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1.
Aging Ment Health ; 9(2): 172-6, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15804636

ABSTRACT

Information regarding older adult emergency center (EC) patient characteristics remains limited, despite its increasing importance in health care delivery systems. This retrospective study encompasses all EC visits over an eight-year period (n = 825,682) to a large urban county hospital. Only participants with a primary psychiatric diagnosis were examined, and included a total of 53,894 adults, 18-64 years old and 1,478 adults, > or =65 years old. Despite an increasing aging population, EC visits for older adults with psychiatric disorders did not increase over time. Within the older adult sample, cognitive, psychotic, and bipolar disorders were associated with higher rates of admission to the hospital, while substance use, depressive, and anxiety disorders were associated with lower numbers of inpatient admissions. African-Americans were over-represented in the EC and admitted to the hospital at higher rates, compared to other ethnic groups. Caucasian patients were the group most frequently diagnosed with a substance use disorder. In conclusion, differences in race, and diagnosis support the idea that such variables directly relate to utilization rates, presentation, and disposition within the EC.


Subject(s)
Emergency Services, Psychiatric/statistics & numerical data , Mental Disorders/rehabilitation , Adolescent , Adult , Aged , Anxiety Disorders/epidemiology , Anxiety Disorders/rehabilitation , Bipolar Disorder/epidemiology , Bipolar Disorder/rehabilitation , Cognition Disorders/epidemiology , Cognition Disorders/rehabilitation , Depressive Disorder/epidemiology , Depressive Disorder/rehabilitation , Female , Hospitalization , Humans , Incidence , Male , Mental Disorders/epidemiology , Middle Aged , Psychotic Disorders/epidemiology , Psychotic Disorders/rehabilitation , Substance-Related Disorders/epidemiology , Substance-Related Disorders/rehabilitation
2.
Int J Geriatr Psychiatry ; 16(4): 356-60, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11333421

ABSTRACT

As many World War II and Korean Conflict veterans suffering from posttraumatic stress disorder (PTSD) grow older, increasing numbers will be diagnosed with dementia. We retrospectively analyzed patients with dementia, comparing the behavioral disturbances of those with PTSD to those without PTSD. We hypothesized that due to the additive effect of the neurobiological and behavioral changes associated with PTSD and dementia, the dementia with PTSD group would show more agitation and disinhibition than the dementia without PTSD group. Sixteen patients with diagnoses of dementia and PTSD were matched on age and Mini-Mental States Examination (MMSE) scores to 16 patients with dementia without PTSD. Demographic characteristics, co-morbid diagnoses, global Assessment of Functioning (GAF), Cohen-Mansfield Agitation Inventory (CMAI), and paranoid items of Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were assessed. The patients with diagnoses of dementia with PTSD did not differ significantly in their clinical presentation, hospital course, and condition at discharge from patients with dementia without PTSD. Chi-square analysis showed that significantly more subjects in the PTSD group were prescribed anti-depressants compared to the non-PTSD group. Interestingly, within the PTSD group, the subgroup of patients who were former prisoners of war had a significantly higher mean score for paranoia and significantly less verbal agitation. This pilot study reveals that a diagnosis of PTSD alone is not sufficient to influence behavior in veterans with dementia; however, we also present provocative results that patients with more severe trauma (POW) do have changes in their behavior.


Subject(s)
Dementia/psychology , Prisoners/psychology , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Aged , Case-Control Studies , Dementia/complications , Humans , Inhibition, Psychological , Male , Psychiatric Status Rating Scales , Psychomotor Agitation , Retrospective Studies , Stress Disorders, Post-Traumatic/complications , Warfare
3.
Psychiatr Serv ; 52(3): 376-8, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11239108

ABSTRACT

This study examined the outcomes associated with shortening hospital stays for geriatric inpatients with dementia at a Veterans Administration medical center. Thirty-three patients who were admitted after January 1997, when the hospital decided to reduce patients' lengths of stay, were matched with 33 patients who were admitted before January 1997. Despite significant differences in lengths of stay, no differences were found between the groups on measures of agitation or overall functioning. Despite significantly shorter stays since January 1997, the results of our study indicate that the cognitive and emotional status of patients discharged since that time are equivalent to those of patients discharged after longer hospital stays.


Subject(s)
Dementia/therapy , Hospitals, Veterans/statistics & numerical data , Length of Stay/statistics & numerical data , Psychiatric Department, Hospital/statistics & numerical data , Treatment Outcome , Aged , Dementia/classification , Female , Geriatric Psychiatry , Humans , Male , Organizational Policy , Psychiatric Status Rating Scales , Texas , Utilization Review
4.
Int J Geriatr Psychiatry ; 16(2): 223-7, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11241729

ABSTRACT

The atypical antipsychotics are gradually becoming the mainstay of treatment for psychosis in the elderly. The present study examines the effectiveness and tolerability of risperidone and olanzapine treatment in 34 matched male patients admitted to a VA Medical Center geriatric inpatient unit. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Cohen-Mansfield Agitation Inventory (CMAI), the Rating Scale for Side-Effects, the Extra-Pyramidal Rating Scale, and the Mini-Mental State Examination were administered at admission and discharge. T-tests at admission and discharge across groups indicate that the patients as a whole were performing significantly better following their stay on the CMAI (t(30)=4.31, p=0.000), the GAF (t(31)=9.73, p=0.000), the PANSS total score (t(29)=3.82, p=0.001), and the positive symptom portion of the PANSS (t(28)=4.29, p=0.000). No significant differences were detected between the two groups with regard to length of hospitalization, or reduction in scores on the PANSS, or CMAI, however the daily cost of risperidone was 1/3 as much as olanzapine (p=0.00). The two treatments were comparable in the elderly men evaluated in this study.


Subject(s)
Antipsychotic Agents/pharmacology , Pirenzepine/analogs & derivatives , Pirenzepine/pharmacology , Risperidone/pharmacology , Schizophrenia/drug therapy , Aged , Antipsychotic Agents/economics , Antipsychotic Agents/therapeutic use , Benzodiazepines , Cost-Benefit Analysis , Humans , Male , Olanzapine , Pirenzepine/economics , Pirenzepine/therapeutic use , Risperidone/economics , Risperidone/therapeutic use
5.
Psychosomatics ; 41(6): 465-71, 2000.
Article in English | MEDLINE | ID: mdl-11110109

ABSTRACT

The authors examined the relationship between functional status and comorbid anxiety and depression and the relationship between utilization of health care resources and psychopathology in elderly patients with chronic obstructive pulmonary disease (COPD). Elderly male veterans (N = 43) with COPD completed anxiety, depression, and functional status measures. The authors constructed regression models to explore the contribution of COPD severity, medical burden, depression, and anxiety to the dependent variables of functional impairment and health care utilization. Anxiety and depression contributed significantly to the overall variance in functional status of COPD patients, over and above medical burden and COPD severity, as measured by the 8 scales of the Medical Outcomes Study (MOS) 36-item Short Form Health Survey. Surprisingly, medical burden and COPD severity did not contribute significantly to overall variance in functional status. Few patients were receiving any treatment for anxiety or depression.


Subject(s)
Activities of Daily Living/psychology , Anxiety/psychology , Depression/psychology , Lung Diseases, Obstructive/psychology , Sick Role , Aged , Anxiety/diagnosis , Comorbidity , Depression/diagnosis , Health Services Misuse , Humans , Male , Middle Aged , Primary Health Care , Veterans/psychology
6.
Int J Geriatr Psychiatry ; 15(9): 831-7, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10984730

ABSTRACT

This cross-sectional study explored age-related differences in the frequency of diagnosis of personality disorder (PD) among 790 veterans admitted to a psychiatric inpatient unit across three age groups: 20-39, 40-59, and 60+. Older adults obtained a lower frequency (55.4%) of PD diagnosis than middle-aged adults (69.0%), who in turn obtained a lower frequency of PD diagnosis than young adults (75.9%). Older adults and middle-aged adults were less likely to receive a diagnosis of Borderline PD than young adults. Older adults were also less likely to receive a diagnosis of Mixed PD than young adults, but received significantly more diagnoses of Narcissistic PD than young adults. Patients diagnosed with PD had higher rates of psychiatric hospitalization than those with no diagnosis of PD. Older adults and middle-aged adults with PD had significantly fewer psychiatric hospitalizations than young adults with PD, whereas there were no age-related differences in the frequency of medical hospitalizations. These findings are consistent with research suggesting an overall softening of PD features with age, particularly those characteristic of the 'dramatic-erratic', Cluster B types.


Subject(s)
Personality Disorders/psychology , Adult , Age Factors , Age of Onset , Aged , Cross-Sectional Studies , Female , Humans , Inpatients , Male , Middle Aged , Severity of Illness Index , Veterans
7.
J Geriatr Psychiatry Neurol ; 13(1): 33-7, 2000.
Article in English | MEDLINE | ID: mdl-10753005

ABSTRACT

The authors determined the prevalence and demographic features of drug use disorders in a database of 565 veteran geropsychiatric inpatients. Twenty-four patients (4%) were diagnosed with nonalcoholic substance use disorders, including 18 (3%) with prescription drug use disorders and 6 (1%) with illegal drug use disorders. The patients diagnosed with prescription drug use disorders were predominantly Caucasian, whereas those diagnosed with illegal substance use disorders were predominantly African American. No other significant demographic differences were noted. Nonalcohol substance use disorders represent an unappreciated problem in psychiatrically hospitalized older adults, with illegal substance use disorders making up a larger than expected proportion of this group.


Subject(s)
Alzheimer Disease/epidemiology , Substance-Related Disorders/epidemiology , Veterans/psychology , Adult , Aged , Aged, 80 and over , Alcoholism/diagnosis , Alcoholism/epidemiology , Alcoholism/psychology , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Comorbidity , Cross-Sectional Studies , Humans , Illicit Drugs , Male , Middle Aged , Psychotropic Drugs , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology , Veterans/statistics & numerical data
8.
J Geriatr Psychiatry Neurol ; 13(1): 49-52, 2000.
Article in English | MEDLINE | ID: mdl-10753008

ABSTRACT

The objective of this study was to compare differences in behavioral, psychiatric, and cognitive status among geropsychiatric inpatients with Alzheimer's, vascular, alcohol-induced, and mixed dementia. Participants included 150 patients with dementia consecutively admitted to an acute geropsychiatric inpatient unit. Measures included the Mini-Mental State Examination, Cohen-Mansfield Agitation Inventory, Cumulative Illness Rating Scale, Basic and Independent Activities of Daily Living, Positive and Negative Syndrome Scale for Schizophrenia, and the Initiation/Perseveration subscale of the Dementia Rating Scale. No significant differences existed in the character or severity of agitation among patients with Alzheimer's, vascular, alcohol-related and mixed dementia. Interestingly, patients with vascular dementia compared to patients with other dementias admitted for behavioral disturbances were less cognitively impaired and more medically burdened.


Subject(s)
Dementia/diagnosis , Social Behavior Disorders/diagnosis , Aged , Aggression/psychology , Alcohol-Related Disorders/diagnosis , Alcohol-Related Disorders/psychology , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Dementia/psychology , Dementia, Vascular/diagnosis , Dementia, Vascular/psychology , Diagnosis, Differential , Female , Humans , Male , Mental Status Schedule , Psychiatric Status Rating Scales , Psychomotor Agitation/psychology , Social Behavior Disorders/psychology
9.
J Gerontol A Biol Sci Med Sci ; 54(3): M157-61, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10191845

ABSTRACT

BACKGROUND: Specific behavioral disturbances in dementia may be associated with underlying disorders such as the presence of psychosis and depression. The objective of this study was to examine the association of depression and psychosis with behavioral disturbances in geropsychiatric inpatients with dementia. METHODS: All admissions between October 1993 and May 1995 were reviewed to identify those patients admitted to the Houston Veterans Affairs Geropsychiatry Unit with a diagnosis of dementia; 208 patients were included in the study. Hierarchical regression models were constructed to explore the contribution of depressive and psychotic symptoms, and depression and psychosis diagnoses to Cohen-Mansfield Agitation Inventory (CMAI) scores. RESULTS: Both depression and psychotic symptoms were significantly and positively correlated with behavioral disturbances. Psychotic symptoms were associated with aggressive behavioral symptoms, and depressive symptoms were associated with constant requests for help, complaining, and negativism. Dementia severity accounted for significant variance in CMAI scores and was positively associated with behavioral disturbance; though disorder symptoms accounted for more behavioral disturbance variance than did depressive symptoms. CONCLUSIONS: Both depressive and psychotic symptoms were associated with overall behavioral disturbances in patients with dementia. Psychotic symptoms and depressive symptoms were associated with different types of behavioral disturbances. Our findings support the contention that underlying depression or psychosis may partially account for different behavioral disturbances and that not all behavioral disturbances should be globally labeled "agitation." Future studies should address symptom-specific treatment of behaviorally disturbed patients.


Subject(s)
Dementia/complications , Depression/complications , Mental Disorders/etiology , Psychotic Disorders/complications , Aged , Aged, 80 and over , Aggression/psychology , Female , Hospitalization , Hospitals, Veterans , Humans , Male , Middle Aged , Negativism , Patient Admission , Psychiatric Department, Hospital , Psychomotor Agitation/etiology , Regression Analysis , Retrospective Studies
10.
J Nerv Ment Dis ; 186(5): 299-303, 1998 May.
Article in English | MEDLINE | ID: mdl-9612447

ABSTRACT

This study investigated the correlates of change in behavioral disturbance in geropsychiatric inpatients with dementia. It was hypothesized that improvement in specific psychiatric symptoms, such as psychosis and depression, contribute to the improvement of specific behavioral disturbances. All admissions between October 1993 and May 1995 were reviewed to identify those patients admitted to the Houston VA geropsychiatry unit with a diagnosis of dementia; 233 patients were included in the study. Improvement in behavioral disturbance symptoms was associated with decreases in depression, thought disorder, and hostility. However, the relative importance of depressive and psychotic symptoms varied depending upon the type of behavioral disturbance examined. These results may support a focused approach employing therapies specific to the type of behavioral disturbance.


Subject(s)
Behavioral Symptoms/diagnosis , Cognition Disorders/diagnosis , Dementia/therapy , Depressive Disorder/diagnosis , Hospitalization , Psychotic Disorders/diagnosis , Aged , Aged, 80 and over , Behavioral Symptoms/psychology , Behavioral Symptoms/therapy , Cognition Disorders/psychology , Cognition Disorders/therapy , Comorbidity , Dementia/diagnosis , Dementia/psychology , Depressive Disorder/psychology , Depressive Disorder/therapy , Geriatric Assessment , Geriatric Psychiatry , Hostility , Humans , Male , Middle Aged , Prognosis , Psychiatric Status Rating Scales/statistics & numerical data , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Treatment Outcome
11.
J Geriatr Psychiatry Neurol ; 10(2): 55-7, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9188019

ABSTRACT

The authors determined the outcome of geropsychiatric hospitalization for 73 very low-functioning demented patients (GAF score < 21). General psychiatric symptoms, depression, and agitation decreased significantly, and mean GAF scores increased significantly, with no significant change in cognitive function. Psychiatric hospitalization can meaningfully improve function and quality of life even in this very impaired population. Despite these improvements many patients are discharged to more restrictive settings.


Subject(s)
Dementia/therapy , Disability Evaluation , Patient Admission , Quality of Life , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Combined Modality Therapy , Comorbidity , Dementia/diagnosis , Dementia/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Hospitals, Psychiatric , Humans , Male , Middle Aged , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/psychology , Neurocognitive Disorders/therapy , Patient Care Team , Psychomotor Agitation/diagnosis , Psychomotor Agitation/psychology , Psychomotor Agitation/therapy , Treatment Outcome
12.
J Geriatr Psychiatry Neurol ; 10(1): 7-10, 1997 Jan.
Article in English | MEDLINE | ID: mdl-9100152

ABSTRACT

The authors examined the effect of hospitalization on cognitive and behavioral symptoms in delirious elderly patients with and without dementia. Forty-four (13%) of the patients admitted to a Veterans Affairs Medical Center geropsychiatric unit were diagnosed with delirium and were administered the Mini-Mental State Examination, the Hamilton Depression Rating Scale, the Brief Psychiatric Rating Scale (BPRS), the Rating Scale for Side Effects, and the Cohen-Mansfield Agitation Inventory. The total sample significantly improved on all measures. When patients with delirium were divided into subgroups with and without dementia, both subgroups improved similarly. Patients discharged to more restrictive environments improved significantly on the BPRS only.


Subject(s)
Delirium/therapy , Dementia/therapy , Hospitalization , Social Environment , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Cohort Studies , Combined Modality Therapy , Delirium/diagnosis , Delirium/psychology , Dementia/diagnosis , Dementia/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Humans , Length of Stay , Male , Mental Status Schedule , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/psychology , Neurocognitive Disorders/therapy , Neuropsychological Tests , Patient Care Team , Psychiatric Status Rating Scales , Retrospective Studies
13.
Article in English | MEDLINE | ID: mdl-9447503

ABSTRACT

This pilot study investigated effectiveness and tolerability of risperidone for the treatment of psychosis and agitation in 9 inpatients with Parkinson's disease and dementia. Investigators found risperidone to be effective and safe, without worsening extrapyramidal symptoms or further impairing cognition.


Subject(s)
Antipsychotic Agents/therapeutic use , Dementia/drug therapy , Parkinson Disease/complications , Psychomotor Agitation/drug therapy , Risperidone/therapeutic use , Aged , Antipsychotic Agents/adverse effects , Dementia/complications , Dementia/psychology , Female , Humans , Male , Parkinson Disease/psychology , Pilot Projects , Psychiatric Status Rating Scales , Psychomotor Agitation/etiology , Psychomotor Agitation/psychology , Risperidone/adverse effects
14.
J Geriatr Psychiatry Neurol ; 9(2): 53-6, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8736586

ABSTRACT

Several studies have reported an association between aggression and cholesterol levels. The purpose of this study was to investigate the relationship of serum cholesterol and triglyceride levels with aggression and cognitive function in elderly inpatients. One hundred ten patients consecutively admitted to the Geriatric Psychiatry inpatient unit at Houston's Veterans Affairs Hospital received comprehensive evaluations by a multidisciplinary team. Fasting serum cholesterol and triglyceride levels were obtained within 3 days of admission. In addition, two geriatric psychiatrists administered the Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). Correlation coefficients were calculated between lipid levels, CMAI total and subscale scores, and MMSE scores. Multiple linear-regression analyses were done to further investigate the relation between lipid concentrations and various confounders. We found no significant correlation between serum triglyceride levels and MMSE, CMAI total, and CMAI factor scores. In addition, we found a significant positive correlation between serum cholesterol levels and physical nonaggressive behavior, and a significant negative correlation between serum cholesterol levels and MMSE scores. We found no relationship between aggressive behavior and serum cholesterol or triglyceride levels. However, an association between high cholesterol levels and agitation exists, which may be mediated by the association between high cholesterol levels and impaired cognition.


Subject(s)
Cholesterol/blood , Dementia/blood , Psychomotor Agitation/blood , Triglycerides/blood , Aged , Aggression/physiology , Dementia/diagnosis , Dementia/psychology , Humans , Hypercholesterolemia/blood , Hypercholesterolemia/diagnosis , Hypercholesterolemia/psychology , Male , Mental Status Schedule , Patient Admission , Patient Care Team , Psychomotor Agitation/diagnosis , Psychomotor Agitation/psychology , Risk Factors
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