Introducing a family intervention to elderly with first episode psychosis.

Schizophrenia guidelines list family interventions as an efficient means in reducing relapses. Interventions aim to help families cope with their relative's problems more effectively, provide support and education, and reduce levels of distress and improve the family communication (see deHaan et al., 2002).

Brain atrophy is a frequent finding in elderly patients with first episode psychosis.

BACKGROUND: To characterize the yearly incidence, diagnostic distribution, and neuro-radiologic findings in patients aged over 60 years, referred to psychiatric treatment with first episode psychosis (FEP). METHODS: A computerized search, including all patients referred to psychiatric treatment during 12 consecutive months with a de novo diagnosis of psychosis was performed in the Helsinki region catchment area with 1.2 million inhabitants. Diagnoses based on hospital records were made by a group of one neurologist and three psychiatrists. MRI- or CT scans performed as a part of routine clinical management were used when available. RESULTS: 107 patients (27 males and 80 females) with FEP were identified and categorized into four diagnostic groups: schizophrenia, delusional disorder, psychotic depression, and psychosis due to another medical condition. No patients with de novo onset mania were found. Psychosis due to another medical condition was the most common diagnosis. A high frequency of signs of cortical brain atrophy was seen in all diagnostic groups, while central atrophy was more frequent in patients with psychosis due to another medical condition than in the other groups. CONCLUSION: Organic brain changes related to ageing or degenerative illnesses may be an etiologic factor in elderly patients with FEP.

[Personality disorders in the elderly]. / Kun mikään ei kelpaa vanhukselle--taustalla persoonallisuushäiriö?

The diagnostic assessment of old age personality disorders is challenging. Medical illnesses and cognitive impairment may influence the clinical symptoms. Common elements of effective approaches such as building a collaborative relationship and maintaining consistency as well as structured framework of treatment can be tailored to the problems of a patient. Pharmacological treatment guidelines of personality disorders need to be individually applied to elderly persons. Comorbid depression is often the primary symptom seen and needs to be treated. Psychiatry should take steps to promote effective treatments and provide support and clinical supervision to health staff treating these individuals.

Homicide, psychopathy, and aging--a nationwide register-based case-comparison study of homicide offenders aged 60 years or older.

With populations aging there have been some concerns on elderly offending. We compared elderly homicide offenders with a younger comparison group with special emphasis on psychopathy. We analyzed nationwide register-based material on all homicide offenders aged 60 or older who were in a forensic psychiatric examination in Finland 1995-2004 and their gender-matched comparison group of younger homicide offenders. The offenders 60 years or older were diagnosed less often than the younger ones with drug dependence and personality disorders and more often with dementia and physical illnesses. The mean Psychopathy Checklist--Revised total scores as well as factor and facet scores were lower in the 60 or older age group. The group 60 years or older had significantly lower scores on eight individual items of social deviance. The interpersonal/affective factor 1 scores did not differ. Understanding the possible underlying phenomena of violent behavior may provide help for developing services for the elderly.

Comparing psychogeriatric units to ordinary long-term care units - are there differences in case-mix or clinical symptoms?

This study is a comparative analysis of long-term psychogeriatric and mixed-care unit patient characteristics in nursing homes and hospitals in Helsinki. The role of the so-called psychogeriatric nursing homes is still under question and not well developed. The aims of the study were to identify and survey psychogeriatric wards and analyze whether these units differ from the rest of the long-term units/wards in terms of patients' characteristics. Participants studied were a total of 2828 elderly long-term care residents, of which 372 were living in long-term psychogeriatric and 2456 in ordinary long-term care units. Data were drawn from the Resident Assessment Instrument (RAI) database and had been collected in the project "Benchmarking and implementation of RAI in Elderly Care in Finland". Scales and items based on Minimum Data Set were used for the comparisons. Resident groups in psychogeriatric units and in ordinary, mixed-client settings were clearly distinguishable. The psychogeriatric residents were younger, had more comorbidity as to psychiatric diseases, and had more often psychiatric symptoms and psychotropic medications. The residents in psychogeriatric units did not differ in cognitive and functional status from those in mixed-client units and had similar comorbidity as to somatic diseases. This study shows that psychiatric symptoms that need to be addressed are common in long-care facilities. The results emphasize the importance of recognition of the multiple care needs of elderly with severe mental symptoms or illness.

Reported differences in management strategies by primary care physicians and psychiatrists in older patients who are depressed.

OBJECTIVE: To compare reported management suggestions by primary care physicians and psychiatry specialists for case vignette examples of old age depression, and to explore further training needs in geriatric depression for both professional groups. DESIGN: Qualitative study using case vignettes in focus groups. Single group training sessions were arranged for 25 primary care physicians and 11 psychiatrists. The same two clinical vignettes were presented at all training sessions. Written management suggestions by participants, group discussion field notes and transcripts of group session videotapes were analysed. RESULTS: Differences emerged in intended depression management. Primary care physicians tended to assess the symptoms as less serious and the situation as less urgent than psychiatrists. Management suggestions given by the psychiatrists included more recommendations of immediate psychiatric treatment and more precise descriptions of medication. Both groups recognized the somatic issues and were willing to assume responsibility for treatment. CONCLUSIONS: Identifying management differences seems to benefit the professional development of both groups. Exploring and discussing the underlying reasoning leading to management differences may be a productive format for primary care doctors and psychiatric specialists to teach and learn together. It may also promote collaboration in caring for the depressed elderly.