Biomedical subjects
Publications and source records attributed to J Snowdon.
The Geriatric Depression Scale (GDS) was used to screen for depression among residents of six nursing homes in Sydney. Of the 61% who could answer the questionnaire, more than one third were depressed. Those who were physically disabled, and those admitted in the previous 3 months scored higher on the GDS. Many of the severely demented patients could be tested with the GDS.
Explore the source record for details and available documents.
This study is concerned with compulsory admissions of patients from a defined catchment area of Sydney in 1979. The rate of such detentions under the present Mental Health Act in New South Wales was found to be about one per 1000 of the total population in one year. A much smaller proportion of psychotic than of non-psychotic patients was considered dangerous by doctors who signed the schedules, yet those (40%) requiring to be on compulsory orders after magisterial hearings were all diagnosed as psychotic. If dangerousness were to be the main criterion for compulsory detention under the Mental Health Act (as recently proposed), many psychotic patients could not legally be detained. Yet follow-up, as in this study, demonstrates the benefits of such admissions. Revision of proposed amendments is recommended.
Two groups of medical students answered a modified version of the Leyton Obsessional Inventory twice, with 8 weeks between tests. On one occasion it was administered in its original card-sorting (postbox) form; on the other, it was given as a written questionnaire. Fifty students answered the postbox form first, 50 the questionnaire first. Correlation between the 2 tests was reasonably good (r = 0.73-0.77). Scores on the first occasion of testing were significantly higher than on the second, but differences between scores on the 2 forms were not significant. Mean scores of male and female students were similar.
Explore the source record for details and available documents.
Family size and birth-order of 156 British-born patients diagnosed as having obsessive-compulsive neurosis were determined from case-notes; these were compared with matched controls. Separate consideration was given to male and female patients. Mean family size of obsessionals was found to be smaller than that of controls. An excess of first-born was found among male obsessional patients.
This study reports changes of suicide rate in Australia and in England and Wales in the twenty years up to 1976. Rates in both places reached a peak in 1963, related to increases in poisoning as a means of suicide. Decreases since then can be attributed partly to reduced likelihood of death after inhalation of domestic gas or after ingestion of poisons. There has been an increase in suicide deaths among younger people, but a decrease among older age groups. The two countries have patterns of suicide which are similar in many respects, the most striking difference being the frequency with which firearms are used by male suicides in Australia. There is good reason to believe that variation in availability of a means of suicide is the factor which has most effect on rates of suicide, though cultural attitude towards each method also is an important determinant of how much it will be used for suicide.
Twelve patients who feigned bereavement are described. Most appeared depressed on admission, and in over half bereavement was erroneously believed by staff to be an important cause of their depression. This type of behaviour, leading to admission to hospital, may be regarded as abnormal illness behaviour, and reasons are given for considering most of the cases as variants of the Münchausen syndrome. Motivation for these deceptions is discussed, and reference is made to features which might arouse suspicion that bereavement is feigned.
Explore the source record for details and available documents.
Most elderly persons in nursing homes and residential care have mental disorders; up to 75% have dementia. Depression and behavioural problems are common. There are big differences between institutions in the proportion of residents prescribed psychotropic medication. A review of the literature suggests that antipsychotics and benzodiazepines are modestly effective in diminishing agitation in some dementing patients. Antidepressants may be underutilized, but clear guidelines about which depressed individuals should receive them are lacking. Attention should be given to ways of improving the environment within these homes, in order to relieve depression and anxiety, and to increase life satisfaction and self-esteem, before commencing psychotropic medication to deal with mental disturbances. Shortage of trained staff and inappropriate design of nursing homes are factors associated with behavioural disturbance in some cases. Special dementia care units are a desirable option for a minority of residents. Involvement of pharmacists and medical directors in monitoring effects, adverse side effects, possible interactions and appropriateness of medications in nursing homes is recommended.
Explore the source record for details and available documents.
Explore the source record for details and available documents.