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PubMed1995

Nonsteroidal anti-inflammatory drugs and the incidence of hospitalizations for peptic ulcer disease in elderly persons.

To determine the incidence rate of serious ulcer disease among users and nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs), a retrospective cohort study was done on 103,954 elderly Tennessee Medicaid recipients with 209,068 person-years of follow-up from 1984 to 1986. There were 1,371 patients hospitalized with peptic ulcer disease or upper gastrointestinal hemorrhage identified by Medicaid hospital claims and verified by review of the medical record. Ulcer hospitalization rates by NSAID exposure category, duration of use, and daily dose were determined. The rates of ulcer hospitalization among nonusers and current users of NSAIDs were 4.2 and 16.7 per 1,000 person-years, respectively, an excess rate among current users of 12.5 (95% confidence interval (CI) 11.4-13.6) per 1,000 person-years. Among new users, the ulcer hospitalization rates were 26.3 per 1,000 person-years during the first 30 days of use and 20.9 per 1,000 person-years over the next 31-180 days, representing excess ulcer hospitalization rates of 22.1 (95% CI 18.6-25.6) and 16.7 (95% CI 13.1-20.1) per 1,000 person-years, respectively. For long-term users (180 days or more of continuous NSAID use), the ulcer hospitalization rate remained elevated at 15.3, an excess of 12.0 (95% CI 10.3-13.6) hospitalizations per 1,000 person-years. The excess hospitalization rates per 1,000 person-years increased with increasing dose from 6.0 (95% CI 4.0-8.0) for the lowest dose category to 17.8 (95% CI 15.5-20.1) for the highest. The excess rate of ulcer hospitalization for elderly NSAID users is high. These drugs should be used with caution in elderly persons, and alternatives to NSAID therapy should be strongly considered.

Age Factors↗
PubMed2002

Spare non-occupational HIV post-exposure prophylaxis by active contacting and testing of the source person.

OBJECTIVE: HIV-1 post-exposure prophylaxis (PEP) is frequently prescribed after exposure to source persons with an undetermined HIV serostatus. To reduce unnecessary use of PEP, we implemented a policy including active contacting of source persons and the availability of free, anonymous HIV testing ('PEP policy'). METHODS: All consultations for potential non-occupational HIV exposures i.e. outside the medical environment) were prospectively recorded. The impact of the PEP policy on PEP prescription and costs was analysed and modelled. RESULTS: Among 146 putative exposures, 47 involved a source person already known to be HIV positive and 23 had no indication for PEP. The remaining 76 exposures involved a source person of unknown HIV serostatus. Of 33 (43.4%) exposures for which the source person could be contacted and tested, PEP was avoided in 24 (72.7%), initiated and discontinued in seven (21.2%), and prescribed and completed in two (6.1%). In contrast, of 43 (56.6%) exposures for which the source person could not be tested, PEP was prescribed in 35 (81.4%), P < 0.001. Upon modelling, the PEP policy allowed a 31% reduction of cost for management of exposures to source persons of unknown HIV serostatus. The policy was cost-saving for HIV prevalence of up to 70% in the source population. The availability of all the source persons for testing would have reduced cost by 64%. CONCLUSION: In the management of non-occupational HIV exposures, active contacting and free, anonymous testing of source persons proved feasible. This policy resulted in a decrease in prescription of PEP, proved to be cost-saving, and presumably helped to avoid unnecessary toxicity and psychological stress.

Anti-HIV Agents↗
PubMed2004

Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries.

OBJECTIVE: This study was undertaken to determine if persons who sustain a spinal cord injury (SCI) and co-morbid brain injury (dual diagnosis [DDS]) evidence smaller functional gains and experience significantly longer rehabilitation lengths of stay than persons with only an SCI. DESIGN: This retrospective comparison study was performed at a 100-bed rehabilitation hospital specializing in acute SCI and traumatic brain injury rehabilitation. Summary scale outcome data of persons who sustained an SCI were compared with outcome data of a group of persons with a DDS. Comparisons were established by matching groups principally on level of SCI and admission Motor FIM trade mark score and secondarily on education, sex, and age. Outcome measures included admission Motor and Cognitive FIM score, discharge Motor and Cognitive FIM score, Motor and Cognitive FIM change, length of stay, and rehabilitation charges. RESULTS: Persons with a DDS evidenced a significantly more impaired Cognitive FIM score at admission and discharge from rehabilitation. Persons with a DDS also achieved a significantly lower Motor FIM change than persons with SCI. There were no significant differences between DDS and SCI groups regarding Cognitive FIM change, length of stay, or rehabilitation charges. Injury severity as defined by the Glasgow Coma Scale or intracranial lesions did not predict response to treatment in the DDS group. CONCLUSION: Persons with a DDS achieved smaller functional gains during rehabilitation than peers with SCI. Brain injuries seem to limit functional gains, although the relationship between brain injury severity and functional change is not linear. Prospective studies are needed to identify factors limiting functional gains in rehabilitation and assist in developing specific treatment programs for persons with SCI and brain injury.

Adult↗
PubMed2005

Understanding personal narratives: an approach to practice.

AIM: This paper explores the need for and nature of personal narratives and their relevance to nursing practice. It proposes that the co-creative aesthetic process can be used to understand and co-create personal narratives through an emphasis on self-defining memories and metaphor. BACKGROUND: Many authors in nursing and other human sciences have recognized the need for and importance of personal narrative, its relationship to aesthetic knowing and its value in qualitative research and in practice. The role of memory and metaphor in the creation of meaning in personal narratives, however, has not been sufficiently explored in nursing literature. DISCUSSION: The nature of personal narrative is explored, focusing on the way meaning is created from self-defining memories using metaphor. Then, the importance of personal narratives in nursing practice is considered, followed by discussion about how meaning in personal narratives may be co-created between clients and nurses using an aesthetic process developed by the author. CONCLUSION: The co-creative aesthetic process is an example of nursing as art and can be used to co-create personal narratives in practice. The experience of co-creating a self story with a nurse can be healing, as the self story is heard by a caring person, memories are understood in new ways, and the self story is both confirmed and recreated.

Communication↗
PubMed2005

Health co-morbidities in ageing persons with Down syndrome and Alzheimer's dementia.

BACKGROUND: Consideration of the relationship between physical and mental health co-morbidities in ageing persons with Down syndrome (DS) and Alzheimer's dementia (AD) is of clinical importance both from a care and resource perspective. AIM To investigate and measure health co-morbidities in ageing persons with Down syndrome with and without AD. METHODS: Recorded physical and mental health needs were ascertained for 124 persons with DS>35 years through a systematic and detailed search of individual medical and nursing case records. Differences in persons with and without AD were investigated, by stage of dementia and by level of intellectual disability (ID). A summed score for health co-morbidities was created and compared using t-tests. RESULTS: Persons with AD had significantly higher co-morbidity scores than persons without AD (t=-8.992, d.f.=121, P<0.0001). There was also a significant difference in summed co-morbidity scores for persons at end-stage vs. persons at mid-stage AD (t=-6.429, d.f.=56, P<0.0001). No differences were found by level of ID. CONCLUSIONS: Increasing health co-morbidities in persons with DS and AD have important implications for care and resources. Appropriate environmental supports combined with competent skilled staff are crucial and will have an important impact on the quality of life for this increasingly at risk population.

Aging↗
PubMed1994

The effects of the presence of a third person on the physician-older patient medical interview.

OBJECTIVE: To compare communication in triadic (three-person) and dyadic (two-person) older patient medical interviews and to determine the influence of the presence of a third person on the physician-older patient relationship. DESIGN: Matched sample of dyadic and triadic audiotaped outpatient medical visits. Audiotapes were coded with the Multi-dimensional Interaction Analysis (MDIA) system. SETTING: Hospital-based medical primary care group practice in a major urban teaching institution. PARTICIPANTS: Patients 60 years and older who were making their first visit to study physicians. In a sample of 96 audiotaped initial medical visits, 15 encounters involved three persons. These 15 cases were matched with 15 dyadic interviews for gender and race of the patient and for gender and race of the physician. MAIN OUTCOME MEASURES: Content, interactional processes, and specific language and communication behaviors of older patients, physicians, and third persons in the medical encounter, as measured by the MDIA system. RESULTS: The specific content and the quality of interactional processes of physicians were not affected by the presence of a third person. However, older patients raised fewer topics in all content areas (medical, personal habits, psychosocial, and physician-patient relationship) in triads than in dyads. Overall, patients were less responsive (ie, the quality of their questioning, informing, and supportiveness was poorer) on patient-raised topics in triads than in dyads. Patients were rated as less assertive and expressive, and there was less joint decision-making and shared laughter in triads than in dyads. Patients were frequently excluded from conversations in visits in which a third person was present. CONCLUSIONS: The presence of a third person in the medical encounter changes the interactional dynamics of older patient medical interviews and may influence the development of a trusting and effective physician-older patient relationship.

Adult↗
PubMed1998

Elder-proxy agreement concerning the functional status and medical history of the older person: the impact of caregiver burden and depressive symptomatology.

OBJECTIVES: To examine the influence of caregiver burden and depressive symptomatology on elder-proxy response concordance regarding the older person's functional status and medical history. DESIGN: Cross-sectional study via telephone interviews. SETTING: Community-dwelling older people and caregivers in North Carolina. PARTICIPANTS: 340 matched pairs of frail persons aged 65 and older and their respective caregivers. MEASUREMENTS: Multidimensional Functional Assessment: The OARS methodology RESULTS: Percent agreement on the ADL items ranged from 97.6% on personal hygiene to 99.7% for toileting, with moderate kappa coefficients. IADL percent agreement ranged from 71.5 to 93.7%, with fair to moderate kappa coefficients. Agreement among the medical history items ranged from 76.3 to 98.5% (kappa = .138-.831). Response bias for the IADL composite measure is influenced marginally by caregiver burden (F[259] = 1.751, P = .098). Five of the individual IADL bias items are influenced significantly by burden, such that an increase in burden results in a greater likelihood that the caregiver will overstate disability compared with the rating by the older person. Response bias on the ADL scale was increased among persons who experienced more caregiver burden (OR = 1.096, 95% CI = 1.000, 1.192) and those who spent more hours providing care (OR = 1.012, 95% CI = 1.001, 1.024). Additionally, black caregivers were more likely than white caregivers to disagree with the older people on the ADL scale (OR = 2.73, 95% CI = 1.642, 3.809). A composite of the medical history items is influenced by the relationship of the caregiver to the older person; bias is more likely among adult children ((F[227] = 1.56, P = .081). CONCLUSION: Elder-proxy concordance is highest among ADL items, followed by medical history items and IADL items. Caregiver depressive symptomotology had no significant impact on elder-proxy response concordance on any of the three outcomes of interest: IADL and medical history bias and ADL disagreement. However, caregiver burden was marginally predictive of bias on the total ADL and IADL scales. Additionally, increased burden was significantly predictive of bias on five of the seven individual items of the IADL scale, suggesting that the more burden a caregiver feels, the greater likelihood that s/he will overstate the older person's disability compared with self-report. These findings suggest that clinicians and researchers who use proxy reports to determine treatment regimens and complete data collection efforts may do so with confidence on ADL individual items and medical history items when the older person's frailty is marginal. However, caregiver burden may result in misleading representation of the older person's functional status, specifically in regard to IADL items.

Activities of Daily Living↗
PubMed1998

Judgments of personal and environmental risks of consumer products--do they differ?

Many psychometric studies have investigated judgments concerning personal risks from technologies, activities or consumer products, but only a few studies have included judgments of risk to the environment. Thus, little is known about this aspect of environmental risk perception, and whether it differs from personal risk perception. This study investigates risk judgments for 30 consumer products of various types such as herbal remedies, mobile telephones, genetically engineered drugs, or garden pesticides. A survey was conducted in two German cities: Leipzig and West Berlin. In total, 408 subjects evaluated the consumer products with regard to personal and environmental risk (and other risk-related aspects) and whether they would recommend the product to others. The findings show statistically significant differences between the mean values of perceived personal risk and environmental risk for most products. Despite these differences, the rank order of mean personal risk and environmental risk judgments for the products is quite similar. However, separate analyses for each product reveal that correlations between perceived personal and environmental risk vary strongly across products. Multiple regression analyses with personal and environmental risk judgments as predictors and product recommendation as criterion, run separately for each consumer product, show that it is mainly the judgment of perceived personal risk that explains product recommendation. Perceived risk to the environment adds little explanatory power. The study also explores differences in judgments of personal and environmental risk with regard to two sociodemographic variables: location (former East Germany vs. West Germany) and gender. Differences in both types of risk judgments are found with regard to location but not for gender.

Adolescent↗
PubMed1989

Comparison of fecal microflora of elderly persons in rural and urban areas of Japan.

The Fecal microflora of 15 healthy elderly persons with a median age of 84 years in a rural area whose inhabitants tend to be long-lived (Yuzurihara-area, Uenohara, Yamanashi Prefecture) was compared with the microflora of individuals with a median age of 68 years in an urban area (Tokyo). The diet of the elderly persons in the Yuzurihara area is characterized by a high intake of dietary fiber. Total numbers of anaerobic bacteria were significantly smaller in the elderly persons in the Yuzurihara area than those in the Tokyo area. A significantly large number of bifidobacteria, but not of lecithinase-negative clostridia, was observed in the elderly persons in the Yuzurihara area. Large numbers and high incidences of bacilli and lecithinase-positive clostridia (mainly Clostridium perfringens) were found in the elderly persons in the Tokyo area. Twenty-five genera and over 81 species were isolated from the elderly persons in the Yuzurihara area, and 25 genera and over 92 species were isolated from the elderly persons in the Tokyo area. Furthermore, significantly larger numbers of Bifidobacterium adolescentis and Fusobacterium mortiferum strains were found in the Yuzurihara group, but significant reductions in the Bacteroides buccae-oris group, B. thetaiotaomicron, Bacteroides spp., C. coccoides, C. paraputrificum, and Clostridium spp. were observed in the same group. A significantly higher isolation rate of Bacillus subtilis was observed in the elderly persons in the Tokyo area. The difference in the fecal microflora between elderly persons in Yuzurihara and those in the Tokyo area might be due to a difference in the intake of dietary fiber.

Aged↗
PubMed2001

Personal growth in medical faculty: a qualitative study.

BACKGROUND: A physician's effectiveness depends on good communication, and cognitive and technical skills used with wisdom, compassion, and integrity. Attaining the last attributes requires growth in awareness and management of one's feelings, attitudes, beliefs, and life experiences. Yet, little empiric research has been done on physicians' personal growth. OBJECTIVE: To use qualitative methods to understand personal growth in a selected group of medical faculty. DESIGN: Case study, using open-ended survey methods to elicit written descriptions of respondents' personal growth experiences. SETTING: United States and Great Britain. PARTICIPANTS: Facilitators, facilitators-in-training, and members of a personal growth interest group of the American Academy on Physician and Patient, chosen because of their interest, knowledge, and experience in the topic area and their accessibility. MEASUREMENTS: Qualitative analysis of submitted stories included initially identifying and sorting themes, placing themes into categories, applying the categories to the database for verification, and verifying findings by independent reviewers. RESULTS: Of 64 subjects, 32 returned questionnaires containing 42 stories. Respondents and nonrespondents were not significantly different in age, sex, or specialty. The analysis revealed 3 major processes that promoted personal growth: powerful experiences, helping relationships, and introspection. Usually personal growth stories began with a powerful experience or a helping relationship (or both), proceeded to introspection, and ended in a personal growth outcome. Personal growth outcomes included changes in values, goals, or direction; healthier behaviors; improved connectedness with others; improved sense of self; and increased productivity, energy, or creativity. CONCLUSIONS: Powerful experiences, helping relationships, and introspection preceded important personal growth. These findings are consistent with theoretic and empiric adult learning literature and could have implications for medical education and practice. They need to be confirmed in other physician populations.

Adult↗
PubMed1998

Evaluation of personal exposure to monoaromatic hydrocarbons.

OBJECTIVES: To evaluate the personal exposure of members of the general public to atmospheric benzene, toluene, and the xylenes, excluding exposure from active smoking. METHOD: 50 volunteers were equipped with active air samplers for direct measurement of personal exposure to monoaromatic hydrocarbons (MAH) and an activity diary was completed during each sampling period. Exposures were also estimated indirectly by combining activity data with independent measurements of hydrocarbon concentrations in several microenvironments. RESULTS: Personal exposure were generally well in excess of those which would be inferred from outdoor measurements from an urban background monitoring station. A wide range of sources contribute to exposure, with indoor and in car concentrations generally exceeding those measured at background outdoor locations. Environments contaminated with tobacco smoke were among those exhibiting the highest concentrations. Personal exposures determined indirectly from activity diaries/microenvironment measurements were well correlated with those determined directly with personal samplers. Personal 12 hour daytime exposures to benzene ranged from 0.23-88.6 ppb (mean 3.81 ppb), with 12 hour night time exposures of 0.61-5.67 ppb (mean 1.94 ppb) compared with an annual average concentration of 1.18 ppb at the nearest suburban fixed site monitoring station. The excess of personal exposure over fixed site concentrations was greater for benzene and toluene than for the xylenes. CONCLUSION: A wide range of sources contribute to personal exposures to monoaromatic hydrocarbons with exposure duration being as important a determinant of total exposure as concentrations. Exposures generally exceed those estimated from concentrations measured by background fixed point monitors. Microenvironment sampling combined with activity diary information can provide satisfactory estimates of personal exposure to these compounds.

Adolescent↗
PubMed2004

Are depressive persons capable of describing changes in their reactions without being able to explain them? A proof of a cybernetic hypothesis of depression.

BACKGROUND: Many studies on the autobiographical memory and the explanation of reasons for success and failure proved that persons suffering from major depression tend to overgeneralize. This study examines the hypothesis that changes of reactions caused by a depressive disorder can be described by the affected persons but not explained. SAMPLE AND METHODS: Persons suffering from major depression and persons with posttraumatic stress disorder or disturbance of accommodation with depressive mood (= reactive form of a depressive disorder) were presented with a list of modalities (behaviour, emotional and physical reactions) characteristic for depression. They were asked to identify modalities applicable to them and to describe and explain them. Their responses were analysed using a content analysis and assigned to the categories description and explanation. RESULTS: Persons with a major depression tended to use explanations or evaluations rather than descriptions for their depression-related modalities. Those persons suffering from a reactive form of depressive disorder tended to prefer evaluations. CONCLUSION: These results support the assumption that states of depression cause general descriptions of depression-relevant behaviour. The specific characteristics that have been perceived confirm the general concepts, which however make the patient prone to the respective selective perceptions. Persons suffering from a reactive form of depressive mood cannot be assumed to have this tendency of self-affirmation. Their depressive state may be maintained by perseverating general pessimistic schemes. LIMITATIONS: It must however be conceded that it was not possible to control the physical comorbidity methodically and to take its effects into consideration, even though only persons without serious illnesses were included in the samples. This study did not verify whether other clinical groups, like patients suffering from anxiety, show the same patterns of explaining and describing their problems. It should furthermore be reviewed how other actions, e.g. positive ones, are represented by depressive persons.

Adult↗
PubMed1987

Survey of underlying conditions of persons hospitalized with acute respiratory disease during influenza epidemics in Houston, 1978-1981.

The peak occurrence of hospitalizations of persons with acute respiratory disease (ARD), usually pneumonia, has coincided with the peak of influenza virus activity each year. The purpose of this study was to examine the diagnoses other than ARD on the discharge record of patients hospitalized with ARD. We were particularly interested in determining the frequency of high-risk conditions for which influenza vaccine is currently recommended. The risk for ARD hospitalization was 19.7 per ten thousand for persons with high-risk conditions and only 9.3 for persons without. Chronic pulmonary disorders were the most common underlying conditions identified, and persons with pulmonary conditions had the greatest risk for ARD hospitalization. The highest rate occurred among persons older than 65 yr of age with pulmonary conditions (87.5 per ten thousand), and the rate was 27.5 for persons 45 to 64 yr of age. Cardiac conditions were the second most frequent group of underlying disorders of patients hospitalized with ARD. Only for persons younger than 20 yr of age was the risk of ARD hospitalization greater for persons with cardiac conditions than for those with pulmonary conditions (22.9 and 14.9 per ten thousand, respectively). Death, however, was more frequent among persons with underlying heart disease. Intensified effort is needed to fully implement recommendations for prophylaxis of influenza in order to reduce these risks.

Acute Disease↗
PubMed1992

Multiple personality disorder in Switzerland.

OBJECTIVE: There are no reliable data on the prevalence of multiple personality disorder. The objective of the study was to determine whether and, if so, how frequently patients with multiple personality disorder are encountered and diagnosed in Switzerland. METHOD: All qualified Swiss psychiatrists were sent a questionnaire on multiple personality disorder along with the DSM-III description of multiple personality disorder and three case examples. A total of 836 psychiatrists (66%) answered after two mailings, and 770 questionnaires qualified for evaluation. In addition, a random sample of nonresponders were contacted by telephone. RESULTS: Three percent of the psychiatrists indicated that, at the time of the inquiry, they were treating or examining one or more patients who met DSM-III criteria for multiple personality disorder, and 10% indicated that they had seen multiple personality disorder at least once during their professional career. The patients were not equally distributed among the psychiatrists; three colleagues reported that they had seen much higher numbers of patients with multiple personality disorder. The point prevalence of multiple personality disorder among patients seen by psychiatrists in Switzerland amounts to 0.05%-0.1%. CONCLUSIONS: Multiple personality disorder appears to be a disorder that genuinely exists, even though it occurs relatively rarely.

Adolescent↗
PubMed1997

Three-year trials of personal therapy among schizophrenic patients living with or independent of family, I: Description of study and effects on relapse rates.

OBJECTIVE: The study of individual psychotherapeutic approaches to the treatment of schizophrenia has yielded equivocal findings, partly because of methodologic problems. Further, the ability of psychosocial treatments to prevent psychotic relapse appears to lessen over time. The authors' goal was to develop and test a demonstrably effective individual therapy for schizophrenia. METHOD: Using a study design that addressed previous methodologic issues, the authors evaluated personal therapy specifically designed to forestall late relapse in patients with schizophrenia. They evaluated the effectiveness of personal therapy over a period of 3 years after hospital discharge among 151 patients with schizophrenia or schizoaffective disorder diagnosed according to Research Diagnostic Criteria. The patients were randomly assigned to receive either personal therapy or contrasting therapies in one of two concurrent trials. One trial studied patients who were living with family (N = 97); the other studied patients who were living independent of family (N = 54). RESULTS: All of the patients had extensive psychiatric histories, but only 44 (29%) experienced recurrent psychotic episodes over the 3-year study period, and only 27 (18%) prematurely terminated the study; most of those who left the study were in the no-personal-therapy conditions. Among patients living with family, personal therapy was more effective than family and supportive therapies in preventing psychotic and affective relapse as well as noncompliance. However, among patients living independent of family, those who received personal therapy had significantly more psychotic decompensations than did those who received supportive therapy. CONCLUSIONS: Personal therapy had a positive effect on adverse outcomes among patients who lived with family. However, personal therapy increased the rate of psychotic relapse for patients living independent of family. The application of personal therapy might best be delayed until patients have achieved symptom and residential stability.

Adolescent↗
PubMed1985

Identity formation as reflected in the acquisition of person pronouns.

Psychoanalytic theory on identity formation during rapprochement is enriched by considering psycholinguistic findings on person-pronoun acquisition. Pronouns such as I and you have often been employed by psychoanalysts as behavioral markers of the intrapsychic concepts of self and other and used to make inferences about the representation of these concepts in children as young as 18 months. Psycholinguistic research, however, reveals two sets of facts which such inferences overlook. First, knowledge of person pronouns, as of other words, is a developmental phenomenon. In children under 22-24 months, prior to the resolution of the rapprochement crisis, pronoun usage is stereotypic and wedded to context. Testing in diverse situations shows that this child has no consistent interpretation of these words. Second, and more important, when children acquire mature understanding of these words at the close of that rapproachement subphase, the knowledge reflected is somewhat different than psychoanalysts have held. Psycholinguistics shows that the meanings children express through person pronouns involve concepts of conversational role where first person indicates speaker, second person, person addressed, and third person, other (third) parties. It is argued that the psycholinguistic and psychoanalytic views on person-pronoun acquisition can be reconciled in the view that this developmental milestone is one of coordinating the expression of concepts of self and other with concepts of conversational roles. For psychoanalysts, then, person pronoun acquisition becomes a signal not only of the child's appreciation of the separateness of self and other, but also of their interrelatedness through the participation of self and other in conversational roles. The cognitive representation of these roles can be considered to function as an early ego identification, facilitating children's progress from the dyad to the larger social milieu.

Child, Preschool↗
PubMed1996

Occurrence and effects of personality disorders in depression: are they the same in the old and young?

OBJECTIVES: To determine the frequency and effects of personality disorders on episodes of depression in elderly and young inpatients. Personality disorders are common and may affect the prognosis of Axis I disorders. METHODS: Clinical records of 89 elderly inpatients and a matched comparison group of 119 young inpatients were reviewed to confirm the diagnosis of a major depressive episode according to the DSM-III-R criteria. The frequency of personality disorder diagnoses in the 2 groups was determined. Within each group, severity, functioning, and treatment were compared between those with and without personality disorders. RESULTS: Personality disorders were diagnosed more frequently in the young (40.3%) than in the elderly (27%). Both rates were similar to previous reports. Cluster C disorders were the most common personality disorders found in the elderly, compared to cluster B disorders in the young. Personality disorder in the young was associated with longer episodes of depression (P = 0.035) and poorer family relations (P < 0.001); whereas in the elderly, personality disorder was associated with more severe episodes (P = 0.014). CONCLUSIONS: These findings suggest that the frequency and effects of personality disorders on the depressed patient may differ according to age.

Adult↗
PubMed2006

Admissions for personality disorders in Italy from 1988 to 1998.

BACKGROUND: Personality disorders affect a substantial proportion of the population. It is unclear, however, whether the burden of personality disorders on modern mental health services has been increasing. To fill this gap, we analyzed trends in admissions for personality disorders in Italy from 1988 to 1998. METHODS: We used the yearly data from the Italian Central Institute of Statistics to analyse trends in the total number of admissions for personality disorders and in the total number of first admissions for personality disorders. RESULTS: The absolute number of admissions for personality disorders almost trebled from 1988 to 1998, as well as the proportion of all psychiatric admissions that were for personality disorders. Whilst there has been a marked increase in the absolute number of first admissions, the proportion of all first psychiatric admissions that were for personality disorders showed a steady but modest increase, from 5.7% to 7.6%. CONCLUSION: In Italy, the burden of personality disorders on modern mental health services has been increasing. In terms of public health, these findings highlight the urgent need of developing policies to tackle the increasing demand of care of this difficult-to-treat patient population.

Journal Article↗