Candida Graham

Carers' knowledge of dementia, their coping strategies and morbidity

Objective. The main hypothesis was that carers of dementia sufferers who have a higher level of knowledge on the subject of dementia have lower rates of physical and psychological morbidity. We also wanted to examine whether a carers level of knowledge bears any relation to their attributional style and coping mechanisms.

Classification of psychotic symptoms in dementia sufferers

Little attention has been payed to the classification of psychotic symptoms in dementia sufferers. This article compares the etiology of delusions, visual hallucinations and delusional misidentification and examines the value of factors generated from principal components analysis as a possible classificatory system in a group of 125 patients with DSM‐III‐R dementia in contact with clinical services who were prospectively evaluated using standardized instruments to describe in detail individual psychotic symptoms. The assessment also included the Geriatric Mental State Schedule, the History and Aetiology Schedule and the CAMCOG. Delusions and visual hallucinations had a distinct cognitive profile as did delusions and delusional misidentification, although there was an overlap between visual hallucinations and delusional misidentification. Four factors were generated from principal components analysis. Three of these closely mirrored the 3 symptom groups delusions, visual hallucinations and delusional misidentification, although the phantom‐boarder delusion was correlated with the visual hallucination factor and not delusional misidentification. The fourth factor included visual hallucinations of relatives and delusions that relatives were in the house. This factor was strongly inversely associated with emotional distress and could perhaps best be seen as a comfort phenomena. The pattern of cognitive deficits and etiological associations of each of the factors were independent of one another, supporting the notion that it is useful to consider them as separate entities.

CARERS' KNOWLEDGE OF DEMENTIA AND THEIR EXPRESSED CONCERNS

Objective. The authors wished to determine how much carers from different settings caring for patients with dementia knew about the disorder and elicit their main concerns about the disease.

The social functioning of older adults with schizophrenia.

A cross-sectional survey of the social functioning of community dwelling older adults was undertaken. Older adults with no psychiatric morbidity, depressed older adults and older adults with schizophrenia were surveyed to see if there were differences in the level of social functioning of the three groups. The setting was two old age psychiatric services, one in an urban area of London and the other in a semi-rural area of Leicestershire. Participants consisted of depressed ( n = 81) or normal ( n = 101) older persons identified as part of a general practice over 75 years check and clients over 65 years with schizophrenia ( n = 30) known to mental health teams for older adults. All participants were interviewed by one of two trained researchers and completed the Mini-Mental State Examination questionnaire, the 15-item Geriatric Depression Scale, a social functioning questionnaire, and the Schedules for Clinical Assessment in Neuropsychiatry or the Brief Psychiatric Rating Scale. In our sample population, community dwelling older persons without any psychiatric diagnosis were the least isolated from their local community, reported more private leisure activities, and had the least contact with professional community services. Clients with schizophrenia reported more isolation from their local community and fewer private leisure activities than clients with a diagnosis of depression.

Anxiety disorder in dementia

Objective : To estimate the prevalence of anxiety disorders and to explore several potential aetiological factors. Method : Ninety two consecutive patients assessed at a day hospital for patients with probable dementia were interviewed using the CAMDEX schedule. Fifty eight patients gave a sufficiently reliable interview and had a first degree relative in close contact as an informant and were hence included in the study group. The prevalence of RDC generalised anxiety disorder in this group was determined. Type of dementia, severity of dementia and insight were explored as possible aetiological factors. Results : The prevalence of RDC generalised anxiety disorder was 31%. Fifty percent of these patients suffered from anxiety symptoms in the context of RDC major depression. Anxiety disorders were most common in those with mild dementia and in those who retained insight, both showing a trend towards a significant association with anxiety. Conclusions : Anxiety disorders are very common in dementia sufferers particularly in those with mild dementia. Further research is needed in this area, particularly with respect to treatment.

VARIABLES WHICH DISTINGUISH PATIENTS FULFILLING CLINICAL CRITERIA FOR DEMENTIA WITH LEWY BODIES FROM THOSE WITH ALZHEIMER'S DISEASE

Objectives. To compare patients fulfilling clinical criteria for Lewy body dementia with those meeting clinical criteria for Alzheimers disease.

Dissociative psychosis: an atypical presentation and response to cognitive-analytic therapy

We report on a patient with a rare type of dissociative disorder, dissociative psychosis (hysterical psychosis), in whom gustatory, olfactory, visual and auditory hallucinations occurred. Auditory and visual hallucinations have been described in previous cases of dissociative psychosis, and olfactory and gustatory hallucinations have been described associated with sexual assault but this case is unusual in that hallucinations occur in all modalities in one patient, as yet not described in the literature The basis of the dissociative disorder lay in a childhood sexual trauma and therefore the traditionally advocated treatment for such a case is the psychotherapeutic abreaction of these previous traumatising events. This approach caused worsening symptomatology and the patient experienced frequent lapses into dissociative psychosis. However, focused cognitive-analytic therapy concentrating on the patients personal conflicts at the time of presentation resulted in a resolution of symptoms and a return to health.

NEUROLEPTIC INDUCED POLYDIPSIA AND HYPERPHAGIA IN AN ADULT WITH LEARNING DISABILITY

This case report is of a young male with learning disability, who presented with long-term polydipsia and hyperphagia. The patients polydipsia and hyperphagia showed a correlation with long-term use of neuroleptics for behavioural problems. Withdrawal of all neuroleptic medication resulted in an immediate improvement in both the polydipsia and hyperphagia leading to a complete resolution of both symptoms. While neuroleptics are a recognised cause of polydipsia, hyperphagia is less frequently described and we believe this to be the first report in which a patient is observed to have polydipsia and hyperphagia induced by neuroleptics. We discuss the possible aetiological mechanisms for both polydipsia and hyperphagia and conclude that the basic pathophysiology in our case appears to be a neuroleptic induced malfunction of the satiety centre due to blockage of dopamine receptors in the ventromedial hypothalamus.