International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.1065-1072.
Publisher:
Wiley
... symptoms in depressed patients were agitation, anxiety and irritability. Depression in dementia patients was significantly associated with dis-inhibition, irritability, agitation, and anxiety. The authors concluded that, before addressing them as isolated symptoms, it is important to consider comorbidity with depression in order to optimise the therapeutic approach.
Ninety percent of patients experience at least one behavioural and psychological symptom in dementia (BPSD) during the course of the disease. One-third of people with dementia have depressive symptoms. This study characterised the psychological and behavioural manifestations of depression in patients with dementia. Patients with dementia from several nursing homes in the Limousin region of France participated. Depression was as diagnosed by the Cornell Scale for Depression in Dementia, and BPSD were assessed using the Neuropsychiatric Inventory (NPI). Of 319 patients with dementia, 43% were depressed and 76% had BPSD. All BPSD were significantly more prevalent among depressed patients, but no significant differences were observed according to sex and age. The NPI showed that the most common additional symptoms in depressed patients were agitation, anxiety and irritability. Depression in dementia patients was significantly associated with dis-inhibition, irritability, agitation, and anxiety. The authors concluded that, before addressing them as isolated symptoms, it is important to consider comorbidity with depression in order to optimise the therapeutic approach.
British Journal of Psychiatry, 191(11), November 2007, pp.408-414.
Publisher:
Cambridge University Press
... offending. In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group. The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced
Studies have examined people with comorbid schizophrenia-spectrum personality disorder and antisocial personality disorder, a subgroup who may differ psychophysiologically and behaviourally from those with either condition alone. The aim was to test whether individuals with both types of personality disorder are particularly characterised by reduced orienting and arousal and by increased criminal offending. In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group. The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced skin conductance orienting to neutral tones compared with the other groups, and significantly reduced arousal and orienting to significant stimuli compared with the control group. Reduced orienting may reflect a neurocognitive attentional risk factor for both antisocial and schizotypal personality disorders that indirectly reflects a common neural substrate to these disorders.
... prevalent psychiatric disorders were conduct disorder (47%), major depression (29%), attention deficit-hyperactivity disorder (17%), and oppositional defiant disorder (11%). Latent class analysis identified 6 distinct profiles of psychiatric comorbidity. All profiles included conduct disorder symptoms, with varying severity. The most prevalent class consisted of teens primarily with conduct problems only (23%). Adolescents with low severity externalizing problems (15%) tended to have relatively high readiness to change alcohol use compared to other comorbidity profiles. Results indicate heterogeneity among youth presenting to addictions treatment, particularly with regard to profile of co-occurring psychiatric symptoms and readiness to change substance use. Youth with overall low severity of externalizing behaviours reported higher readiness to change alcohol use relative to teens with other comorbidity profiles, highlighting the potential importance of enhancing and maintaining teens' readiness to change substance use behaviour during treatment, specifically in relation to the adolescent's profile of psychiatric comorbidity. (Copies of this article are available from: Haworth Document Delivery
In this American study 169 adolescents aged 14-18 years old were recruited from addictions treatment completed a comprehensive assessment of substance use and other psychiatric disorders, and measures of readiness to change substance use. Latent class analysis was used to identify distinct profiles of comorbid psychopathology, which were then related to measures of readiness to change. The most prevalent psychiatric disorders were conduct disorder (47%), major depression (29%), attention deficit-hyperactivity disorder (17%), and oppositional defiant disorder (11%). Latent class analysis identified 6 distinct profiles of psychiatric comorbidity. All profiles included conduct disorder symptoms, with varying severity. The most prevalent class consisted of teens primarily with conduct problems only (23%). Adolescents with low severity externalizing problems (15%) tended to have relatively high readiness to change alcohol use compared to other comorbidity profiles. Results indicate heterogeneity among youth presenting to addictions treatment, particularly with regard to profile of co-occurring psychiatric symptoms and readiness to change substance use. Youth with overall low severity of externalizing behaviours reported higher readiness to change alcohol use relative to teens with other comorbidity profiles, highlighting the potential importance of enhancing and maintaining teens' readiness to change substance use behaviour during treatment, specifically in relation to the adolescent's profile of psychiatric comorbidity. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
personality disorders, substance misuse, young people, ADHD, behaviour, depression, comorbidity;
International Journal of Geriatric Psychiatry, 25(2), February 2010, pp.142-149.
Publisher:
Wiley
Compulsive hoarding is a debilitating disorder, yet little is known about its onset or clinical features. Hoarding symptoms often come to clinical attention with older patients. However, no prior study has examined whether elderly compulsive hoarders have early or late onset of hoarding symptoms, whether their hoarding symptoms are idiopathic or secondary to other conditions, or whether their symptoms are similar to compulsive hoarding symptoms seen in younger and middle-aged populations. This study determines the onset and clinical features of late life compulsive hoarding, including psychiatric and medical relationships. A group of 18 participants over 60 with clinically significant compulsive hoarding were assessed using structured interviews, including the Mini International Neuropsychiatric Interview, Structured Clinical Interview for DSM-IV, Yale-Brown Obsessive Compulsive Scale, and UCLA Hoarding Severity Scale. Self-report Measures Included the Beck Anxiety Inventory, Beck Depression Inventory, Sheehan Disability Scale, and Savings Inventory-Revised. Psychosocial and medical histories were also obtained. Participants were asked to rate their hoarding symptoms and describe major life events that occurred during each decade of their lives. Results show that onset of compulsive hoarding symptoms was initially reported as being in mid-life but actually found to be in childhood or adolescence - no subjects reported late onset compulsive hoarding. Compulsive hoarding severity seemed to increase with each decade of life. Comorbid mood and anxiety disorders were common, but only 16% of patients met criteria for OCD. The vast majority of patients had never received treatment for hoarding behaviour. Older adults with compulsive hoarding were usually socially impaired and lived alone. In conclusion compulsive hoarding appears to be a progressive and chronic condition that begins early in life. Left untreated, its severity increases with age. Compulsive hoarding should be considered a distinct clinical syndrome, separate from OCD.
Compulsive hoarding is a debilitating disorder, yet little is known about its onset or clinical features. Hoarding symptoms often come to clinical attention with older patients. However, no prior study has examined whether elderly compulsive hoarders have early or late onset of hoarding symptoms, whether their hoarding symptoms are idiopathic or secondary to other conditions, or whether their symptoms are similar to compulsive hoarding symptoms seen in younger and middle-aged populations. This study determines the onset and clinical features of late life compulsive hoarding, including psychiatric and medical relationships. A group of 18 participants over 60 with clinically significant compulsive hoarding were assessed using structured interviews, including the Mini International Neuropsychiatric Interview, Structured Clinical Interview for DSM-IV, Yale-Brown Obsessive Compulsive Scale, and UCLA Hoarding Severity Scale. Self-report Measures Included the Beck Anxiety Inventory, Beck Depression Inventory, Sheehan Disability Scale, and Savings Inventory-Revised. Psychosocial and medical histories were also obtained. Participants were asked to rate their hoarding symptoms and describe major life events that occurred during each decade of their lives. Results show that onset of compulsive hoarding symptoms was initially reported as being in mid-life but actually found to be in childhood or adolescence - no subjects reported late onset compulsive hoarding. Compulsive hoarding severity seemed to increase with each decade of life. Comorbid mood and anxiety disorders were common, but only 16% of patients met criteria for OCD. The vast majority of patients had never received treatment for hoarding behaviour. Older adults with compulsive hoarding were usually socially impaired and lived alone. In conclusion compulsive hoarding appears to be a progressive and chronic condition that begins early in life. Left untreated, its severity increases with age. Compulsive hoarding should be considered a distinct clinical syndrome, separate from OCD.
Subject terms:
mental health problems, obsessive compulsive disorders, older people, social exclusion, vulnerable adults, activities of daily living, anxiety, behaviour, comorbidity;
International Journal of Geriatric Psychiatry, 25(2), February 2010, pp.166-174.
Publisher:
Wiley
This research investigates the extent of, and factors associated with, male residents who change their wandering status post nursing home admission. A longitudinal study, with secondary data analyses, compares admissions over a 4-year period to formulate a model to understand the development of wandering behaviour. Over six thousand participants from 134 Veterans Administration nursing homes, admitted between October 2000 and October 2004, throughout the United States were included. Measurements included cognitive impairment, mood, behaviour problems, activities of daily living and wandering. Eighty six percent of the sample group were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study, and 51% of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than twice. Variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behaviour, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. In conclusion, a resident’s change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but does not affect mobility.
This research investigates the extent of, and factors associated with, male residents who change their wandering status post nursing home admission. A longitudinal study, with secondary data analyses, compares admissions over a 4-year period to formulate a model to understand the development of wandering behaviour. Over six thousand participants from 134 Veterans Administration nursing homes, admitted between October 2000 and October 2004, throughout the United States were included. Measurements included cognitive impairment, mood, behaviour problems, activities of daily living and wandering. Eighty six percent of the sample group were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study, and 51% of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than twice. Variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behaviour, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. In conclusion, a resident’s change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but does not affect mobility.
Subject terms:
long term care, longitudinal studies, mental health problems, nursing homes, older people, wandering, behaviour, challenging behaviour, comorbidity;