The high prevalence of mental disorders such as depression and dementia in institutionalized elderly patients warrants screening for psychiatric diagnosis in patients newly admitted to long-term care facilities. The diagnostic accuracy of the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) was evaluated against a standardized psychiatric interview. The MMSE was found to be 81% sensitive and 83% specific in screening for dementia using a previously established cutpoint of less than 24/30 points. Adjusting MMSE scores for physical disabilities precluding completion of specific tasks on the MMSE did not significantly change the diagnostic accuracy of the test. The GDS was 47% sensitive and 75% specific in screening for depression using the suggested cutpoint of greater than 13/30 points. The MMSE was significantly correlated with functional status (r = 0.48, P = .0001), but not with the scores on the GDS or the clinical diagnosis of depression. The GDS did not correlate with functional status. In summary, the MMSE is a good screening test for dementia in institutionalized elderly, but the GDS is not sensitive for depression in this population.

Objective. To examine the prevalence and correlates of depressive symptoms among patients with systemic sclerosis (SSc; scleroderma).Method. Fifty-four outpatients with scleroderma were administered the Beck Depression Inventory, the Neuroticism-Extraversion-Openness Personality Inventory, the Health Assessment Questionnaire, and the Psychosocial Adjustment to Illness Scale. In addition, patients underwent a comprehensive clinical assessment, and pulmonary function tests were obtained.Results. Nearly half of the patients had mild depressive symptoms, and an additional 17% had symptoms in the moderate-to-severe range. Younger patients, those with digital ulceration, and those with more self-rated functional impairment had more depressive symptoms, but there were few other relationships between depressive symptoms and either demographic or physician-rated medical variables. In contrast, there were highly significant relationships between depression and aspects of personality, psychosocial adjustment to illness, and social support.Conclusion. Depressive symptoms in patients with SSc are more strongly related to personality, self-rated disability, and adequacy of emotional support than to objective medical indices of illness severity. Depression in scleroderma is a debilitating comorbid condition that should be recognized and treated in its own right.

SWAP) is a 14-item questionnaire, assessing both the subjective appraisal and social-behavioral components of body image among bum survivors. Burn survivors requiring hospitalization (n = 165} completed a packet of psychometric instruments, including the SWAP at 1-week postdischarge. The SWAP demonstrated a high level of internal consistency (Cronbach's alpha, r. = .87; the mean interitem correlation, r,, = .32, the mean itemtotal correlation, rit = .53). Eighty-four participants were retested approximately 2 months after the initial assessment to evaluate test-retest reliability (rlt, = .59). A principal-components analysis with a varimax rotation yielded 4 easily interpretable factors accounting for 66% of the total variance. The correlations of die SWAP total score with other selected psychometric measures provided evidence for both convergent and discriminant validity. This initial evaluation of the SWAP suggests that it is both a reliable and valid measure of body image for a burn-injured population.Enduring a severe burn presents a burn survivor with numerous challenges, not the least of which is adjusting to scarring and related changes in his or her appearance (Patterson et al., 1993). To date, most research on the psychological effect of scarring and disfigurement following a severe bum injury has focused on the relationship between burn characteristics (e.g., size and location of burn), demographic characteristics of the burn survivors (e.g., sex and age), and subsequent emotional distress. For example, a number of researchers have emphasized the importance of the distinction between hidden (e.g., back, stomach) or visible (e.g., face) scars. Abdullah et al. (1994) found that children with visible scars from burn injuries reported more body-image disparagement than did children with hidden scars. Similarly, in adult populations, visible scarring has been shown to relate to decreased interaction with nonfamily members (Browne et al., 1985) and to increased withdrawal from activities that emphasize physical appearance (Andreasen & Norris, 1972). Other studies have suggested that alterations in

Investigators have reported poor recognition of dementia by primary physicians. For this reason, mental status examinations were performed on 72 demented and 144 nondemented medical inpatients to assess the sensitivity, specificity, and predictive value of components of this examination in the diagnosis of dementia. Sensitivity of individual level-of-orientation items was low (15.3 to 56.9%), though specificity was high (91.7 to 100%). Sensitivity of several nonorientation items was high (80.6 to 100%), though specificity was low. A multivariate discriminant equation using both orientation and nonorientation items achieved high sensitivity (89.6% test cases, 87.5% validation cases) and specificity (78.1% test cases, 87.5% validation cases). Adding the easily obtained patient characteristic of age to the equation further increased sensitivity (95.8%, 91.3%), while maintaining specificity (82.3%, 85.4%). From these results, it is concluded that the level-of-orientation screening examination used by clinicians to detect dementia is unacceptably insensitive. In contrast, a composite decision rule including nonorientation items achieves high sensitivity with relatively high specificity.