The use of THA for Alzheimer's disease.
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Alzheimer Disease↗
Biomedical subjects
H Brodaty
Publications and source records attributed to H Brodaty.
Perceived dysfunctional intimate relationships: a specific association with the non-melancholic depressive subtype.
Associations between perceptions of dysfunctional current intimate relationships and subtypes of depressive disorders were quantified in a sample of 136 patients, using the Intimate Bond Measure (IBM). Deficient care was two to three times more likely to be reported by patients with non-melancholic disorders than by matched subjects, but was no more likely to be reported by patients with melancholic disorders, suggesting a risk factor selective for depressive type. Patients who reported markedly deficient care in childhood were more likely to report very poor current intimate relationships. For the remaining patients, however, no evidence of continuity between a dysfunctional parental relationship and a current dysfunctional intimate relationship was found.
Adult↗
Low diagnostic yield in a memory disorders clinic.
A review of the first 144 patients to attend a Memory Disorders Clinic found not one case of treatable dementia. The use of a routine comprehensive battery of investigations was not supported: however, computerized tomographic brain scans and electroencephalograms were moderately useful in diagnosing dementia. Clinical features and historical data did not discriminate early- from late-onset Alzheimer's disease or Alzheimer's disease from multi-infarct dementia.
Activities of Daily Living↗
Depressive type and state effects on personality measures.
We examine the hypothesis that the effect of mood state on personality questionnaire scores is more a function of diagnosis than of depression severity. Sixteen endogenous and 83 neurotic depressives completed a battery of personality questionnaires at a baseline assessment and again 20 weeks later. Scores on the personality measures changed significantly. Endogenous depressives were found to have more pronounced changes on measures of dependence and timidity, but when change in mood state was partialed out only one of the dependence measures and timidity remained significant. Thus the hypothesis only received partial support--change in mood state appears to be the major factor in elevating personality questionnaire scores.
Adolescent↗
Personality differences between patients with remitted melancholic and nonmelancholic depression.
Seventy-five patients with remitted depression were categorized as having melancholic-endogenous or non-melancholic-nonendogenous depression according to DSM-III criteria, Research Diagnostic Criteria, and the Newcastle endogeneity scale. The patients' scores on four personality scales--the Eysenck Personality Inventory, the Interpersonal Dependency Inventory, locus of control, and the Interpersonal Sensitivity Measure--were then compared. Patients with nonmelancholic-nonendogenous depression were generally rated as having more vulnerable personality styles, but the differences were dependent on the particular diagnostic system used. A principal components analysis isolated three underlying personality constructs--dependency, introversion, and timidity. Patients with nonmelancholic-nonendogenous depression scored as significantly more dependent.
Adult↗
Classifying depression by mental state signs.
The possibility that separation of a categorical depressive disease ('melancholia') from remaining depressive disorders can be improved by assessment of mental state signs was examined in patients treated by representative Sydney psychiatrists and patients referred to a specialised mood disorders unit. A set of signs, principally assessing retardation, was derived within the two samples by principal-components and latent-class analyses. Scores were significantly correlated with clinical, DSM-III, and RDC diagnoses, and appeared independent of severity, suggesting that melancholia can be defined phenomenologically. Scores were also associated with several 'validating' factors. Comparative analyses of a refined list of melancholia symptoms suggested that ratings of defined signs are likely to have greater capacity than symptom ratings to differentiate melancholia from residual depressive disorders.
Adjustment Disorders↗
Hormonal responses to fenfluramine in depressive subtypes.
In order to study putative differences in central neurotransmitter function in depressive subtypes, serum cortisol and prolactin responses to the putative serotonin agonist fenfluramine were examined in 30 subjects with major depression. Patients with endogenous depression (melancholia) as defined by each of ICD-9, DSM-III, RDC and Newcastle scale demonstrated a reduced prolactin response to 60 mg oral fenfluramine when compared with non-endogenous subjects. This was independent of either prolactin or cortisol baseline levels, and indicates that there are differences in brain neurotransmitter function in the endogenous and non-endogenous subtypes of depression. Basal prolactin levels were reduced in bipolar compared with unipolar subjects, and delusional compared with non-delusional patients, although there were no differences in the prolactin responses to fenfluramine between these subgroups. Basal cortisol levels and cortisol response to fenfluramine did not distinguish between any of the subtypes.
Administration, Oral↗
Psychosocial effects on carers of living with persons with dementia.
A survey of members of the Alzheimer's Disease and Related Disorders Society confirmed high rates of psychological morbidity, though not of depression, and social isolation in family carers of persons with dementia. Psychological morbidity in carers was associated with having an affected person at home, the carer being a spouse, demanding problem behaviours, poor physical health in the carer, social isolation, dissatisfaction with social supports, greater use of psychotropic medication, and a deteriorated marital relationship. Carers and patients had high rates of consultations with doctors and other health professionals. There was a vulnerable group of carers who were impaired psychologically, socially and physically. The identification of risk factors to carer morbidity may lead to useful interventions.
Adaptation, Psychological↗
A survey of dementia carers: doctors' communications, problem behaviours and institutional care.
A survey of carers belonging to the Alzheimer's Disease and Related Disorders Society (ADARDS) had three aims: (i) to investigate the process of health professionals providing information to patients and carers: (ii) to determine the nature of problems burdening carers; and (iii) to examine factors associated with institutional placement. Carers reported on deficiencies in the provision of information and indicated their preferences as to how the information should be given. ADARDS, general practitioners and other health professionals were reportedly helpful, with each appearing to have a role in providing information about dementia. Multiple problem behaviours were reported by most carers, especially difficulties with communication, the need for constant supervision and disruption to personal life. Institutional care was most highly correlated with dependency problems, severity of dementia and a non-spouse carer. Implications include the need for training of doctors in communication and education about dementia with particular attention to management of dependency problems.
Adaptation, Psychological↗
Effect of a training programme to reduce stress in carers of patients with dementia.
OBJECTIVE: To reduce the psychological stress and improve the skills in coping of people who care for relatives with dementia. DESIGN: Assessment and suitability of carers by questionnaire; assessment of patients and carers in a hospital outpatient clinic; allocation to groups according to date of application to study. Linkage of groups of four carers and programme coordinator by telephone conference calls over 12 months after programmes. Reassessment at three, six, 12, and, for those in the "wait list" group, 18 months. SETTING: The programmes were conducted in the psychiatry unit of a Sydney teaching hospital. SUBJECTS: Eligible patients were less than 80 years old, had mild to moderate dementia, and lived at home with their carer. Of the 96 patient-carer pairs in the study, 33 were in the dementia carers' programme group, 31 were in the memory retraining group, and 32 were in the wait list group. INTERVENTIONS: Carers in the dementia carers' programme received training in coping with the difficulties of looking after patients with dementia while the patients had sessions in subjects such as memory retraining. In the memory retraining programme patients were admitted and received the patient component of the carers' programme while their carers had 10 days' respite. In the wait list group carers waited six months before undertaking the carers' programme. MAIN OUTCOME MEASURES: Effect of the programmes on carers' general health questionnaire scores and the rate of placement of patients in institutions. RESULTS: At 12 months' follow up the carers' programme had resulted in significantly lower psychological stress among carers than the memory retraining programme (mean (SD) general health questionnaire scores at 0 months were 6.31 (6.23) and 3.60 (6.25) respectively, and at 12 months were 4.69 (5.58) and 7.40 (9.39); p less than 0.05.) In the wait list group distress scores remained stable, even after the carers and patients had undertaken the carers' programme. Patients deteriorated over 12 months regardless of group allocation, but at 30 months, allowing for patients who died and could not be included in the analysis, 65% of patients in the carers' programme group were still living at home compared with 26% in the memory retraining programme group. CONCLUSION: The intensive intervention programme described for carers of patients with dementia can reduce the psychological morbidity of the carer and delay the placement of the patient in an institution without increasing the use of health services by either patient or carer.
Adaptation, Psychological↗
THA and Alzheimer's disease.
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Alzheimer Disease↗
The establishment of a mood disorders unit.
The establishment within a general hospital psychiatry ward of a mood disorders unit (MDU), a specialised facility for the assessment and treatment of patients with affective disorders, is described. The aims include provision of a clinical service, a teaching resource for affective disorders and the development of a research centre. Details are provided of the organisation of the MDU, the development of programs for management of patients and the difficulties encountered. In the first year, 164 patients were assessed, of whom 36 were judged not to have a primary mood disorder. For the remainder, the most common DSM-III diagnosis was major depressive episode (n = 68), with about half having the melancholic sub-type. It is argued that a specialised diagnosis-related facility is feasible within a general hospital psychiatry service with area health commitments.
Affective Disorders, Psychotic↗
Brief psychotherapy in family practice. A controlled prospective intervention trial.
In a prospective (controlled) trial, the result in 18 patients receiving eight, weekly half-hour sessions of brief problem-oriented dynamic psychotherapy was compared with the result in an equal number receiving eight, weekly half-hour sessions of family practitioner therapy and in another 20 receiving no additional therapy. The subjects were drawn from patients at ten suburban family practices in Sydney. They had had psychological complaints for at least six months. No differences between the three treatment groups were found in the final outcome, either in a symptom severity and social dysfunction factor or in a physical disability and medication factor.
Adolescent↗
Techniques in brief psychotherapy.
There is a need for clear definitions of psychotherapeutic techniques in order to allow for proper evaluation and application of the process of brief psychotherapy. The literature is reviewed on five technical factors germane to brief dynamic psychotherapy: time, activity, focus, transference and termination. With the exception of Malan's (1963, 1976a) finding of the efficacy of therapist-parent interpretations there are no replicated data available to support the use of any particular technique. This lack of supporting evidence may reflect insufficient specificity and definition in the use of brief psychotherapy, and an excessively generalised approach to research.
Humans↗
Iatrogenic danger for joggers.
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Hemorrhage↗
An attempt to predict who will benefit from brief psychotherapy in a general practice setting.
The possibility of predicting success in patients receiving brief problem orientated psychotherapy was tested in 18 adult patients selected from 10 Sydney general practices. Ratings were made of six clinical prediction criteria at the beginning of therapy and outcome was assessed directly after therapy and 12 months later. There were modest but significant correlations, particularly among the women, between the sum of the prediction ratings and the outcome 12 months after therapy.
Adult↗
Life after hospital: trials of a boarding house 'mother'.
What is life like for the many psychiatric patients discharged from hospital to boarding houses? The 'mother' of a Sydney boarding house describes how her 'family' has taken root, grown, developed and made a stable home. Many behaviours not tolerated in the community (e.g. public masturbation) are acceptable in the home but there are limits and rules (e.g. not in the dining room). A good home needs the responsible person to be open, honest, understanding and sensitive to changes in guests. Psychiatric services and welfare agencies need to recognise the major contributions of well-run boarding houses and need to liaise more with the proprietors.
Adolescent↗
Psychiatric illness in general practice. I: Why is it missed?
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Diagnosis, Differential↗