ABSTRACT
OBJECTIVES: The aim of this overview is to present the developments of music therapy in France, its techniques, mechanisms and principal indications, mainly in the context of Alzheimer's disease. METHODS: An international review of the literature on music therapy applied to Alzheimer's disease was conducted using the principal scientific search engines. A work group of experts in music therapy and psychosocial techniques then considered the different points highlighted in the review of literature and discussed them. RESULTS AND DISCUSSION: Clinical and neurophysiological studies have enlightened some positive benefits of music in providing support for people with Alzheimer's disease or related disorders. Music therapy acts mainly through emotional and psycho-physiological pathways. It includes a series of techniques that can respond to targeted therapeutic objectives. Some studies have shown that music therapy reduces anxiety, alleviates periods of depression and aggressive behaviour and thus significantly improves mood, communication and autonomy of patients. CONCLUSION: Psychosocial interventions, such as music therapy, can contribute to maintain or rehabilitate functional cognitive and sensory abilities, as well as emotional and social skills and to reduce the severity of some behavioural disorders.
Subject(s)
Alzheimer Disease/rehabilitation , Music Therapy/methods , Treatment Outcome , France , HumansABSTRACT
Psychogeriatrics is a rapidly growing field. In France, the focus is currently on targeted education and specific management. Psychiatric disorders may be atypical in the elderly, and may also be difficult to distinguish from the effects of aging or somatic disorders. The principal disorders observed in old age are depression, late delusion, anxiety disorder, hysteria, delirium and mania. Depression has specific features, depressive equivalents, particular risk factors, and a categorical and dimensional therapeutic approach. Diagnosis and screening must be improved Late delusion is organized around a notion of injury, and is an active attempt to deal with isolation, depression and anxiety. The term "very late-onset schizophrenia-like psychosis" has been proposed. Anxiety also has specific features in the elderly and is intimately related to depression. If left untreated, the consequences can be severe. Hysteria is pathoplastic with time, age and educational status. Pseudocognitive conversions are starting to be seen in old age. Delirium is very frequent in the elderly; it is often multifactorial, but psychosocial factors must not be underestimated. Mania can also be provoked by somatic disease, and mixed syndromes are far from rare. Dementia can be approached from its psychopathological dimension, particularly in terms of psychosocial risk factors and protective factors relating to the individual's biography and personality. Thus, psychogeriatrics is an integrated medical discipline in which psychiatric disorders are approached through specific clinical management, oriented research and structured training.
Subject(s)
Geriatric Psychiatry/trends , Mental Disorders , Age Factors , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/therapy , Bipolar Disorder/diagnosis , Bipolar Disorder/therapy , Delirium/diagnosis , Delirium/therapy , Depression/diagnosis , Depression/therapy , Diagnosis, Differential , Humans , Hysteria/diagnosis , Hysteria/therapy , Mental Disorders/diagnosis , Mental Disorders/therapy , Psychopathology , Risk Factors , Socioeconomic FactorsABSTRACT
The prognosis of depression, when the depression is diagnosed, is rather similar in the elderly and in younger adults. Recovery, after the initial episode or after one relapse or recurrence, is observed in about two thirds of the patients. However, depression increases the vulnerability of the elderly and is associated with an elevation of mortality, mainly due to the occurrence of somatic pathologies, which could be facilitated by the depression. Relapses, recurrences, chronicity and absence of therapeutic response are associated with inadequate treatment or follow-up. The prognosis of depression in elderly people requires a systematic diagnostic research and an appropriate treatment. The importance of follow-up and of a psychotherapeutic approach associated with antidepressant drugs should be emphasized.
Subject(s)
Depressive Disorder/diagnosis , Aged , Cause of Death , Chronic Disease , Comorbidity , Depressive Disorder/mortality , Depressive Disorder/therapy , France , Humans , Prognosis , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/mortality , Psychophysiologic Disorders/therapy , Recurrence , Risk Factors , Suicide/psychology , Suicide/statistics & numerical data , Survival Rate , Treatment FailureABSTRACT
The aim of this study was to describe the epidemiological features of agitation and aggressiveness in elderly individuals living in French nursing and retirement homes in the year 2000. Data were collected on the type, time of onset, and duration of symptoms, medical evaluation and treatment, and medical and psychiatric comorbidities of the elderly patients. The most frequently reported behavior was verbal aggressiveness and the least reported behavior was physical aggressiveness. A triggering factor initiating the symptoms of agitation or aggressiveness was reported in 61% of the cases. In 61% of the study population, there were several morbidities reported as caused by the agitated or aggressive behavior (anorexia, weight loss, dehydration). A specialist was consulted for nearly half of the agitated or aggressive patients. For 55% of the patients, a new medication regimen was started or the administration of previous medications was modified, the most frequently prescribed drugs being antipsychotics. The results of our study and others show that agitation and aggression have a substantial impact on the lives of the elderly population, as well as on the lives of their family members and caretakers.
