International Journal of Geriatric Psychiatry, 22(1), January 2007, pp.23-31.
Publisher:
Wiley
The aim was to investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001. By means of a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs. 1b: female vs. male patient)
The aim was to investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001. By means of a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs. 1b: female vs. male patient) and moderate dementia (case 2a vs 2b: vascular type (VD) vs Alzheimer's disease (DAT)), respectively. By means of a structured face-to-face interview, they were asked for their diagnostic considerations. In comparison to 1993, dementia was significantly more frequently considered. However, there was a striking tendency in overestimating vascular aetiology and under-diagnosing probable DAT. As a possible contributor to a dementia syndrome, concomitant medication was considered only exceptionally. Physicians above 50 years of age showed a significantly lower early diagnostic awareness. At follow-up, the presumed interest in geriatric (psychiatric) topics dramatically faded from 66.9% to 35.2%. These results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care.
Subject terms:
primary care, Alzheimers disease, dementia, diagnosis, early intervention;
Clinical Social Work Journal, 47(2), 2019, pp.222-232.
Publisher:
Springer
Place of publication:
New York
In recent years, much research has focused on the lived experience of people diagnosed with a mental illness, resulting in a better understanding of what helps or hinders their recovery. This study aimed to investigate a rather neglected aspect of recovery: how people with a mental illness talk about their diagnosis and how concealing or revealing such a diagnosis affects different live domains. People (n = 16) diagnosed with a mental illness participated in an in-depth qualitative interview study, allowing insight into how they experience and evaluate living with a mental health diagnosis. The results are particularly interesting for clinical social work. Based on the findings of this study, the concept of ‘diagnosis talk’ has been derived. This concept is understood to thematize the different aspects related to whether and how a person with a mental illness talks about their diagnosis, such as motivation for disclosure and its timing, or which terms they use when referring to their diagnosis. The results indicate that receiving a mental health diagnosis requires consideration of how to cope with this “label”, which has to be distinguished from coping with the illness and the symptoms
(Publisher abstract)
In recent years, much research has focused on the lived experience of people diagnosed with a mental illness, resulting in a better understanding of what helps or hinders their recovery. This study aimed to investigate a rather neglected aspect of recovery: how people with a mental illness talk about their diagnosis and how concealing or revealing such a diagnosis affects different live domains. People (n = 16) diagnosed with a mental illness participated in an in-depth qualitative interview study, allowing insight into how they experience and evaluate living with a mental health diagnosis. The results are particularly interesting for clinical social work. Based on the findings of this study, the concept of ‘diagnosis talk’ has been derived. This concept is understood to thematize the different aspects related to whether and how a person with a mental illness talks about their diagnosis, such as motivation for disclosure and its timing, or which terms they use when referring to their diagnosis. The results indicate that receiving a mental health diagnosis requires consideration of how to cope with this “label”, which has to be distinguished from coping with the illness and the symptoms in itself. This needs to be taken into account by clinical social workers providing comprehensive recovery-oriented support for people with a mental illness. Using the findings, concrete recommendations for psycho-social practice are presented in this article.
(Publisher abstract)
Subject terms:
mental health problems, social work, recovery, diagnosis, self-concept, disclosure;
BARTH Janina, NICKEL Franziska, KOLOMINSKY-RABAS Peter L.
Journal article citation:
International Journal of Geriatric Psychiatry, 33(3), 2018, pp.459-474.
Publisher:
Wiley
Objectives: Due to the demographic change, the global prevalence of dementia will continually rise. Barriers to diagnosis and care are still high. But timely diagnosis is associated with valuable benefits and can promote timely and optimal management. Receiving an early diagnosis is especially in rural areas a problem due to the limited access to assessments. Therefore, the aim of our scoping are appropriate to screen for mild cognitive impairment or cognitive decline, but are not valid to establish a dementia diagnosis. Conclusions: Telehealth applications can appropriately be used to diagnose dementia. However, most of the studies included only small sample sizes and did not test the applications explicitly in rural or remote populations. Therefore, studies taking these limitations into account
(Publisher abstract)
Objectives: Due to the demographic change, the global prevalence of dementia will continually rise. Barriers to diagnosis and care are still high. But timely diagnosis is associated with valuable benefits and can promote timely and optimal management. Receiving an early diagnosis is especially in rural areas a problem due to the limited access to assessments. Therefore, the aim of our scoping review is to investigate different interventions targeted at rural living elderly to screen and diagnose cognitive decline and dementia. Methods: A scoping review was conducted in line with the framework of Arksey and O'Malley. The following databases were systematically searched: PubMed, PsycINFO, Cochrane Library, and ScienceDirect. The interventions were categorized in four main categories (interventions for general practitioners/institutions; online/mobile offers; telehealth applications; telephone-based screenings). Results: Thirty studies were included. The four categories show different scopes of application. Telehealth applications show that it is feasible and valid to diagnose dementia via videoconference. Assessments described in three other categories show that remotely used tools are appropriate to screen for mild cognitive impairment or cognitive decline, but are not valid to establish a dementia diagnosis. Conclusions: Telehealth applications can appropriately be used to diagnose dementia. However, most of the studies included only small sample sizes and did not test the applications explicitly in rural or remote populations. Therefore, studies taking these limitations into account are needed. On top, only two RCTs are included in this review indicating that more high quality studies in this field are needed.
(Publisher abstract)
Subject terms:
literature reviews, dementia, rural areas, diagnosis, screening, telehealth;
International Journal of Geriatric Psychiatry, 28(11), 2013, pp.1197-1204.
Publisher:
Wiley
The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. Data from 92 residents aged 65–97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression, whereas the GDS-15 was sensitive only for major depression, but not for minor depression. For specificity, there was no significant difference between WHO-5 and GDS-15, but both instruments outperformed the GDS-4. The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.
(Edited publisher abstract)
The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. Data from 92 residents aged 65–97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression, whereas the GDS-15 was sensitive only for major depression, but not for minor depression. For specificity, there was no significant difference between WHO-5 and GDS-15, but both instruments outperformed the GDS-4. The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.
(Edited publisher abstract)
Social Science and Medicine, 65(10), November 2007, pp.2081-2092.
Publisher:
Elsevier
This paper discusses the policy debate and ethical discussion surrounding pre-implantation genetic diagnosis (PGD) for sibling donor (SD) in Germany and Israel. Based on an analysis of the regulations and ethical discourse concerning a unique form of new reproductive technology (NRT) - PGD for SD - the authors complement the scholarly discussion of NRTs in these countries, by pointing
This paper discusses the policy debate and ethical discussion surrounding pre-implantation genetic diagnosis (PGD) for sibling donor (SD) in Germany and Israel. Based on an analysis of the regulations and ethical discourse concerning a unique form of new reproductive technology (NRT) - PGD for SD - the authors complement the scholarly discussion of NRTs in these countries, by pointing to an explanatory factor that has been so far neglected, namely the hegemonic notions regarding the ideal relationship between the generations, and the mutual obligations between different family members in Germany and Israel. It is argued the fact that PGD (in general) and PGD for SD (in particular) have been banned in Germany, but were endorsed without hesitation in Israel, has to do with different perceptions of family ethics within the two societies. Furthermore, we argue that this factor contributes significantly to the more general understanding of German and Israeli policies regarding NRTs.
British Journal of Clinical Psychology, 45(4), November 2006, pp.515-529.
Publisher:
Wiley
... patients with a diagnosis of alcohol dependence were recruited from an in-patient alcohol-detoxification facility. Patients were sequentially assigned to either cue exposure or a standard cognitive-behavioural treatment. The authors assessed self-reports of craving and self-efficacy prior to treatment participation and at the end of treatment. Drinking behaviour was assessed in the 6-month period
The aim of the present study was to investigate beneficial effects of cue exposure treatment for alcohol dependence by contrasting it with a well-established treatment approach. The authors hypothesized that cue exposure treatment is associated with a stronger decline of craving, a stronger increase in self-efficacy and has beneficial effects on drinking behaviour after discharge. Sixty-three patients with a diagnosis of alcohol dependence were recruited from an in-patient alcohol-detoxification facility. Patients were sequentially assigned to either cue exposure or a standard cognitive-behavioural treatment. The authors assessed self-reports of craving and self-efficacy prior to treatment participation and at the end of treatment. Drinking behaviour was assessed in the 6-month period following discharge. Both treatments were associated with a reduction of self-reported craving and an increase in self-reported measures of self-efficacy. A significant time x treatment interaction indicated a greater increase in self-reported measures of self-efficacy after cue exposure treatment. Measures of drinking behaviour showed clearly that both treatments were efficacious. Relapse rates and drinking-related variables were not significantly different for the two treatments at the 6-month follow-up. There was preliminary evidence that suggests that cue exposure therapy may be more effective for patients with severe alcohol dependence With respect to drinking behaviour, cue exposure and standard cognitive-behavioural treatment seem to be equally effective.
Subject terms:
self-determination, treatment, therapy and treatment, addiction, alcohol misuse, diagnosis;
British Journal of Visual Impairment, 35(1), 2017, pp.29-43.
Publisher:
Sage
Social-emotional competences are an important developmental domain for children with a visual impairment (VI). Therefore, early diagnosis in this regard is needed to ensure that VI children receive appropriate support. In this study, the authors used two preliminary German versions of the Infant–Toddler Social Emotional Assessment (ITSEA) and the Social-Emotional Assessment/Evaluation Measure
(Edited publisher abstract)
Social-emotional competences are an important developmental domain for children with a visual impairment (VI). Therefore, early diagnosis in this regard is needed to ensure that VI children receive appropriate support. In this study, the authors used two preliminary German versions of the Infant–Toddler Social Emotional Assessment (ITSEA) and the Social-Emotional Assessment/Evaluation Measure (SEAM) to assess social-emotional competences in 92 VI infants and toddlers aged 12–36 months. The results indicate that both instruments provide valid, reliable data and are suitable for use in practice. The results still reveal that understanding the emotions of other persons, paying attention to things around them and engaging with their environment, in addition to relating to other peers, seem to be the most important challenges for early intervention in VI toddlers. An additional disability is yet another condition that poses a specific challenge for VI education. The data also corroborate well-known findings from other research on the education of children with different conditions; in particular, the role of parental responsivity for the development of social-emotional competences is confirmed. Overall, the results suggest that the two instruments employed provide important information for educational practice, but further research is needed to demonstrate their full value.
(Edited publisher abstract)
Dementia: the International Journal of Social Research and Practice, 15(5), 2016, pp.931-957.
Publisher:
Sage
Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people
(Publisher abstract)
Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.
(Publisher abstract)
Subject terms:
dementia, training, participation, diagnosis, treatment, service provision, knowledge management, professionals, professional role, screening;
Content type:
research
Location(s):
United Kingdom, Finland, Netherlands, Spain, Germany, Sweden, Estonia
British Journal of Psychiatry, 187(Supplement 48), August 2005, pp.s45-s48.
Publisher:
Cambridge University Press
The Early Detection and Intervention Programme of the German Research Network on Schizophrenia (GRNS) investigates the initial prodromal phase of psychosis in a multidimensional approach. Two intervention strategies are being studied by two large-scale multicentre projects. The aim was to present the concept of the intervention studies, and to provide an interim report of the recruitment procedure. Comprehensive cognitive–behavioural therapy has been developed for patients in the ‘early initial prodromal state’. For patients in the ‘late initial prodromal state’ the atypical neuroleptic amisulpride is explored. Both interventions are evaluated in randomised controlled trials using clinical management as the control condition. Between January 2001 and March 2003, 1212 individuals seeking help for mental health problems were screened for putative prodromal symptoms at four university centres. More than 388 individuals fulfilled criteria for both interventions and 188 (48.5%) gave informed consent to participate in the trials. The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.
The Early Detection and Intervention Programme of the German Research Network on Schizophrenia (GRNS) investigates the initial prodromal phase of psychosis in a multidimensional approach. Two intervention strategies are being studied by two large-scale multicentre projects. The aim was to present the concept of the intervention studies, and to provide an interim report of the recruitment procedure. Comprehensive cognitive–behavioural therapy has been developed for patients in the ‘early initial prodromal state’. For patients in the ‘late initial prodromal state’ the atypical neuroleptic amisulpride is explored. Both interventions are evaluated in randomised controlled trials using clinical management as the control condition. Between January 2001 and March 2003, 1212 individuals seeking help for mental health problems were screened for putative prodromal symptoms at four university centres. More than 388 individuals fulfilled criteria for both interventions and 188 (48.5%) gave informed consent to participate in the trials. The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.
Subject terms:
psychiatric care, psychoses, risk, schizophrenia, screening, behaviour therapy, diagnosis, early intervention;
British Medical Journal, 5.11.94, 1994, pp.1218-1221.
Publisher:
British Medical Association
Despite legislation to harmonise mental health practice throughout Europe and convergence in systems of training there remains an extraordinary diversity of psychiatric practice in Europe. Approaches to tackling substance misuse vary among nations; statistics on psychiatric morbidity are affected by different approaches to diagnosis and treatment of psychiatric disorders; attitudes towards mental
Despite legislation to harmonise mental health practice throughout Europe and convergence in systems of training there remains an extraordinary diversity of psychiatric practice in Europe. Approaches to tackling substance misuse vary among nations; statistics on psychiatric morbidity are affected by different approaches to diagnosis and treatment of psychiatric disorders; attitudes towards mental illness show definite international differences. Everywhere, though, mental health care for patients with psychotic illness is a "cinderella service", and there is a general move towards care falling increasingly on the family and the community.
Subject terms:
law, mental health, mental health problems, mental health services, psychiatry, social care provision, treatment, therapy and treatment, training, attitudes, community care, diagnosis, families;