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PubMed1976

A 2-year follow-up of 72 hyperactive boys. Classroom behavior and peer acceptance.

A 2-year, prospective follow-up of 72 hyperactive boys (94 per cent of the initial sample) examined classroom and home behavior, academic achievement, peer status, and depressive symptomatology for patients and a matched control group. Sixty-five per cent of the sample was still on medication at follow-up. The patient group continued to manifest behavioral and academic difficulty. Off-drug classroom behavior showed considerable stability from baseline to 2-year follow-up which did not appear to be significantly influenced by change of school or interim stimulant drug treatment. Academic difficulties, low peer status, and depressive symptoms exceeded that of the control group. Low peer status at 2 years were predicted for the patient group by baseline (but not current) classroom hyperactivity. The continued difficulties for this middle-class sample, in spite of faithful stimulant drug intake, ancillary educational and psychiatric support, are disappointing. However, as no untreated comparison group was available, the relative benefit of continued drug treatment could not be directly examined. Some indirect evidence, however, indicates that although drugs may continue to have a suppressant effect on impulsive and hyperactive behavior, peer status and academic achievement may not be improved. An "optimally medicated" group (86 per cent of responders from an initially randomly assigned group) had almost identical academic achievement and social acceptance as did a group of dropouts from drug treatment, or the sample as a whole.

Child↗
PubMed1975

One-year follow-up of hyperactive boys treated with imipramine or methylphenidate.

The authors report on a one-year follow-up of 76 hyperactive boys who had participated in a comparative study of methylphenidate, imipramine, and placebo. They found that there was a higher rate of discontinuance of imipramine than of methylphenidate in this sample and that both medications decreased the boys' rate of weight gain but had no significant effect on growth in height. This findings is of concern because larger doses than were used in this study are in use elsewhere. Teachers reported that the group of boys who had discontinued either medications showed continued hyperactivity and behavior problems in the classroom at one year. The two treatment groups showed continued improvement at one year in classroom and home behavior and did not suffer significantly from each other.

Administration, Oral↗
PubMed2002

Decreasing aggressive, agitated, or disruptive behavior: perticipation in a behavior management unit.

A 32-bed Behavior Management Unit was opened in a long-term care facility to care for dementia patients who exhibit aggressive, agitated, or disruptive (AAD) behaviors. The purpose of the study was to evaluate the effectiveness of the Behavior Management Program (BMP) in decreasing such behaviors. The sample consisted of all patients (N = 32) who resided in the unit for at least 3 months. The Nursing Home Behavior Problem Scale (NHBPS) was used to collect data. Hypothesis 1, predicting participation in the BMP would decrease the total number of AAD behaviors was supported, with a significant decrease from the baseline to 6-month measurements. Hypothesis 2, predicting participation in the BMP would decrease the frequency of occurrence of specific AAD behaviors was supported, with 7 behaviors being significantly reduced by 6 months. Nurses in long-term care often treat patients with AAD behavior. Because staff members on general long-term care units and even in dementia units may not be experts in caring for patients with AAD behaviors, the implications of this study might be helpful. The interventions that were effective in reducing AAD behaviors included verbal distraction, time-outs, activity diversion, getting to know the patient well, and managing the environment.

Adult↗
PubMed2004

Prevalence of, and factors associated with, adolescent physical fighting while under the influence of alcohol or drugs.

PURPOSE: To determine: (a) the prevalence of physical fighting while under the influence of alcohol or drugs, and (b) the associations among demographic factors, other risk behaviors, and physical fighting while under the influence of substances. METHODS: Cross-sectional analysis of The National Longitudinal Study of Adolescent Health (Add Health) 1994-1995, a school-based, nationally representative survey of 6504 7th to 12th graders. The dependent outcome variables of interest were: "The most recent time you got into a fight, had you been drinking?" and "Have you ever gotten into a fight when you had been using drugs?" Independent variables included: demographics, adolescent characteristics and risk behaviors, home environment, and peer substance use. Univariate and bivariate analyses, and logistic regressions, using SUDAAN, were performed for the two outcome behaviors for the overall sample (p </= .05). RESULTS: Eleven percent of both drinkers (n = 1110) and drug users (n = 1869) reported being under the influence while fighting. These adolescents were significantly more likely to injure or sustain injury than their counterparts. Selling drugs, gang fighting, and peer substance use were significantly associated with both outcomes. CONCLUSIONS: A significant proportion of adolescents who use substances also engage in physical fighting while under the influence. Health providers should counsel their patients about the potential for injury and be mindful that concurrent fighting and substance use may be markers for other more high-risk delinquent behaviors.

Adolescent↗
PubMed1997

The relationship between vision impairment and the assessment of disruptive behaviors among nursing home residents.

This study examines the relationship between vision impairment, defined as best corrected distance acuity, and disruptive behaviors among nursing home residents (N = 89). All data were collected from nursing home records. Vision impairment was significantly related on the bivariate level to the disruptive behavior index (r = .21; p < .05). Hierarchical regression analyses, with disruptive behaviors as the criterion and age and comorbid conditions as covariates, indicate that vision status is a significant independent contributor to disruptive behaviors among long-term care residents. Several interpretations for this observed relationship are discussed, as are implications for nursing home services and future research.

Aged↗
PubMed2005

Practice of health-promoting behaviors by nursing home residents.

The decade of the '90s witnessed the emergence of health promotion as a national priority for all age groups. Despite the fact that Healthy People 2010 identified objectives for the nursing home population, little is known about factors that promote the practice of health-promoting behaviors by nursing home residents. This study examined the separate and combined contributions of personal and contextual influences on the practice of health-promoting behaviors by nursing home residents. One hundred eighty-four residents and 90 staff members from six nursing homes participated in this study. Using a modified version of contextual regression analysis, 57.8% of the variance in health-promoting lifestyle (HPL) behaviors was explained when all variables were entered into the equation. Personal influences explained a significant amount of variation (53.5%) in current HPL behaviors. These findings underscore the importance of looking at ways to support the efforts of nursing home residents to engage in the practice of health-promoting behaviors.

Activities of Daily Living↗
PubMed1992

Bedside assessment of executive cognitive impairment: the executive interview.

OBJECTIVE: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside. DESIGN: Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior. PARTICIPANTS: Forty elderly subjects randomly selected across four levels of care. SETTING: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community. MEASUREMENTS: The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of "frontal" executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses. RESULTS: Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79). CONCLUSIONS: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.

Aged↗
PubMed1994

Correlates of disruptive behaviors in nursing homes. A reanalysis.

This study reexamines factors associated with the occurrence of disruptive behaviors using a representative sample of nursing home residents in Rhode Island in 1984-1985. Four indicators of disruptive behaviors are examined using multivariate methods: evidence of any disruptive behaviors, abusive behavior, wandering, and noisiness. Results are compared with the 1989 study by Jackson et al., which was based on the same data. Findings indicate that the likelihood of exhibiting disruptive behaviors in nursing homes increases with the severity of cognitive impairment, ADL dysfunction, and incontinence, and decreases with immobility. Immobility not only is negatively associated with wandering behavior, but with other behaviors as well. Women are less likely to be abusive. In contrast to the earlier study, which did not use multivariate methods, age and communication problems are not related to disruptive behaviors.

Activities of Daily Living↗
PubMed2002

Resident dog in the Alzheimer's special care unit.

Behavioral disturbances are a commonfeature of Alzheimer's disease (AD). Prior studies have demonstrated a significant reduction in agitation behaviors during short-term exposure to a dog on an Alzheimer's special care unit (SCU)for persons with AD. The purpose of this study was to determine the effect over time of a resident dog on problem behaviors of persons with AD in an SCU. A within-participants repeated-measures design was used for this study. The Nursing Home Behavior Problem Scale was used to document behaviors (on days and evenings) I week before and 4 weeks after placement of the dog. Participants on the day shift exhibited significantly fewer problem behaviors across the 4 weeks of the study (F[1, 80] = 7.69, p < .05). No significant change in behaviors occurred on the evening shift. Thefindings support the long-term therapeutic effects of dogs for persons residing in Alheimer's SCUs.

Alzheimer Disease↗
PubMed2006

The caring behaviors of the home health nurse and influence on medication adherence.

The purpose of this study was to determine if the caring behaviors of the home health nurse toward the patient influence the patient's medication adherence. The study focused on what effects the verbal and nonverbal caring behaviors of the nurse toward the patient have on the patient's medication adherence. How is the patient's perception of caring by the nurse related to his or her medication adherence? The study was conducted in a Midwestern home health agency over a 4-week period. Findings indicated an improvement in the use of verbal and nonverbal caring behaviors by the nurses with their patients. The patients perceived an increased use of these caring behaviors by the nurses with them. The patients' medication adherence and barriers to adherence improved. Other significant findings indicated that the verbal and nonverbal caring behaviors of the nurses and the patients' perception of the caring behaviors influenced and improved the patients' medication adherence by week 4.

Adult↗
PubMedDate not supplied

Propranolol for disruptive behaviors in nursing home residents with probable or possible Alzheimer disease: a placebo-controlled study.

OBJECTIVE: Enhanced behavioral responsiveness to central nervous system (CNS) norepinephrine (NE) in Alzheimer disease (AD) may contribute to the pathophysiology of disruptive behaviors such as aggression, uncooperativeness with necessary care, irritability, and pressured pacing. We evaluated the efficacy of the beta-adrenergic antagonist propranolol for treatment-resistant disruptive behaviors and overall behavioral status in nursing home residents with probable or possible AD. METHODS: Thirty-one subjects (age 85 +/- 8 [SD]) with probable or possible AD and persistent disruptive behaviors that interfered with necessary care were randomized to propranolol (n = 17) or placebo (n = 14) in a double-blind study. Stable doses of previously prescribed psychotropics were maintained at pre-study dose during the study. Following a propranolol or placebo dose titration period of up to 9 days (per a dosing algorithm), subjects were maintained on maximum achieved dose for 6 weeks. Primary outcome measures were the Neuropsychiatric Inventory (NPI) and the Clinical Global Impression of Change (CGIC). RESULTS: Propranolol augmentation (mean achieved dose 106 +/- 38 mg/d) was significantly more effective than placebo for improving overall behavioral status on the total NPI score and CGIC. Improvement in individual NPI items within propranolol subjects was significant only for "agitation/aggression" and "anxiety," and reached borderline statistical significance favoring propranolol over placebo only for "agitation/aggression." Pressured pacing and irritability did not appear responsive to propranolol. In propranolol subjects rated "moderately improved" or "markedly improved" on the CGIC at the end of the double-blind study phase, improvement of overall behavioral status had diminished substantially after 6 months of open-label propranolol treatment. CONCLUSION: Short-term propranolol augmentation treatment appeared modestly effective and well tolerated for overall behavioral status in nursing home residents with probable or possible AD complicated by disruptive behaviors. Propranolol may be helpful specifically for aggression and uncooperativeness (the behaviors assessed by the NPI "agitation/aggressiveness" item). However, the usefulness of propranolol in this very old and frail population was limited by the high frequency of relative contraindications to beta-adrenergic antagonist treatment and diminution of initial behavioral improvements over time.

Adrenergic beta-Antagonists↗
PubMed2005

[Treatment of the psychological and behavioural disorders of Alzheimer's disease].

When psychological and behavioral disorders of Alzheimer's disease appear suddenly, somatic, iatrogenic and reactive or relational psychological causes must be ruled out or treated before concluding that the cause is lesional. Non-pharmacological interventions should be privileged for the prevention and management of behavioral manifestations of mild to moderate intensity: psychological support of the patient (short therapies), training the caregiver, work on daily habits, reorganization of the home, behavioral measures against apathy and especially agitation, rehabilitation strategies, and therapy involving music, light, aromas, etc. Pharmacological therapies are only moderately effective in these disorders. They must be targeted and follow a sequence of prescription that maximizes tolerance and distinguishes treatment of acute and chronic states. Anticholinesterase agents may be useful in this domain to prevent or ease some symptoms (especially apathy). The efficacy of memantine must be confirmed by additional data. Some selective serotonin reuptake inhibitors agents may be useful not only in depression but also anxiety, emotional disturbances, irritability and compulsiveness. Atypical neuroleptics are better tolerated than the classic ones. They are most effective in this context but must be reserved for specific indications and limited in time because of the increased risk of stroke. Other psychotropics (benzodiazepines, carbamates, antiepileptics) should be used cautiously in this context.

Activities of Daily Living↗
PubMed1979

Preferential homing of passively transferred T cells into skin allografts of mice.

An assay which uses two differentially labeled cell populations was used to characterize the preferential localization of passively transferred syngeneic cells immunized to specific alloantigens. Splenocytes cytotoxic to B10.D2 and B10.BR alloantigens were harvested from (C57BL/6 X A/J)F1 (B6AF1) donors bearing acutely rejected skin allografts. One population was labeled in vitro with 3H-thymidine and the other with 14C-thymidine. The labeled cells were pooled and then transferred i.v. into B6AF1 hosts bearing 5-day-old skin grafts from B10.D2 and B10.BR donors. After 48 hr the mice were killed, and the relative amount of cells present in the skin grafts and draining axillary lymph nodes was derived by comparing the 3H:14C ratios of the harvested tissues. The results of these studies indicated that cytotoxic splenocytes harvested from donors bearing acutely rejected skin allografts preferentially localize to the relevant skin allograft after passive systemic transfer. The homing behavior of these splenocytes was augmented by T cell enrichment and significantly diminished by pretreatment with anti-Thy-1.2 serum plus rabbit complement. There was no evidence of preferential homing within the draining axillary lymph nodes. It can be concluded that a T cell population derived from in vivo sensitized splenocytes exhibits preferential homing to relevant skin allografts upon passive transfer.

Animals↗
PubMed2005

A comparison of wandering behavior in nursing homes and assisted living facilities.

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF). This study compared wandering behavior of residents (N = 108) in 21 long-term care facilities (15 NH, 6 ALF). Staff used the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) to quantify wandering. While there were some differences in demographic variables (i.e., race, motor ability) between NH and ALF participants, no significant differences were found in either RAWS-NH overall or any of the 6 subscale scores. This suggests that the expression of wandering is similar in long-term care residents across all dimensions of the RAWS-NH regardless of facility type. Findings are of concern for those involved in the safe management and protection of residents at risk for wandering, particularly in long-term care facilities with underregulated staffing and training requirements.

Activities of Daily Living↗
PubMed2002

Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder.

To determine safety and the efficacy of carnitine treatment in children with attention-deficit hyperactivity disorder (ADHD). The ADHD behavior was observed by parents completing the Child Behavior Checklist (CBCL) and by teachers completing the Conners teacher-rating score, in a randomized, double-blind, placebo-controlled double-crossover trial. In 13/24 boys receiving carnitine, home behavior improved as assessed with the CBCL total score (P < 0.02). In 13/24 boys, school behavior improved as assessed with the Conners teacher-rating score (P < 0.05). Before treatment, the CBCL total and sub-scores were significantly different from those of normal Dutch boys (P < 0.0001). Responders showed a significant improvement of the CBCL total scores compared to baseline (P < 0.0001). In the majority of boys no side effects were seen. At baseline and after carnitine treatment, responders showed higher levels of plasma-free carnitine (P < 0.03) and acetylcarnitine (P < 0.05). Compared to baseline, the carnitine treatment caused in the responsive patients a decrease of 20-65% (8-48 points) as assessed by the CBCL total problem rating scale. Treatment with carnitine significantly decreased the attention problems and aggressive behavior in boys with ADHD.

Adolescent↗
PubMed1992

Disruptive behavior in elderly nursing home residents: a survey of nursing staff.

A significant number of nursing home residents exhibit behavior disturbances that are disruptive to the living and working environment in the nursing home. The most common disruptive behaviors cited by licensed nursing personnel included hitting/slapping, verbally aggressive remarks, screaming, pacing, wandering, and repetitive verbal requests. Self-injurious behavior, property destruction, and hiding things were not mentioned. Many of the nursing strategies listed by nursing staff as being used to alleviate disruptive behaviors are traditional care activities, eg, talking to and counseling patients, touching, or altering care. However, chemical and physical restraints were also frequently listed.

Aged↗
PubMed1999

Visual homing in analog hardware.

Insects of several species rely on visual landmarks for returning to important locations in their environment. The "average landmark vector model" is a parsimonious model which reproduces some aspects of the visual homing behavior of bees and ants. To gain insights in the structure and complexity of the neural apparatus that might underly the navigational capabilities of these animals, the average landmark vector model was implemented in analog hardware and used to control a mobile robot. The experiments demonstrate that the apparently complex task of visual homing might be realized by simple and mostly peripheral neural circuits in insect brains.

Animals↗