[Treatment courses and therapeutic effectiveness of a psychogeriatric day hospital]. / Behandlungsverläufe und therapeutische Effektivität in einer gerontopsychiatrischen Tagesklinik.

Since 1976, 37 psychogeriatric day hospitals have been set up in Germany. As only few empirical studies on the effectiveness of this day hospital system are available even 25 years on, the treatment course of 58 patients attending the psychogeriatric day hospital run by the Department of Psychiatry, University of Tübingen was evaluated. The course analysis was based on a series of tests comprising the following questionnaires: Social Situation Scale, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Munich Quality of Life Dimension List (MLDL), Mini Mental Status (MMS), Hamilton Depression Scale, and Cumulative Illness Rating Scale (CIRS). Women accounted for three-quarters of the sample, and men for one-quarter. The average age was 72 years. The fact that only 16% of the patients had been transferred from psychiatric hospitals and that more than half had been referred directly by their local doctors underlines the acute-psychiatric nature of the institution. More than 80% of the patients were discharged to their previous place of residence. A highly significant improvement in affective state was verified by the Hamilton Depression Scale. Significant improvements were also registered in the following items: general satisfaction with life, state of health, physical and mental performance, and scope for personal development. The quality of life, measured with the Munich Quality of Life Dimension List (MLDL), improved in nine of the nineteen items covered, with correction of the significance level alpha taken into account. The treatment outcomes confirmed the therapeutic effectiveness of this type of psychogeriatric institution from aspects of acute psychiatry too and should encourage the continued expansion of partial hospitalization facilities for the elderly.

[The German Alzheimer Family Groups. An assessment of current status]. / Die deutschen Alzheimer-Angehörigengruppen. Eine Bestandsaufnahme.

Counselling the relatives of psychiatric patients is becoming increasingly important. This includes the relatives of patients with Alzheimer's disease. Since little is known about the organization and function of support groups for family caregivers of Alzheimer patients, in 1994 we wrote to all such groups known to us and asked them to fill in a questionnaire. The response rate was 85% (84/99), and 66 of the forms could be used for further analysis. The results were as follow: Most groups for relatives of Alzheimer patients admitted new members at any time. 69% had existed for more than 1 year and 19% for more than 5 years. 81% consisted of 6-15 participants. 73% of the groups met once in a month. Health professionals organized the groups in 65% of cases. The main topics were trading information about the disease and support as well as daily care requirements. 73% of the groups were associated with health institutions or nationwide support organizations. Public relations were managed by personal contacts and press reports; did the groups rarely advertise. Based on a review of the literature, the impact of structure upon the function of groups is discussed.

Dementia and depression: Co-distribution and risk factors in a geriatric in- and outpatient sample.

The results of a cross-sectional study on N = 212 elderly in- and outpatients are presented including sociodemographic data, physical findings, CAT-scan and EEG, as well as psychological tests for cognitive performance and affective symptoms. Forty-one percent of the patients showed mild and 13% severe cognitive deficits. Depression was diagnosed in 23% of the severely impaired and in 16% of the cognitively mildly impaired or unimpaired patients. Statistical analysis revealed that increasing age, female sex and low premorbid intellectual level were significantly associated with loss of cognitive function. Dementia and depression were not significantly associated with each other. The only risk factor for depression was a history of affective illness, but not cognitive deficits or social situation. CAT-scan and EEG were abnormal in 50% of the patients; however, this did not correlate with cognitive impairment or the presence of depression. From this study it is concluded that depression and dementia coincide frequently in elderly patients, but that they are associated with different risk factors It is suggested that dementia and depression are treated as two distinct disease entities.

[Treatment availability for patients with dementia]. / Behandlungsangebot für dementiell erkrankte Patienten.

Starting at a short account of epidemiological, symptomatical and therapeutical aspects of dementia, a group-referential concept for persons suffering from dementia is presented. Aims of treatment, points of view of carrying through and contents of the treatment are described. A summary of experiences up to now and recommendations for the therapeutical dealing with this group of patients follow.

Insertional mutations in mammals and mammalian cells.

The retroposon sequences, their mechanisms of transposition and the occurrence of insertional mutation in the mammalian genome are reviewed. Insertional mutations fall into two broad categories: those due to the disruption of a gene following the physical integration of a foreign DNA sequence result in loss of gene product and would be expected to be associated with a recessive mutation. A second class of insertional mutation is well documented in which upon integration the promoter/enhancer activities inherent in the retroposon genome exert their influence on neighboring genes. This promoter/enhancer activity of integrated retroposons may have effects over relatively long distances and thus limit the possibilities of establishing an association between retroposon integration and mutation. It is emphasized that a systematic search for insertional mutations in the mammalian genome involves an extensive two-dimensional array of possible retroposon sequences and mutant alleles. Present results represent only a small portion of the total array. Future studies promise to be fruitful in efforts to isolate genes through insertional tagging, to characterize the mechanisms of retroposon transposition, as well as to study the stability of the mammalian genome.

Effect of irradiation and mutagenic chemicals on the generation of ADH2- and ADH4-constitutive mutants in yeast: the inducibility of Ty transposition by UV and ethyl methanesulfonate.

A strain defective in fermentation due to a deletion in the ADH1 gene was used to generate revertants which are constitutive mutants of the genes ADH2 and ADH4. By analyzing the DNA of the mutants we determined the frequency of Ty insertions into the promoter region of these genes. We found an increase in transposition after UV irradiation and treatment with ethyl methanesulfonate (EMS). Chemical inhibition of DNA synthesis and translation decreased the induced mutant yield and the transposition frequency, whereas inhibition of transcription had no effect. Differences in transposition frequencies between different strains and between the 2 loci lead to the conclusion that not only the transposable element itself but also the insertion sites determine the frequency of Ty transposition to a given locus.

Effect of irradiation and mutagenic chemicals on the generation of ADH2-constitutive mutants in yeast. Significance for the inducibility of Ty transposition.

Mutations caused by the insertion of a Ty element resulting in an antimycin-A-resistant phenotype in an adh1- strain of Saccharomyces cerevisiae were used as an assay for the quantitative detection of Ty transposition. Antimycin-A-resistant mutants were found to be inducible by ethyl methanesulfonate (EMS) as well as by gamma- and UV irradiation. DNA analysis of gamma-induced mutants showed an increase of the fraction of Ty insertions in the ADH2 locus with increasing dose.