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S Holroyd

Publications and source records attributed to S Holroyd.

At least 37 records · Page 2Linked to original sources
PubMed1997

Substance use disorders in a geriatric psychiatry outpatient clinic: prevalence and epidemiologic characteristics.

This study was conducted to determine the prevalence of substance use disorders in a geriatric psychiatry outpatient clinic. The overall prevalence for any substance use disorder was 20% (N = 28). The prevalence of benzodiazepine dependence was 11.4% (N = 16); the prevalence of alcohol dependence was 8.6% (N = 12); and the prevalence of prescription narcotic dependence was 1.4% (N = 2). These findings suggest that substance use disorders in the geriatric psychiatry outpatient population exist to a significantly greater extent than previously reported. Descriptive statistics were used to characterize patients with benzodiazepine dependence, alcohol dependence, and no substance use disorder. These groups were compared on demographic and clinical variables using one-way analysis of variance (ANOVA) and chi-squared statistical techniques. Clinicians working in comparable outpatient settings may be in a better position to prevent, detect, and treat substance use disorders in their patients as a result of increased awareness of its epidemiologic characteristics in this population.

Aged↗
PubMed1997

A descriptive study of elderly community-dwelling alcoholic patients in the rural south.

Alcohol-related disorders, estimated to be more prevalent in the South, are associated with serious comorbid disorders, such as depression and suicide. In a rural outreach program, the authors examined patients with a diagnosis of alcoholism and compared them with nonalcoholic patients on various demographic and descriptive variables. Of 166 patients referred to the program, 35 (21.1%) had an alcohol-related disorder. Alcoholism was significantly associated with male gender and younger age, but nearly half of the alcoholic subjects were women. Alcoholism is associated with inappropriate health care utilization; alcohol-related disorders produced significantly more emergency room visits and somewhat more hospital admission; these patients were less likely to have a primary care physician. No patient was receiving treatment for alcoholism.

Activities of Daily Living↗
PubMed1997

Characteristics of persons utilizing a geriatric psychiatry outpatient clinic.

Mental-health service utilization among elderly people has been shown to be low relative to younger age groups. This study was done to determine the current proportion of elderly persons served in a university-affiliated psychiatry outpatient clinic, and to better characterize elderly patients who receive specialized mental-health care in this setting. The proportion of visits from elderly patients (aged 60 and over) was found to be 16%. Demographic and clinical characteristics of a sample of 140 consecutive geriatric patients evaluated at the clinic were obtained. The data revealed that the patients had a mean age of 74.7+/-7.5 (SD) years, and were mostly female (72.1%) and white (78.6%). Surprisingly, the age distribution was found to be bell shaped, with a small upper tail. The three most prevalent psychiatric diagnoses were depression (56.4%), dementia (35.7%), and substance use disorder (20%). Overall, 59.3% of geriatric patients had a history of prior psychiatric treatment. Females were significantly more likely than males to have a psychiatric history (69.3% vs. 33.3%, P = .0001). Among patients with a psychiatric history, females were more likely to have a current diagnosis of major depression (P = .0006), while males were more likely to have a current substance use disorder (P = .03). The prevalence of dementia increased with each successive decade above 60, while the occurrence of bipolar and adjustment disorders was confined to younger geriatric patients. Elderly patients receiving psychiatric treatment in the clinic thus formed a heterogeneous group. Gender, age, and presence of a psychiatric history were all associated with differences in prevalence and distribution of various mental disorders in this geriatric psychiatry outpatient clinic.

Age Distribution↗
PubMed1996

Attitudes of older adults' on being told the diagnosis of Alzheimer's disease.

OBJECTIVE: Controversy exists as to whether Alzheimer's disease (AD) patients should be told their diagnosis, yet no research has been done examining older patients' attitudes on this topic. This study examines patient's attitudes toward this topic. DESIGN: A prospective, community-based study. Participants read vignettes of two patients, one with AD and one with terminal cancer, and then answered questions regarding their attitudes toward these illnesses. SETTING: A community-based retirement community in Charlottesville, Virginia. PARTICIPANTS: One hundred fifty-six community-dwelling older persons (mean age 79.7 +/- 6.9 years). MEASUREMENTS: A structured questionnaire disclosed demographic data (age, sex, race, religion, marital status), personal experience with cancer and AD, and opinions about being told the diagnosis of these diseases. RESULTS: Most participants (n = 124, 79.5%) responded that they would prefer to know if they had AD, but the number was significantly fewer (Fischer exact test, P < .001) than those who would want to know if they had terminal cancer (n = 143, 91.7%) Interestingly, significantly fewer married subjects would want their spouse to know if the spouse had either illness. Only 65.7% (n = 69) of subjects would want their spouse to know if the spouse had AD (Fisher exact test, P = .008), whereas for cancer, 80.2% (n = 77) would want their spouse to know if the spouse had cancer (Fisher exact test P < .001). No demographic variables distinguished subjects who did from those who did not want to know the diagnosis for themselves or their spouses for either AD or cancer. Among the reasons some subjects gave for wanting to know of the diagnosis of AD was being able to consider suicide. CONCLUSION: Although these results may support disclosure of diagnosis for most patients with AD, clinical and ethical issues remain in individual cases.

Aged↗
PubMed1996

Visual hallucinations in a geriatric psychiatry clinic: prevalence and associated diagnoses.

Visual hallucinations are associated with a variety of psychiatric, medical, neurologic, and ophthalmologic disorders. One hundred forty outpatients presenting to a geriatric psychiatric clinic were screened for visual hallucinations and assessed on a number of descriptive variables, medical history, ophthalmologic history, psychiatric diagnosis, and cognitive score. The data revealed that 14 patients (10%) experienced visual hallucinations. Presence of visual hallucinations was significantly associated with diagnoses of dementia or delirium, living in a nursing home, lower cognitive score, and presence of auditory hallucinations and delusions. There was no association to number of medications, age, gender, or presence of eye disease. No patient had "insight' into their visual hallucinations. Despite the numerous disorders that are associated with visual hallucinations, the most common causes in a geriatric psychiatry clinic are dementia and delirium. Clinicians assessing older patients with visual hallucinations should first carefully evaluate for these disorders.

Aged↗
PubMed1995

Disabling parkinsonism due to lithium: a case report.

Two cases of disabling parkinsonism have been previously reported in association with lithium treatment and only one occurred without other signs of lithium toxicity. We report a case of an elderly female who suddenly developed disabling parkinsonism, apparently as a side effect from treatment with lithium carbonate without other signs of lithium toxicity. All neurologic symptoms completely resolved on discontinuation of lithium. Resuming lithium at serum levels below 0.7 mmol/L resulted in no further neurologic side effects, but serum levels of 0.7 to 0.9 mmol/L resulted in the return of mild Parkinson's symptoms. Older age, longer duration of lithium treatment, and high therapeutic levels of lithium may be risk factors for this side effect. Implications for clinicians are discussed.

Aged↗
PubMed1994

Visual hallucinations in patients from an ophthalmology clinic and medical clinic population.

Although visual hallucinations have been associated with patients with visual disorders, no study has specifically examined whether visual hallucinations are indeed more prevalent than in a general medical population. In this study, 127 consecutive visual disorder patients and 100 consecutive general medical patients were screened for complex visual hallucinations. A total of 6.3% of visual disorder patients and 2% of general medical patients had visual hallucinations. Interestingly, the two medical patients with visual hallucinations also had visual disorders. Factors significantly associated with visual hallucinations were female sex (p = .029) and lower cognitive score (p = .001). Data from a previous study of patients with the visual disorder age-related macular degeneration were combined with this study to increase the sample size of visual hallucinators. Factors significantly associated with visual hallucinations in the combined sample were female sex (p = .015), living alone (p = .019), having hearing problems (p = .047), older age (p = .013), and lower cognitive score (p < .001). Implications and future research are discussed.

Adolescent↗
PubMed1994

Multidisciplinary assessment of patients with Alzheimer's disease.

The complexity of AD necessitates that multiple disciplines interface effectively in the assessment of patient, caregiver, and family. This multidisciplinary effort should not be focused on the mere exchange of data. As this article emphasized, just from the perspective of nursing, it is critical that the various disciplines involved know about the purpose, focus, and process of assessment approaches used by each in the convergent effort to comprehensively evaluate the disease and its possible changes, as well as its impact on function, cognition, behavior, and emotion. From this article, it should be apparent that effective multidisciplinary assessment is not exchange of data but rather purposive interchange of clinical information to achieve the clinical goals of assessment, diagnosis, explanation, intervention, prognosis, and evaluation.

Alzheimer Disease↗
PubMed1994

Alzheimer's disease and nursing. New scientific and clinical insights.

This article aimed to provide an orientation to major new insights in the causes, pathogenesis, and management of AD. This article certainly does not offer a comprehensive overview, and this was not the intent. Instead, the aim was to provide an orientation to the major issues in the complex debate over "causes and cures," and to so serve as a foundation for further study as well as platform for this issue of Nursing Clinics of North America on AD.

Aged↗
PubMed1992

Visual hallucinations in patients with macular degeneration.

OBJECTIVE: This study was undertaken to determine the prevalence of visual hallucinations in patients with macular degeneration, describe such hallucinations phenomenologically, and possibly determine factors predisposing to their development. METHOD: Using a case-control design, the authors screened 100 consecutive patients with age-related macular degeneration for visual hallucinations. Each patient with visual hallucinations was matched to the next three patients without hallucinations. The patients and comparison subjects were compared in terms of scores on the Beck Depression Inventory, Eysenck Personality Questionnaire, Telephone Interview for Cognitive Status, and a structured questionnaire including demographic characteristics, family history, and medical and psychiatric history. Ophthalmologic data were obtained by chart review. RESULTS: Of the 100 patients, 13 experienced visual hallucinations. Four variables were significantly associated with having hallucinations: living alone, lower cognition score, history of stroke, and bilaterally worse visual acuity. Hallucinations were not associated with family or personal history of psychiatric disorder or with personality traits. In 11 (84.6%) of the 13 patients, the hallucinations had begun in association with an acute change in vision. CONCLUSION: These results indicate that visual hallucinations are prevalent among patients with macular degeneration. They appear unrelated to primary psychiatric disorder. The predisposing factors of bilaterally worse vision and living alone support an association with sensory deprivation, while history of stroke and worse cognition support a decreased cortical inhibition theory.

Aged↗
PubMed1991

Autistic features in Joubert syndrome: a genetic disorder with agenesis of the cerebellar vermis.

Recent reports in the literature have suggested a link between abnormalities of the cerebellar vermis and the behavioral syndrome of autism. Joubert syndrome is an autosomal recessive disorder characterized by partial or complete agenesis of the cerebellar vermis. However, there is little behavioral or psychiatric description of patients with this genetic condition. In this report, the neuropsychiatric characteristics of two children with Joubert syndrome are described in detail. One child met DSM-III-R diagnostic criteria for autistic disorder, while the other displayed autistic features. The female child displayed stereotypic behavior and impairments in social interaction and communication, had a markedly restricted repertoire of interests, and showed distress over changes in the environment. The male child demonstrated perseveration and preoccupation with sounds and textures, but had no abnormalities in social interaction. Although both children showed developmental disabilities, the degree of cognitive delay was significantly less than that described in previous reports of children with Joubert syndrome. This report adds to the growing body of evidence implicating cerebellar involvement in developmental disabilities and autistic behavior.

Autistic Disorder↗
PubMed1990

Bipolar disorder and Crohn's disease.

Despite an extensive literature examining the relationship between Crohn's disease and psychiatric illness, there is only one published report of mania in a patient with Crohn's disease. The authors describe seven patients, six men and one woman, with both bipolar disorder and Crohn's disease. The age at onset of Crohn's disease was highly correlated with the age at onset of affective disorder (r = .89, p = .016) and mania (r = .79, p = .06). Four patients received prednisone therapy for Crohn's disease from 3 to 52 weeks before their first manic episode. The authors discuss the relationship of the two illnesses, including possible common provoking factors, the possible role of steroids, and the genetics of the disorders.

Adult↗
PubMed1989

Major depression in Down's syndrome.

Five patients with trisomy 21 (Down's syndrome (DS], referred to us for evaluation of dementia, were instead found to have major depression. All had shown cognitive and behavioural deterioration and this had led to a mistaken diagnosis of Alzheimer's disease in two. We outline and contrast the features of major depression and Alzheimer's disease in DS, and suggest that electroconvulsive therapy is an effective treatment for major depression in DS.

Adolescent↗