ABSTRACT
The authors examined availability, characteristics, and perceived adequacy of psychiatric consultation in nursing homes, as reported by directors of nursing, who returned 899 questionnaires. Thirty-eight percent of nursing home residents were judged to need a psychiatric evaluation; current frequency of consultation was rated as adequate by half of nursing directors. Nearly two-thirds reported that psychiatrists adequately provided diagnostic and medication recommendations; however, advice on nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts was largely viewed as inadequate. Findings suggest that perceived need for psychiatric services is far greater than the level actually provided. Overall, more attention must be directed to identifying incentives for psychiatrists to practice in nursing homes, determining clinical effectiveness of mental health services, and examining effects of alternative payment mechanisms on level of care.
Subject(s)
Nursing Homes , Psychiatry , Referral and Consultation , Humans , Mental Health Services/economics , Needs AssessmentABSTRACT
OBJECTIVE: An evaluation of the safety and efficacy of electroconvulsive therapy (ECT), for the treatment of patients with severe medical and neurological illness, was undertaken. METHOD: The English-language literature reporting the use of ECT in patients with neurological and somatic disease was reviewed. This review included reports describing ECT used for the treatment of affective disturbances and catatonia in patients with concurrent neurological or somatic disease, as well as reports dealing with the efficacy of ECT for the treatment of certain neurological conditions for which it has been reported to have some benefit independent of its psychiatric effect. CONCLUSIONS: ECT is safe and effective for the treatment of affective and catatonic disorders in patients with most neurological and medical diseases, including elderly and debilitated patients with multiple illnesses, if the specific medical risks are carefully evaluated in each case, and appropriate modifications of technique are used to reduce the risk of potential complications. Apart from its use in psychiatry, ECT has been reported to have therapeutic effects in Parkinson's disease, neuroleptic malignant syndrome, aggressive behavioral disorders following brain injury, certain forms of epilepsy, and some forms of delirium due to toxic or metabolic encephalopathies. The potential for ECT to play an active role in the clinical management of patients with these disorders, many of whom are presently refractory to maximal medical treatment, should be evaluated by systematic studies.
Subject(s)
Central Nervous System Diseases/therapy , Electroconvulsive Therapy , Aged , Aged, 80 and over , Brain Neoplasms/therapy , Cardiovascular Diseases/therapy , Catatonia/therapy , Cerebrovascular Disorders/therapy , Delirium/therapy , Dementia/therapy , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/methods , Electroconvulsive Therapy/standards , Epilepsy/therapy , Female , Humans , Huntington Disease/therapy , Male , Neurocognitive Disorders/therapy , Neuroleptic Malignant Syndrome/therapy , Parkinson Disease/therapyABSTRACT
Depression in medical-surgical patients has great impact on their well-being and medical condition. Although depression is like cancer, it is like a treatable cancer. If it is recognized and treated, the positive results can be dramatic and rewarding.
Subject(s)
Depressive Disorder/therapy , Neurocognitive Disorders/therapy , Patient Care Team , Psychophysiologic Disorders/therapy , Sick Role , Aged , Antidepressive Agents/therapeutic use , Combined Modality Therapy , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diagnosis, Differential , Female , Humans , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/psychology , Personality Assessment , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Psychotherapy, BriefABSTRACT
Rats maintained on limited-access daily feeding schedules develop food-anticipatory activity rhythms which coexist with the photic circadian activity rhythm. These food anticipatory rhythms appear to depend upon a food-entrainable circadian oscillator which is separate and distinct from the light-entrainable circadian oscillator system. This study explored the long-term behavior of the putative food-entrainable oscillator in the presence and in the absence of a feeding schedule, and under light-dark cycles and constant light. The results suggest that a food-entrainable oscillator can show persisting self-sustained oscillations in the absence of a feeding schedule, and that the food- and light-entrainable circadian oscillators may show varying degrees of coupling, depending upon feeding conditions. Such a flexible coupling arrangement may allow the oscillator system to function as a "continuously consulted clock" in the adaptive temporal coordination of behavior with stable and unstable environmental periodicities.
