common abuse types were assault (49.7%) and verbal abuse (31.6%). Spouses were the largest group of victims (50.8%) followed by children (8.8%). Physical abuse was common, occurring in 82.4% of events, but injuries were relatively mild. Although weapons were infrequently used, they were involved in 5% of events, mostly by POIs aged 75 years and older. Similarly, the POIs were mainly aged 75+ years (60%), however the proportion of those aged <65 was relatively high (20.8%) compared to the reported prevalence of dementia in that age group. Conclusions: This study demonstrates that some cases of DV perpetrated by people with reported dementia are significant enough to warrant police involvement. This highlights the need to proactively discuss the potential for violence as part of the holistic management and support family members, particularly those caring for people with young-onset dementias.

A comparison of older and younger offenders with delusional jealousy.

We sought to determine whether or not there were differences in medical, criminological and legal factors between older and younger offenders with diagnoses of delusional jealousy by undertaking a retrospective case-file search of Australian legal databases. Our results demonstrate that older offenders were more likely to have comorbid dementia whereas younger offenders were more likely to have comorbid substance use and chronic psychotic conditions. A history of domestic violence frequently predated the index offence but we were unable to determine if this was due to psychosis or a pre-existing tendency for violence. Despite a common diagnosis, the older offenders were more likely to be made forensic patients rather than sentenced prisoners when compared with the younger offenders. Consequently, different factors might mediate the pathway to violence in older and younger people suffering from delusional jealousy and could be additional targets for clinical intervention.

Homicides by older offenders in New South Wales between 1993 and 2010.

OBJECTIVE: Homicides by older people are rare and might differ from those committed by younger people. To investigate the characteristics of older homicide offenders in New South Wales (NSW), Australia. METHODS: A systematic search of legal, criminological and media databases for cases of homicide committed by people in NSW aged 55 and over, during the 18 years from 1993 to 2010. RESULTS: Eighty-seven cases were identified through databases. Legal documents were obtained for 70 offenders, comprising about 5% of homicides committed in NSW in the period of the study. The proportions of male offenders and rates of firearm use were similar to other age groups. Twelve of the 14 homicides using guns occurred outside the metropolitan area. Older offenders were more likely to have cognitive impairment or psychotic illness. Victims were more likely to be female and in a domestic relationship with the offender. CONCLUSIONS: Homicide by an older person is rare, and more commonly involves a man killing a family member. Correctional facilities will increasingly have to consider the needs of older people serving long sentences.

Frontotemporal dementia - features, diagnosis and management.

BACKGROUND: Frontotemporal dementia is the third or fourth most common form of dementia in the 45-65 years age group. It causes significant morbidity as well as a six to eightfold increase in mortality risk. OBJECTIVE: This article provides an overview of the pathophysiology of frontal lobe function and the genetics of frontotemporal dementia. It also summarises the clinical features, diagnosis and management of frontotemporal dementia. DISCUSSION: While the clinical presentation of frontotemporal dementia was described as early as the nineteenth century, recent advances in genetics have resulted in greater understanding of the pathophysiology of this disease. While imaging may support the diagnosis of frontotemporal dementia, it is essentially a clinical diagnosis based on the presence of typical clinical features and the findings of neuropsychological tests. Clinical management of frontotemporal dementia remains a challenge and is largely centred on behavioural management. Pharmacological agents such as selective serotonin reuptake inhibitors and antipsychotics may be helpful, although evidence to support their use is minimal.

Management and outcomes of delirious patients with hyperactive symptoms in a secured behavioral unit jointly used by geriatricians and pyschogeriatricians.

To compare the clinical outcomes and length of stay (LOS) between delirious patients with hyperactive symptoms admitted directly and those admitted indirectly from Emergency Department into a secured, behavioral unit jointly used by geriatricians and pyschogeriatricians (the Unit). A retrospective study analyzing data from the medical records of 122 patients with an admission diagnosis of delirium with hyperactive symptoms and subsequently discharged from the Unit, including restraint, one-to-one nursing care, falls, absconding, duration of delirium, recovery from delirium, destination and LOS. Significantly fewer patients with direct admission (n=68) required physical restraint or chemical restraint compared with those transferred (n=54). Patients admitted directly showed a higher discharge rate back home, shorter LOS, shorter duration of delirium and a higher rate of recovery from delirium than transferred patients. Of the transferred patients, more received one-to-one nursing care before transfer than after transfer. Three (5.6%) absconded before transfer, but none absconded from the Unit. The falls rate reduced from 14.2 to 6.7 falls/1000 patient delirium days after transfer. Delirious patients with hyperactive symptoms admitted directly to the Unit fared better in clinical outcomes and LOS. They also required less restraint, less intensive nursing and were unlikely to abscond compared to those transferred.

Suicide attempts by jumping and psychotic illness.

BACKGROUND: Several recent studies have reported that serious violence towards self and others is more common in the first episode of psychosis than after treatment. AIM: To estimate the proportion of survivors of suicide attempts during psychotic illness by jumping from a height who had not previously received treatment with antipsychotic medication. METHODS: An audit of the medical records of patients admitted to nine designated trauma centres in New South Wales, Australia, after surviving a jump of more than 3 m. Jumping was defined using routine hospital ascribed International Classification of Diseases (ICD) codes. The height of the jump and all clinical data were extracted from case notes. RESULTS: The files of 160 survivors of jumps of more than 3 m were examined, which included 70 who were diagnosed with a psychotic illness (44%). Thirty-one of the 70 diagnosed with a psychotic illness (44%, 95% confidence interval [CI] 32-56%) had never received treatment for psychosis and hence were in the first episode of psychosis. One in five (19.4%) of all survivors of a suicide attempt by jumping had an undiagnosed and untreated psychosis that was often characterized by frightening delusional beliefs. CONCLUSION: A large proportion of the survivors of suicide attempts by jumping were diagnosed with a psychotic illness, which confirms an association between psychosis and suicide by jumping. Some suicides might not have been linked to psychosis had the patient not survived the suicide attempt, suggesting that the contribution of schizophrenia to suicide mortality might have been underestimated in psychological autopsy studies. The finding that nearly half of the survivors diagnosed to have a psychotic illness had never received treatment with antipsychotic medication indicates a greatly increased risk of suicide by jumping in the first episode of psychosis when compared to the annual risk after treatment.

Depersonalization disorder.

PURPOSE OF REVIEW: There is increasing interest in depersonalization disorder, in part because of the increased community awareness of the condition via the Internet. The disorder may be more prevalent than schizophrenia but is often misdiagnosed; hence, an update is timely. RECENT FINDINGS: Recent research has included characterization of the nosology and phenomenology of the disorder, whereas emerging evidence demonstrates a neurophysiological dampening down in addition to psychological dampening in the face of emotional stimulation. SUMMARY: Greater understanding of the clinical characteristics of this disorder will improve the reliability of diagnosis and aid the development of neurobiological and psychological models for empirical testing. Although response to current treatments has been disappointing, recent research has identified the basis for the development of new pharmacological and psychological treatments.

Workforce and advanced training survey of the RANZCP Faculty of Psychiatry of Old Age: issues and challenges for the field.

OBJECTIVES: There is concern that there are insufficient old age psychiatrists in an ageing population. We aim to describe the work patterns of old age psychiatrists in Australia and New Zealand in order to identify barriers to training and practice. METHODS: Members of the Faculty of Psychiatry of Old Age (FPOA) and other psychiatrists who have completed the Certificate of Psychiatry of Old Age were notified of the online survey by email in October 2008. RESULTS: Two hundred and twenty FPOA members resident in Australia and New Zealand were surveyed and 87 responded (56% male, mean age 49.2 years). While 82% had a public appointment, 34% worked in private practice where barriers included the lack of a multidisciplinary team and remuneration. Only 18% of clinical time was in a rural or regional setting. High levels of job satisfaction (88%) were found, with the main factors being working with older people, working in a multidisciplinary team and the intellectual challenge. Advanced training was felt to be beneficial, though some weaknesses were identified. CONCLUSIONS: Old age psychiatry is a satisfying career with an advanced training program that is reported to be beneficial to practice. Because the old age psychiatry workforce will face mounting challenges over the next decades, it is imperative that planning for the future mental health needs of older Australians be commenced immediately.

Clinical outcomes and length of stay of a co-located psychogeriatric and geriatric unit.

To examine the effect of co-location of psychogeriatric and geriatric services on length of stay and changes in patients' psychosocial characteristics. A retrospective analysis of the performance indices of psychogeriatric patients aged > or =50 years admitted to a co-located psychogeriatric and geriatric unit at Bankstown-Lidcombe Hospital, New South Wales (NSW), Australia from April 2004 to June 2006. Comparisons were made between the performance of the Bankstown-Lidcombe's unit and the NSW state average (consisting of traditional solitary models of care) with respect to patients' length of stay (LOS) and changes in psychosocial indices. Bankstown's patients had a higher burden of psychosocial impairments. The mean LOS for psychogeriatric episodes was significantly shorter at Bankstown-Lidcombe Hospital than the NSW state average (28.3+/-19.6 days vs. 33.4+/-22.7 days, p<0.001). The overall improvement in aspects of mental state and social behaviors for psychogeriatric admissions at Bankstown-Lidcombe Hospital was significantly better than the NSW state average. Co-location of psychogeriatric and geriatric services reduced patients' LOS and improved psychosocial performance compared to traditional models of care. However, more robust studies are required to fully examine the benefits of this type of service.

Periodic limb movements and other movement disorders in sleep: neuropsychiatric dimensions.

Movement disorders such as Parkinson's disease and Tourette's syndrome, primarily manifest during wakefulness, intrude into sleep. There are some disorders, however, such as periodic limb movements in sleep, restless legs syndrome, paroxysmal nocturnal dystonia, bruxism, and somnambulism, which occur primarily during sleep. The diagnosis and management of these disorders pose a challenge to neuropsychiatric practice, not only because they may be difficult to distinguish from other neuropsychiatric disorders, but also because psychiatric disorders are often co-morbid with them. Study of these disorders is necessary for an understanding of the interaction of sleep and movement, and how disturbance in one may affect the other.

Homocysteine in neuropsychiatric disorders of the elderly.

OBJECTIVE: There is increasing interest in homocysteine as a risk factor for neuropsychiatric disorders such as stroke, dementia, depression and Parkinson's disease. This article reviews the current literature on the relationship between homocysteine and these disorders to ascertain if any clinical recommendations can be made. METHOD: A MEDLINE and EMBASE search was made for English language publications between 1966 and 2002 using the search terms 'Homocysteine' and 'Stroke', 'Dementia', 'Vascular Dementia', 'Alzheimer's dementia', 'Cognition disorders or cognitive decline or memory disorders', 'Depression or depressive disorders' or 'Parkinson's disease'. In addition, individual articles were hand searched for relevant references. RESULTS: Cross-sectional studies consistently suggest that elevated homocysteine increases the risk of stroke, and may also increase the risk of leukoariosis, vascular dementia (VaD), cognitive impairment and Alzheimer's disease (AD). Longitudinal studies of homocysteine as a risk factor are few and inconsistently supportive of these associations. No intervention trials to determine the effect of lowering homocysteine levels have yet been published. The pathological mechanisms for homocysteine-mediated disease await complete elucidation. Mild hyperhomocysteinemia is common in the elderly population, and folate supplementation can decrease homocysteine levels. CONCLUSION: The epidemiological evidence for homocysteine as a risk factor for neuropsychiatric disease is an emerging area of great interest. Screening the population for hyperhomocysteinemia cannot be recommended at this stage, but individuals at increased risk of cerebrovascular disease or cognitive impairment should be investigated and treated for elevated homocysteine levels.