Eating disorders in dementia.

OBJECTIVES: To examine the prevalence and associations of altered eating patterns in dementia sufferers. DESIGN: Prospective cohort study. SETTING: Psychiatric services and a memory clinic. SAMPLE: 124 patients with DSM-III-R dementia. MEASURES: The Geriatric Mental State Schedule, the History and Aetiology Schedule, the Cornell Depression Scale and the CAMCOG. Additional standardized questions were asked about eating patterns in the month prior to the study. RESULTS: Information concerning eating patterns was obtained from 105 of the 124 patients: 21% had increased food consumption, 22.1% had decreased food consumption, 2.9% tried to eat inedible substances, 11.4% had an increased preference for sweet things, 7.6% became more fussy about their food choices and 4.8% became less fussy. Decreased food consumption was significantly associated with less severe cognitive impairment and was related to RDC major depression in some patients. An increased preference for sweet things showed an association with a diagnosis of Alzheimer's disease. Increased food consumption was probably heterogeneous. Neither increased food consumption nor an increased preference for sweet foods was associated with the severity of cognitive impairment. CONCLUSION: Altered eating patterns are common in dementia sufferers.

A prospective study of psychotic symptoms in dementia sufferers: psychosis in dementia.

Eighty-seven out of a clinical cohort of 124 patients with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) dementia were followed up at monthly intervals for 1 year. Psychotic symptoms were assessed using the Burns's Symptom Checklist, and cognitive functioning was evaluated with the CAMCOG. The annual incidence rate of psychotic symptoms was 47%, although many of the incident symptoms lasted less than 3 months. Fifty-three percent of patients with psychosis experienced resolution of their symptoms. Patients either experienced brief or persistent psychotic disorders, with few having an intermediary course. Persistent psychosis was significantly associated with a 3-month duration of symptoms at baseline. Neuroleptics did not significantly influence the course of psychotic symptoms.

The aetiology of depression in the carers of dementia sufferers.

OBJECTIVE: To examine the associations of depression in the carers of dementia sufferers, diagnosed on the basis of a semistructured interview. DESIGN: Case control study. SETTING: Referrals to clinical services. SUBJECTS: The informal carers of 109 dementia sufferers, 32 with depression and 77 without. MEASURES: Carers were interviewed using the Geriatric Mental State Schedule. The diagnosis of depression was made according to Research Diagnostic Criteria. Instruments used to assess associations included Carers' Stress Scale, Marital Intimacy Scale, Cornell Depression Scale and CAMCOG Schedule. RESULTS: Only increasing age was significantly associated with depression in the overall group of carers. The severity of cognitive impairment was significantly associated with depression in carers who lived with a dementia sufferer and a low level of premorbid marital intimacy was significantly associated with depression amongst carers who were marital partners. CONCLUSION: Few factors are clearly associated with depression in the carers of dementia sufferers. The pattern of associations was, however, different for carers in different situations.

The use of thiopentone in the treatment of non-organic locomotor disorders.

Eleven patients who had been fully investigated and diagnosed by orthopaedic surgeons as suffering from non-organic locomotor disorders were assessed and treated by a psychiatrist (AW) using a technique involving one or more injections of thiopentone sodium. The patients had been ill for an average of 3.4 yr (3 mths to 10 yr) and suffered severe disablement. Injections of short-acting barbiturates have been used for many years to facilitate the release and discussion of repressed feelings and emotions (narcoanalysis). This paper describes the use of a similar injection but given to facilitate the movement and return to normality of muscles whose function is deranged. The authors suggest that this technique be called 'narcokinesis'. All eleven patients showed initial improvement with seven patients showing moderate or marked benefit from the treatment at the time of discharge from hospital. A detailed case study is described of the advantages of narcokinesis and possible mode of action discussed. The general practitioners of these patients were sent a questionnaire by post and all replied. At the time of follow-up (6-9 yr) the whereabouts of three patients were unknown, three had died, two remained ill and three patients remained well or moderately well.