Gonadal hormones, but not sex, affect the acquisition and maintenance of a Go/No-Go odor discrimination task in mice.

In mice, olfaction is crucial for identifying social odors (pheromones) that signal the presence of suitable mates. We used a custom-built olfactometer and a thirst-motivated olfactory discrimination Go/No-Go (GNG) task to ask whether discrimination of volatile odors is sexually dimorphic and modulated in mice by adult sex hormones. Males and females gonadectomized prior to training failed to learn even the initial phase of the task, which involved nose poking at a port in one location obtaining water at an adjacent port. Gonadally intact males and females readily learned to seek water when male urine (S+) was present but not when female urine (S-) was present; they also learned the task when non-social odorants (amyl acetate, S+; peppermint, S-) were used. When mice were gonadectomized after training the ability of both sexes to discriminate urinary as well as non-social odors was reduced; however, after receiving testosterone propionate (castrated males) or estradiol benzoate (ovariectomized females), task performance was restored to pre-gonadectomy levels. There were no overall sex differences in performance across gonadal conditions in tests with either set of odors; however, ovariectomized females performed more poorly than castrated males in tests with non-social odors. Our results show that circulating sex hormones enable mice of both sexes to learn a GNG task and that gonadectomy reduces, while hormone replacement restores, their ability to discriminate between odors irrespective of the saliency of the odors used. Thus, gonadal hormones were essential for both learning and maintenance of task performance across sex and odor type.

Should patients who assault staff be prosecuted?

This article discusses the issue of prosecution of mentally disordered patients particularly in relation to assaults or acts of violence in health care settings. The arguments for prosecuting those responsible for committing acts of dangerous behaviour are discussed, as are the arguments against prosecution and some of the possible reasons why this is a contentious area of discussion. There are significant risks to the integrity of mental health services if the consideration of prosecution as a strategy to reduce risk of violence in hospitals does not become an area of meaningful discussion at all levels. The risk of violence is real, but the risks of accepting it without taking measures to reduce the frequency or severity of violence is no less acceptable than accepting that burglary is inevitable and leaving one's front door ajar every day. Health care professionals may wish to consider that in the absence of a clinically based solution or ownership of the problem, the risk of an organizational response to this sensitive area, perhaps guided or driven by political concerns is likely, as has happened in areas such as risk assessment, treatability and compliance with treatment.

Effectiveness of nursing home staff as managers of disruptive behavior: perceptions of nursing directors.

Nursing directors of 899 geographically diverse skilled nursing facilities reported substantial limitations in the competence of staff at all levels in managing behaviorally disturbed patients and a broad-based need for improvements in skills. The authors propose an interdisciplinary team training model as an appropriate design for improving competence and promoting collaborative care.

Primary vs subspecialty care: a structured follow-up of dementia patients and their caregivers.

All dementia patients and their caregivers who had received a University-based comprehensive evaluation and a diagnosis of Alzheimer's disease during 1997 (N = 80) were surveyed 1 year after their initial assessment. Of the original cohort, 72.5% were contacted, and two subgroups were defined: 31 patients were being seen only by their primary care physicians (MED), and 27 patients were being treated in addition by a geriatric psychiatry faculty member (GERO). There were statistically significant differences between the two groups (MED vs. GERO, respectively) at follow-up in terms of: 1) hospitalization (39% vs. 15%; P

Partial characterization of apoptotic factor in Alzheimer plasma.

We have previously demonstrated that a plasma natriuretic factor is present in Alzheimer's disease (AD), but not in multi-infarct dementia (MID) or normal controls (C). We postulated that the natriuretic factor might induce the increased cytosolic calcium reported in AD by inhibiting the sodium-calcium antiporter, thereby activating the apoptotic pathway. To test for a factor in AD plasma that induces apoptosis, we exposed nonconfluent cultured LLC-PK1 cells to plasma from AD, MID, and C for 2 h and performed a terminal transferase-dUTP-nick-end labeling (TUNEL) assay. The plasma from AD increased apoptosis nearly fourfold compared with MID and C. The effect was dose dependent and the peak effect was attained after a 2-h exposure. Additionally, apoptotic morphology was detected by electron microscopy, and internucleosomal DNA cleavage was found. We inhibited apoptosis by removing calcium from the medium, inhibiting protein synthesis with cycloheximide, alternately boiling or freezing and thawing the plasma, and digesting a partially purified fraction with trypsin. Heating AD plasma to 56 degrees C did not deactivate the apoptotic factor. These results demonstrate the presence of an apoptotic factor in the plasma of patients with AD.

Psychiatric consultation in the nursing home. A survey of six states.

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.

Past utilization of geriatric psychiatry outpatient services by a cohort of patients with major depression.

The authors examined past utilization of outpatient psychiatric services by elderly depressed patients. A chart review identified 49 patients (mean age = 69.4) who had ceased active treatment, of whom 28 were successfully contacted. Reasons for discontinuation were 1) patient perception that care was no longer needed (51.5%); 2) existence of barriers to care (33.3%); and 3) perception that treatment was ineffective (15.2%). Findings included 1) a higher number of visits by patients referred from a non-healthcare source and by married patients; 2) lower Beck Depression Inventory scores among those who reported that they did not need additional treatment; and 3) a greater willingness to re-engage in treatment by those patients with a higher number of visits during their previous treatment. Patient characteristics and source of referral were associated with both past service utilization and likelihood of future usage; however, many individuals do not access treatment because of both practical and attitudinal barriers to care.

Ca2+-binding stoichiometry of calbindin D28k as assessed by spectroscopic analyses of synthetic peptide fragments.

Calbindin D28k is an intracellular Ca2+-binding protein noted for its abundance and specific distribution in mammalian brain and sensory neurons. This protein contains six putative Ca2+-binding sites, referred to as EF-hands. Due to the presence of the large number of putative sites, previous studies have been unsuccessful in definitively establishing the stoichiometry of Ca2+ binding. We describe a synthetic approach to identify the number of Ca2+-binding sites in which 6 33-residue peptides, designated EF1-EF6, corresponding to the 6 EF-hand sequences of calbindin D28k, were made. The response of each peptide to Ca2+ addition was assessed by 1H NMR spectroscopy, circular dichroism (CD) spectroscopy, and agarose gel electrophoresis. The Ca2+ binding by CD experiments was performed at two peptide concentrations, 20 and 200 microM, and the NMR studies at peptide concentrations ranging from 20 to 100 microM. The CD and 1H NMR data show that five of the six peptides bind Ca2+ as isolated peptides, namely, EF1, EF3, EF4, EF5, and EF6. The EF6 peptide appears to bind Ca2+ with lower affinity than the other four functional sites. In contrast, EF2 does not appear to bind Ca2+ under any of the spectroscopic conditions tested. The data suggest that at least five of the six putative sites in the native protein bind Ca2+, although their relative affinities cannot be deduced from studies of the isolated peptides.

Negative symptoms in Alzheimer's disease.

OBJECTIVE: This study was undertaken to demonstrate that negative symptoms are prominent in patients with Alzheimer's disease and are distinct from depression. METHOD: patients with Alzheimer's disease (N=24) and a group of cognitively intact older adults (N=26) were compared in terms of scores on the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease. RESULTS: Negative symptoms were more severe in patients with Alzheimer's disease than in the healthy elderly comparison subjects. Among the patients with Alzheimer's disease, negative symptoms were correlated with dementia severity. CONCLUSIONS: Patients with Alzheimer's disease display little interest in self-care, work and household tasks, social and family activities, and emotional needs of others, despite an absence of depressive symptoms, positive symptoms, comorbid systemic illnesses, or medication exposure. Such negative symptoms may contribute to functional disability and thus complicate management of such patients.

Depressive symptoms in Alzheimer's disease and multi-infarct dementia.

We examined the prevalence of major depression, depressed mood/anhedonia, and subjective and neurovegetative symptoms of depression that were unaccompanied by depressed mood/anhedonia in patients with clinically-diagnosed Alzheimer's disease (AD) and multi-infarct dementia (MID). The specificity of subjective and neurovegetative depressive symptoms for depressed mood in dementia was examined, as was the impact on depression of clinical variables such as family history, patient age, and dementia severity. Subjects were 105 outpatients who met DSM-III-R criteria for AD (n = 67) or MID (n = 38). Depressed mood/anhedonia was frequently noted in both the AD (40.3%) and MID (34.2%) groups. One or more depressive symptoms, not accompanied by depressed mood/anhedonia, were also common in AD and MID (49.3% and 36.8%, respectively). Major depression was relatively uncommon in AD (10.5%) but was noted more frequently in MID (29.0%). Among AD patients, neurovegetative symptoms of depression were not any more common in patients with depressed mood/anhedonia than in those without depressed mood/anhedonia. Subjective symptoms of depression were also not significantly associated with depressed mood/anhedonia. The study highlights the importance of viewing major depression, depressed mood-anhedonia, and other depressive symptoms (subjective and neurovegetative) as separate entities in AD and MID.

The effects of resistance strategies on rape.

This investigation sought to clarify which resistance strategies were associated with rape avoidance and at what cost. Data were gathered from initial and supplemental police reports about 150 sexual assault victims, ages 16 and older, who were assaulted between June 1, 1988, and May 31, 1989, in Omaha, Neb. Although this analysis could not determine causality, it did indicate that forceful verbal resistance, physical resistance, and fleeing were all associated with rape avoidance, whereas nonforceful verbal resistance and no resistance were associated with being raped. Further, women who used forceful resistance were no more likely to be injured than women who did not resist.

Convex third ventricle: a possible sign for dementia using MRI.

The shape and thickness of the third ventricles were studied with magnetic resonance imaging in 46 patients under evaluation for memory impairment. We compared this population with 23 subjects imaged for other reasons. The study group consisted of patients with diagnoses of probable dementia of the Alzheimer's type (DAT; 35.6%), multi-infarct dementia (MID; 22.2%), depression (8.9%), alcoholic dementia (6.7%), other dementias (OD; 13.2%) and no dementia (6.7%). Within the study group, there were no significant differences across diagnostic categories for duration of symptoms or level of education. Patients with DAT were, however, more impaired than others (Mini-Mental State Examination scores: DAT 14.6 [+/- 8.2] versus MID 17.4 [+/- 6.2] versus OD 21.2 [+/- 6.4]). Demented subjects were more likely than nondemented individuals to have a convex third ventricle and greater wall separation. The results suggest that the shape of the third ventricle may correlate with dementia. Possibly, the dorsal medial nucleus of the thalamus is involved in the dementia.

Characteristics of older adults referred to a psychiatric emergency outreach service.

Although older adults typically underutilize mental health services, problems associated with dementing illnesses, chronic medical illnesses, affective disorders, social isolation, and multiple medication use, among other phenomena, have increased referrals of the elderly to psychiatric emergency services. The present study reviewed characteristics of elderly adults referred to a psychiatric emergency outreach/screening service. Of all individuals for whom a referral was made, 24% were aged 60 or older. Among those older adults referred, 63% were seen by screening service personnel; 37% did not meet screening criteria or voluntarily sought mental health services. Diagnoses of individuals evaluated included dementia (27%), affective disorders (27%), schizophrenia (16%), psychosis (12%), alcohol abuse (7), and diagnosis deferred (11%). Findings highlight the limited options available for mental health care of the aged.

Diagnosis of multi-infarct dementia: predictive value of clinical criteria.

Clinical and neuroimaging features that best discriminated a multi-infarct dementia diagnosis from a diagnosis of Alzheimer's disease were retrospectively reviewed for 192 patients of a university-based dementia diagnostic clinic. Only a subset of features usually ascribed to multi-infarct dementia actually distinguished that diagnosis from the diagnosis of Alzheimer's disease.

The relationship between dementia and elder abuse.

OBJECTIVE: Alzheimer's disease and other dementias may be associated with greater risk for physical abuse than other illnesses of the elderly. The authors examined the relationship between dementia and abusive behavior in a group of demented patients and their caregivers. METHOD: An anonymous questionnaire was distributed to 1,000 caregivers who called a telephone help line specializing in dementia. Demographic characteristics of patients and caregivers were assessed, the occurrence of abuse was examined, and caregivers completed the Zarit Burden Interview and the Zung Self-Rating Depression Scale. RESULTS: Questionnaires were completed by 342 caregivers. The mean age of caregivers was 56.1 years; 163 (54.5%) were adult children caring for parents, 111 (37.1%) cared for spouses, and 25 (8.4%) cared for other relatives. Thirty-three caregivers (11.9%) reported that they had directed physically abusive behavior (e.g., pinching, shoving, biting, kicking, striking) toward the dementia patient in their care. These caregivers had been providing care for more years, cared for patients functioning at a lower level, displayed higher burden scores, and displayed higher depression scores than caregivers who reported no abuse. In addition, 92 caregivers (33.1%) reported that the patient directed abuse toward them during the course of providing care. Caregivers who had been abused by patients, in comparison to those who had not, were more likely to direct abusive behavior back toward the patient in their care. CONCLUSIONS: These results support the hypothesis that abuse involving cognitively impaired older adults and their caregivers may be associated with the relatively high psychological and physical demands placed on family members who care for relatives with dementia.

A retrospective study of syphilis seropositivity in a cohort of demented patients.

A retrospective study of 376 patients with dementia was performed to determine the rate of syphilis seropositivity. Subjects were seen over a 2.5-year period and received medical, social, psychiatric, neurological, and laboratory evaluations. Mean age was 74 years and 73% were women. Diagnoses included Alzheimer's disease (AD; 29.8%), vascular dementia (VascD; 24.7%), combined AD/VascD (14.3%), and other diagnoses (31.2%). Dementia was moderately advanced with a mean Folstein Mini-Mental State Score of 16. Fluorescent treponemal antibody absorption tests (FA) were performed on 338 of the patients with 10.9% being reactive. Two of nine subjects with reactive FA's had reactive rapid plasma reagin tests.

Information and referral service usage among caregivers for dementia patients.

Questionnaires were mailed to 257 callers of a toll-free telephone "helpline" specializing in Alzheimer's disease and related dementing illnesses; 125 (48.6%) were completed and returned. On the average, 3.94 requests for information were made per call. The most common requests concerned services delivered to the home, general information about dementia, information about adult day care, and support group information. Results indicated that a telephone-based information and referral helpline is useful in disseminating knowledge about resources to caregivers of older community-residing adults with cognitive impairment.

The diagnosis of dementia: demographic characteristics.

The demographic characteristics of 242 clinic outpatients evaluated for dementia were examined. Each individual received a comprehensive assessment of medical status, psychological functioning, and social abilities. Diagnoses were arrived at by consensus, and appropriate treatment plans and follow-up recommendations were generated, with comprehensive feedback provided to family members and other caregivers. The results of this study help increase our knowledge of the characteristics of individuals with Alzheimer's disease, multi-infarct dementia, or other related disorders.

The effect of goal-setting and feedback on age differences in secondary memory.

Goal-setting and feedback have been found to improve performance on a variety of tasks. The present study applied this finding to an examination of adult age differences in secondary memory. Elderly and young adults completed a free-recall task in which one subgroup established a performance goal for blocks of trials and received feedback on a trial-by-trial basis. A second, comparison subgroup completed the same task without setting goals or receiving feedback. Results indicated that the use of the motivational technique of goal-setting and feedback increased memory performance of both age groups beyond that obtained under standard recall conditions.

Are there age differences in chunking?

We examined the ability of younger and older adults to organize letter sequences in memory when no external inducement of chunking was used. In order to do so, subjects were tested on a paired-associate, serial recall task. From these data the number of completely recalled sequences was computed, as well as global and stop transitional error probabilities (TEPs). Older adults recalled fewer correct letter sequences than did the young adults, but the global and stop TEP data indicated that both age groups were chunking the four-letter sequences into two sets of two letters. Thus, the present study indicates that there are no age differences in primary organization, but that older adults exhibit an age deficit in serial recall.