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Quality of diagnosis and treatment plans after using the ‘diagnostic guideline for anxiety and challenging behaviours’ in people with intellectual disabilities: a comparative multiple case study design
- Authors:
- PRUIJSSERS Addy, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, pp.305-316.
- Publisher:
- Wiley
Background: People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. Materials and Methods: A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. Results: The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Conclusions: Working with the ‘Diagnostic Guideline for Anxiety and CB’ leads to improved diagnoses and treatment plans compared with care as usual. (Publisher abstract)
HIV-related cognitive dysfunction: implications for aging and social work
- Authors:
- VANCE David E., et al
- Journal article citation:
- Social Work in Mental Health, 13(6), 2015, pp.553-570.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Half of adults with HIV experience HIV-Associated Neurocognitive Disorder (HAND). HIV infects microglial and macrophages in the brain, resulting in a neurotoxic environment that inhibits the function of neurons, thus impairing cognition. Social workers require an understanding of how HIV-related cognitive dysfunction develops within the larger context of mental illness, substance use, and socioeconomic status. This article briefly reviews the clinical diagnosis of HAND and some interrelated neurobiological and psychosocial factors. Research implications for improving cognition are important as one considers: (1) The impact of the ageing process on cognition and (2) the growing number of older adults with HIV. (Edited publisher abstract)
Delirium: QS63
- Author:
- NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
- Publisher:
- National Institute for Health and Care Excellence
- Publication year:
- 2014
- Place of publication:
- Manchester
This quality standard covers the prevention, diagnosis and management of delirium in adults (18 years and over) in hospital or long-term care settings. It is designed to contribute to improvements in the following outcomes: length of hospital stay; detection of delirium; incidence of delirium; falls in hospital; mortality; adults' experience of hospital care; and carer involvement in healthcare.
Why don't older adults with subjective memory complaints seek help?
- Authors:
- HURT Catherine S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(4), April 2012, pp.394-400.
- Publisher:
- Wiley
Subjective memory complaints (SMCs) are common among older adults, often causing significant distress. Although they show little relation to current cognitive abilities there appears to be a relationship to future cognitive decline. Low rates of help-seeking for memory complaints are well documented but the reasons for this remain unclear. The common-sense model of illness perception (CSM) proposes that the beliefs people hold about their health underlie help-seeking behaviour. This study investigated factors affecting the decision to seek help in people with SMCs within the framework of the CSM. Cognition, illness perceptions, coping styles, depression and anxiety were assessed in 98 adults with SMCs, aged 50 years and over, including 60 attending a memory clinic in Manchester and 38 non-help-seekers. Objective cognitive performance did not differ in relation to help seeking. Logistic regression revealed that illness perceptions including social comparison and causal attributions predict help-seeking behaviour. More general coping style did not predict help-seeking. Help seekers were more likely to have had a close relative with dementia. The results suggest that beliefs about memory, rather than objective cognitive impairment, are associated with the decision to seek help. Education regarding memory problems and challenging causal attributions may help to encourage help-seeking in people with SMCs and improve care in early stage dementia.
Placing the person at the centre in the diagnosis of dementia
- Authors:
- MANTHORPE Jill, et al
- Journal article citation:
- Journal of Dementia Care, 19(4), July 2011, pp.37-38.
- Publisher:
- Hawker
A research study undertook interviews with 53 people with dementia and family carers in 3 areas of England about their experience of the dementia journey, from when they or their relative first sought help with their problems to diagnosis and afterwards. This article briefly describes the study (The Transition from Cognitive Impairment to Dementia: Older People's Experiences) and its findings. It reports that the study identified key features of service responses which could be improved, such as tailoring information, providing better information about how long things might take and who people could turn to with questions, and developing a person-centred approach to memory assessment and diagnosis. The article urges professionals such as GPs to keep in touch with people during the investigations or diagnostic journey, and to tailor services to individual needs.
Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages
- Authors:
- MARENGONI Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.27-34.
- Publisher:
- Wiley
This article seeks to evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.
School performance in secondary education shows no decline before the onset of a first episode of psychosis in schizophrenia
- Authors:
- GAAG Mark van der, et al
- Journal article citation:
- Journal of Mental Health, 12(6), December 2003, pp.585-593.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Early identification of people developing psychosis is now a goal of all psychiatric services to reduce the delay for treatment and support. The neurodevelopmental model of schizophrenia predicts cognitive limitations and decline before the onset of the first episode which may be a factor in early identification. This study aims to evaluate cognitive decline prior to the first episode using school performance data. Ninety-nine school reports of the first and last class in secondary education are compared for 33 probands, 33 of their siblings and 33 normal control subjects who were matched for academic level according to Dutch school types. The findings indicate that probands performed at a lower level than siblings and normal controls after transfer to secondary education and on leaving but there was no expected progressive performance decline over this period. The findings support the neurodevelopmental view that people who develop schizophrenia experience delays in development that are apparent in school performance at age 13. Serious cognitive decline probably occurs quite rapidly just before the frank expression of psychotic symptoms.
Negative symptoms in Alzheimer's disease: a confirmatory factor analysis
- Authors:
- DE JONGHE Jos F. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(8), August 2003, pp.748-753.
- Publisher:
- Wiley
Negative symptoms are a prominent clinical feature of Alzheimer's disease and they are related to memory impairment but not to mood disturbances. Methods employed in this research included Nurses' Behavioural observation scale for psychogeriatric inpatients (GIP). Global clinical ratings of severity of dementia and depression based on the Cambridge Examination for Mental Disorders of the Elderly-Dutch version (CAMDEX-N). A unidimensional model of dementia fitted the data poorly. Multidimensional models produced better results. In two- and three-factor models negative symptoms were separated from cognitive impairment and mood disturbances. The more severe the memory impairment, the more socially withdrawn patients were. In this sense negative symptoms may have been secondary to cognitive decline. However, no association was found between negative symptoms and mood disturbances.
Depressive symptoms and cognitive decline in elderly people
- Authors:
- PATERNITI Sabrina, et al
- Journal article citation:
- British Journal of Psychiatry, 181(11), November 2002, pp.406-410.
- Publisher:
- Cambridge University Press
Depressive symptoms are associated with cognitive decline in elderly people, but the nature of their temporal relationship remains equivocal. Persistent but not episodic depressive episodes were associated with cognitive decline. High levels of depressive symptoms, when persistent, are associated with cognitive decline in a sample of elderly people.
Relationship of behavioral and psychological symptoms to cognitive impairment and functional status in Alzheimer's disease
- Authors:
- HARWOOD Dylan G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(5), May 2000, pp.393-400.
- Publisher:
- Wiley
This cross-sectional study examined the relationship of behavioural and psychological symptoms to cognitive and functional impairment in Alzheimer's disease (AD). The results suggest that some non-cognitive symptoms may be related to the neurobiologic mechanisms underlying the increased cognitive dysfunction in AD. Specific symptoms of behavioural pathology may also impact a patient's ability to perform important self-maintenance behaviours.