SynopsisThe effects of age and depression on cognitive function were investigated in two groups of in-patient major depressives aged under and over 60 years who were tested when depressed and after recovery. The majority of the tests showed impaired performance during depression with improvement after recovery, and also differences between the two age-groups in both the depressed and recovered phases. However, the older subjects were not more severely affected by depression than the younger subjects. The pattern of impairment associated with depression was different to that associated with older age: depression affected performance on more ‘complex tasks’, whereas age was associated particularly with slowing on timed tests. This study did not suggest that the impairment from baseline due to depression is greater in the elderly than in younger subjects.
Enduring neuropsychological deficits may be a feature of chronic, severe manic-depressive illness.
SummaryAnxiety has reported prevalence rates between 38 and 72% among people with dementia. It has a negative impact on cognitive impairment and is associated with agitation and poor quality of life. The presence of excessive anxiety can be difficult to establish in people with dementia, especially when expressive or receptive speech is impaired. Unfortunately, there is a lack of research on the treatment of anxiety in dementia, and also on the wider issue of the management of anxiety disorders in old age. We explore the prevalence, presentation and diagnosis of anxiety in dementia and discuss the therapeutic options available.
Parasuicides ( N = 18) were compared with matched controls ( N = 18) on their subjective probability judgements for nine future, negative, self-relevant events. Prior to the probability judgements, subjects were asked to think of reasons why the events would or would not happen. The ease with which they were able to think of reasons was assessed by time taken to think of the first reason, number of different reasons given in 90 seconds and a subjective rating of difficulty. Relative to controls, parasuicides judged negative events to be more likely. They also showed evidence of finding it more difficult to think of why those events might not happen, but were no different from controls in their ability to think of reasons why the events would happen. The effect of thinking of reasons against negative events happening was to reduce the pessimism of parasuicides. It is suggested that parasuicide subjects may not actively anticipate future negative outcomes, but when presented with the possibilities, they judge them to be likely because of an inability to think of positive aspects of themselves or their circumstances which would prevent those events happening.
Purpose -The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.Design/methodology/approach -This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50 þ groups were assessed using Fisher's exact test.Findings -Amongst the 92 in the group 50 years and above, 67 (average dose ¼ 63.25 mg) were on methadone maintenance (average dose ¼ 63.25 mg) and 19 (average dose ¼ 10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood-borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50 þ age group.Practical implications -There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.Originality/value -This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age-related differences in particular related to physical health and social needs.
SIR,-Three summers ago our 2 year old son wandered from our garden. He was found in the swimming pool of a neighbouring garden: the pool was unfenced and had a non-weightsbearing cover.Resuscitation was not successful. We know of three families within 16 km who have suffered similar tragedies: as Alison Kemp and J R Sibert point out, drowning is a common cause of accidental death in children. ' In our society, where there is increased emphasis on out ofdoors activities, the incidence ofdrowning in children will surely increase unless effective preventive measures are taken. We have written on this matter to our member of parliament without success. We support Kemp and Sibert's recommendations that domestic pools should have toddler proof fences with self locking doors and covers that can bear the weight of a child. People may argue that this interferes with personal liberty: the same was said about seat belt legislation. The children whose lives are at risk are too young to appreciate such abstract arguments.
SUMMARYThe MEAMS (Middlesex Elderly Assessment of Mental State) is a relatively new scale specifically developed to detect intellectual impairment secondary to organic brain dysfunction in the elderly. In this study the MEAMS was compared with the MMSE (Mini-Mental State Examination), a widely known and commonly used brief cognitive rating scale, in a group of 60 elderly acute psychiatric inpatients. Scores on both scales were highly correlated. However, the MEAMS was shown to be more sensitive in the detection of mild cognitive impairment, and was more sensitive to the presence of focal brain lesions than the MMSE. In the second part of the study, a further 25 inpatients were assessed using both scales by six junior and staff-grade doctors, who then rated the scales according to various criteria. Despite taking slightly longer to administer, the MEAMS was rated superior overall by the medical staff. It is suggested that the MEAMS is a sensitive instrument acceptable to both patients and staff, and is suitable for routine use in an old age psychiatric setting.KEY woms-Cognitive impairment, cognitive assessment, rating scales.
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