Pathways to care for people with dementia: An international multicentre study.

OBJECTIVE: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.

Development of an international schedule for the assessment and staging of care for dementia.

BACKGROUND: A reliable and valid global staging scale has been lacking within dementia care. OBJECTIVE: To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. METHODS: The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the project's steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedule's inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. RESULTS: Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. CONCLUSION: The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed.

Treatment of insomnia with hypnotics resulting in improved sexual functioning in post-menopausal women.

BACKGROUND: This study sought to determine whether trazodone used in hypnotic doses, compared to the hypnotic agent zopiclone, had any specific positive effect on sexual function in non-depressive post-menopausal women with insomnia. SUBJECTS AND METHODS: Fifty (50) subjects participated in the study. Insomnia and sexual performance were evaluated before and after 4 weeks of hypnotic treatment. RESULTS: At week four, both treatments improved sleep quality to a similar degree. Sexual function also improved significantly with both treatments, with no significant difference between the groups. CONCLUSIONS: In post-menopausal women, sexual problems and sleep problems may be related and solving sleep problems may help sexual functioning, independently of depression.

The relation of sexual function to migraine-related disability, depression and anxiety in patients with migraine.

BACKGROUND: Depression and anxiety are two phenomena that affect quality of life as well as sexual function. Depression and anxiety levels are reported to be high in migraine sufferers. We aimed to understand whether sexual function in women with migraine was associated to migraine-related disability and frequency of migraine attacks, and whether this relationship was modulated by depressive and anxiety symptoms. METHODS: As migraine is more commonly seen in females, a total of 50 women with migraine were included. The diagnosis of migraine with or without aura was confirmed by two specialists in Neurology, according to the second edition of International Headache Society (IHS) International Classification of Headache Disorders (ICHD-II) in 2004. Migraine disability assessment scale score, female sexual function index scores, Beck depression inventory score and Beck anxiety inventory scores. RESULTS: Mean MIDAS score was 19.3 ± 12.8, and mean number of migraine attacks per month were 4.3 ± 2.7. Mean Female Sexual Function Index score was 20.9 ± 5.9 and 90% of patients had sexual dysfunction. Sexual dysfunction was not related to MIDAS score or frequency and severity of attacks. No relationship between sexual function and anxiety was found, whereas severity of depressive symptoms was closely related to sexual function. Depressive symptoms affected all dimensions of sexual function, except for pain. CONCLUSION: Sexual dysfunction seemed to be very common in our patients with migraine, while not related to migraine related disability, frequency of attacks and migraine severity or anxiety. The most important factor that predicted sexual function was depression, which was also independent of disease severity and migraine related disability. While future larger scale studies are needed to clarify the exact relationship, depressive and sexual problems should be properly addressed in all patients with migraine, regardless of disease severity or disability.

Interpersonal communication in and through family: structure and therapy in Turkey.

It is essential for professionals in the mental health sector to identify and understand the different family models and the effects of social transformations. Historically and at present, however, Turkish families live in a 'culture of relatedness', with emotional and/or material interdependence between generations. Marriage and family therapy is a newly emerging discipline in Turkey. Although studies on family structure and common problems in families have been made, data on the practice of family therapy are limited. To our knowledge, this is the first paper aiming to describe the practice of family therapies in Turkey, situating them against a backdrop of sociological and social/psychological studies in family structure.

Eating disorder symptoms improved by antireflux surgery: a case report with a six-year follow up.

BACKGROUND: Anorexia nervosa (AN) is a chronic disorder that can overlap with lower esophageal sphincter failure and delayed gastric emptying. Patients with anorexia nervosa or other eating disorders may have a high incidence of gastrointestinal complaints, which can also be observed in gastroesophageal reflux disease (GERD). The overlap in the symptoms of these disorders may cause problems in differential diagnosis and treatment decisions. CASE DESCRIPTION: We report on a case of a patient with anorexia nervosa who did not benefit from conventional treatment strategies such as psychotropic drugs and psychotherapy, but remitted after antireflux surgery. CONCLUSION: When dealing with patients with symptoms of anorexia nervosa, physicians should keep in mind that these patients may have serious esophagogastric complications that can affect their response to psychiatric treatment. Alternatively, some patients with primary esophageal disorders may present with symptoms of eating disorders.

The risk factors and symptomatology of perimenopausal depression.

OBJECTIVES: The aim of this study is to determine if the depression in perimenopausal women is symptomatologically different than depression in premenopausal women, and if these depressive women are under more risk for depression when factors like premenstrual dysphoric syndrome, socio-economical status, vasomotor symptoms and familial inclination to depression are considered. METHODS: Fifty major depressive women with hormonally established perimenopause (follicle stimulating hormone (FSH) levels over 20IU/l and estrogen levels lower than 40IU/l) and who were not taking any psychotropic or hormone replacement therapy, were enrolled in the study. In order to investigate the characteristic clinical features of perimenopausal depression, a drug free control group consisting of 48 pre-perimenopausal women with a diagnosis of major depression was formed. Another control group was formed with 53 non-depressive perimenopausal women in order to investigate the risk factors of perimenopausal depression. RESULTS: The depressive and non-depressive groups did not differ from each other according to level of education, marital and economical status and comorbid physical problems. No major symptomatological difference between perimenopausal depression and pre-perimenopausal depression was found. No correlation was found between the severity of vasomotor symptoms and severity of depression. CONCLUSIONS: Findings of our study suggest that vasomotor symptoms and socio-economical status do not predict the severity and existence of perimenopausal depression. Episodes of major depression are not necessarily the normal result of such vasomotor symptoms. Therefore, the evaluation and management of perimenopausal depression should be carried out as carefully as is done in episodes of depression seen in the rest of women's life span.

Obsessive-compulsive symptoms in schizophrenia: prevalance and clinical correlates.

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive-compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) were evaluated by the structured and clinical interview for axis-1 DSM-IV disorders-patient edition (SCID-P), the Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y-BOCS total score > or =7) also met the DSM-IV criteria for OCD. The total score on Y-BOCS was significantly correlated with total score on PANSS, Positive-PANSS score, General-PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.

Paroxetine augmentation to tianeptine treatment causes exacerbation of depressive symptoms: presentation of two cases.

We present two cases whose depressive symptoms partially remitted with tianeptine treatment but exacerbated after paroxetine augmentation to tianeptine. Although tianeptine has structural similarities with tricyclic antidepressants, unlike tricyclic agents or selective serotonin- reuptake inhibitors(SSRIs), it enhances 5-HT reuptake in brain, leading to decreased availability of the transmitter in the synaptic cleft. Thus, efficacy of tianeptine as an antidepressant agent caused a challenge to the concept of serotonergic deficit theory in depression. Both paroxetine and tianeptine are found equivalently effective in treatment of major depression, but no data are available for combined use of these two agents.