Memory clinics.

Memory clinics were first described in the 1980s. They have become accepted worldwide as useful vehicles for improving practice in the identification, investigation, and treatment of memory disorders, including dementia. They are provided in various settings, the setting determining clientele and practice. All aim to facilitate referral from GPs, other specialists, or by self referral, in the early stages of impairment, and to avoid the stigma associated with psychiatric services. They bring together professionals with a range of skills for the benefit of patients, carers, and colleagues, and contribute to health promotion, health education, audit, and research, as well as service to patients.

A survey of the views of geriatric psychiatrists in the United Kingdom on the use of electroconvulsive therapy to treat physically ill people.

BACKGROUND: One of the main concerns about ECT is its use for people with concurrent medical illnesses. Geriatric psychiatrists are more often likely to encounter this situation in working with older age groups. Drawing on the collective experience of all UK geriatric psychiatrists may allow a better understanding of the use of ECT for people with major medical illness. METHODS: A postal questionnaire was used to seek the views of all consultant geriatric psychiatrists in the UK on the use of ECT in the presence of major illness. The questionnaire was developed from previous literature on the subject, a previous pilot study, published guidelines and clinical experience of the authors. RESULTS: Geriatric psychiatrists most often favour bilateral ECT. They are likely to carry out physical examination, chest X-ray, ECG, haemoglobin estimation, urea and electrolytes, thyroid and liver function tests in medically ill people before considering ECT. They are more likely to change their ECT assessment procedures when dealing with medical illness, rather than any other aspect of treatment, and are unlikely to change any aspect of ECT treatment in someone of advanced age. CONCLUSIONS: Geriatric psychiatrists see their roles in relation to ECT as primarily that of assessment, and rely on others to advise on anaesthetic drug use, treatment technique, concurrent drug treatment and post-ECT management. It is important that the ECT consultant and ECT anaesthetist are aware of their role and prepared to offer appropriate advice. The role of the ECT consultant in relation to the responsible medical officer requires clarification.

Challenging the stigma of Alzheimer's disease.

Changing Minds--Every Family in the Land is a national campaign launched by the Royal College of Psychiatrists which aims to reduce discrimination against people who suffer from mental disorders. One of its target areas is dementia. What is the stigma associated with Alzheimer's disease and how can hospital doctors challenge it in everyday practice?

Stigma and Alzheimer's disease: causes, consequences and a constructive approach.

The term 'Alzheimer's disease' has entered the vocabulary of ordinary people. This has been useful, encouraging patients and families to seek medical help for conditions that were previously neglected as inevitable consequences of old age. Yet Alzheimer's itself can carry negative connotations. Some people who believe they have Alzheimer's disease are suffering from less sinister and more easily treated conditions. Even when the diagnosis is confirmed, many months of happy and worthwhile life continue for most patients and families if they are given appropriate information and support. It is important that neither families nor clinicians see life with presumed Alzheimer's disease as of no value.

Gender, isolation, work patterns and stress among old age psychiatrists.

OBJECTIVE: To investigate work patterns and stress in consultant old age psychiatrists over a period of 1 week and to attempt to identify areas amenable to change. DESIGN: Postal survey. PARTICIPANTS: Full-time old age psychiatrists on the list held by the Faculty of Old Age Psychiatry, Royal College of Psychiatrists. MAIN OUTCOME MEASURES: Hours spent on different work activities during a period of 1 week, Stress Checklist score, stressors perceived by respondents. MAIN RESULTS: Men and women doctors did not differ in numbers of hours worked. Consultants working with colleagues worked similar hours to single-handed consultants. Community activity was greater among consultants working with colleagues than among single-handed doctors, whose work was based more in outpatient clinics. For the whole group, time in acute ward rounds correlated positively with stress score and time spent on research at home correlated negatively with stress score. CONCLUSIONS: Doctors spending more than 50 hours at work might be advised to review their work pattern. Excessive time on administrative activities should be reduced. Peer support should be encouraged. Consultants and managers should be sensitive to work patterns and possible sources of stress.

Burnout: current knowledge and relevance to old age psychiatry.

OBJECTIVES: To review the literature on burnout and consider its relevance to old age psychiatry and the role of the consultant. DATA SOURCES: Medline and PsychLit computerized databases. DATA SYNTHESIS: Burnout is a syndrome of emotional exhaustion, depersonalization and decreased sense of personal accomplishment which is recognized in people working in the human service professions and can have adverse effects on the workforce. There is little evidence of unique stressors related to care of elderly mentally ill people. Burnout is likely to be modified by workplace interventions. Relevant areas for intervention are political and social, organizational and management, training and personal issues. Support to consultants and their continuing professional development need to be radically reviewed.

The role of the old age psychiatry consultation liaison nurse.

OBJECTIVE: To assess and describe service changes when a psychiatric consultation liaison nursing service is introduced. DESIGN: Prospective collection of basic service data before and after implementation of the service change. SETTING: A newly established comprehensive old age psychiatry service. PATIENTS: People on medical and surgical wards aged over 65 years referred for psychiatric assessment. OUTCOME MEASURES: Numbers of referrals made and patients seen, details of psychiatric diagnoses made and follow-up offered before and after the change in the service. RESULTS: Within 6 months there was an increase in liaison referrals to the service. The proportion of people offered follow-up showed little change and delay before assessment decreased substantially with the PCLN service. CONCLUSIONS: A psychiatric consultation liaison nursing (PCLN) service was successfully initiated. Numerous difficulties were encountered but this is a useful model for old age psychiatry services to consider researching and developing further.

Old age psychiatrists: what do they find stressful?

OBJECTIVE: To examine the main sources of stress for practising old age psychiatrists. DESIGN: Postal survey. SETTING: Old age psychiatry services in England and Wales. PARTICIPANTS: Old age psychiatrists on the list held by the Section of Old Age Psychiatry, Royal College of Psychiatrists. MAIN OUTCOME MEASURES: Number and nature of stresses identified by respondents. MAIN RESULTS: One hundred and thirty-eight old age psychiatrists identified a mean of 5.1 stresses per respondent, which fell into seven broad categories: changes within the health service, community care changes, personal, management-related, resource-related, related to time pressures, overwork and others. CONCLUSIONS: Unavoidable stresses were rarely listed. Most were related to work overload and organizational structure and climate. More research is needed on stress in other areas of psychiatry, ways to minimize/prevent stress and how to optimize the balance between work and home life.

The everyday work of geriatric psychiatrists.

A workload questionnaire, detailing activities undertaken over a specified 7-day period, was circulated by post to geriatric psychiatrists on the list held by the Section of Old Age Psychiatry, Royal College of Psychiatrists. One hundred and thirty-eight responses have been analysed to show patterns of work over the days of the week. Much of the respondents' time is concentrated on clinical work. Administration and committee work extends into every day of the week, but personal study and research are only reported by small numbers of respondents.

Sexual abuse of the elderly mentally ill.

Sexual abuse of the elderly may occur more commonly than is recognized. Reasons for the neglect of this area and possible risk factors are discussed. A definition of elder sexual abuse is proposed, and four case histories, each of which raises various issues about the nature, detection and management of sexual abuse, are described. In the absence of procedures for dealing with elder sexual abuse, professional staff need to be open to its occurrence and to be prepared to carry out thorough, sympathetic, collaborative assessments of both parties involved where it is suspected.

Depression in old age. A reconsideration of cerebral disease in relation to outcome.

In a prospective study, 32 patients with depressed mood and cerebral pathology were compared over one year with 66 depressed patients who were cerebrally intact. The hypothesis that the former would have a poorer outcome for depression was not confirmed, although the group with cerebral pathology had a significantly higher than expected death rate. Prognostic factors were identified only for the cerebrally intact group. Those who had major depression were more likely than those with minor depression to be given physical treatments, irrespective of which group they belonged to.

Management of depression in the elderly.

Depressive illness in late life may present to doctors in the community or on general hospital wards. Management often involves physical treatments, but social and psychological approaches may also be important. This article considers acute treatment, continuation treatment (to prevent relapse) and the treatment of resistant depressive illnesses.

Visual hallucinations as the presenting symptom of senile dementia.

A case of senile dementia that initially presented with complex visual hallucinations in the absence of clinical cognitive impairment or other psychopathology is described. Dementia must be added to the differential diagnosis of isolated visual hallucinations in the elderly.

Medical Students and Electroconvulsive Therapy: Their Knowledge and Attitudes.

Two consecutive cohorts of medical students who received their fourth year psychiatry training at Manchester University completed knowledge and attitude questionnaires on ECT at the start and conclusion of their clerkships. Their understanding and knowledge of ECT was shown to be greater at the end of the clerkship and their attitudes towards treatment were more positive. The second cohort received an extra teaching session on ECT but this did not confer any additional benefit. It is concluded that increased contact with and knowledge about the treatment has a positive effect on medical students' attitudes. There is still room to improve teaching about ECT.