Carl I. Cohen

Schizophrenia and Older Adults: An Overview: Directions for Research and Policy

The Group for the Advancement of Psychiatry, Committee on Aging, believes that a crisis has emerged with respect to the understanding of the nature and treatment of schizophrenia in older persons. Moreover, critical gaps exist in clinical services for this population. In this article, we examine the epidemiology of aging and schizophrenia; life-course changes in psychopathology, cognitive function, social functioning, and physical health; and various concerns regarding treatment, services, and financing. Finally, we propose six research and policy recommendations and suggest methods for addressing the research questions that we have posed.

Emotional Expression During Mid- to Late-Stage Dementia

This study examined the quality of emotional responsivity in mid- to late-stage dementia patients. Eighty-two nursing home patients with a DSM-III-R diagnosis of primary degenerative dementia of the Alzheimer type served as subjects. Patients were staged using the Global Deterioration Scale. The level and type of patient affectivity were assessed by family reports, aide reports, and direct observation and coding of patient facial expressions during a family visit. All three measures indicated that patients with Alzheimers disease expressed a range of affective signals. Some showed an intact and functional emotion system even during the last stage of the disease; one third of end-stage dementia patients expressed sadness at the departure of their relatives as coded by an objective facial affect coding system.

Impact of training dementia caregivers in sensitivity to nonverbal emotion signals.

Ninety-one mid- to late-stage dementia patients residing in nursing homes, along with their staff caregivers, participated in a study designed to assess whether training caregivers in sensitivity to nonverbal communication could enhance mood and reduce symptoms in patients and improve psychological well-being in caregivers. Patients and staff at three nursing homes comprised three groups that were randomly assigned to either a nonverbal sensitivity group, a behavioral placebo group that received instruction in the cognitive and behavioral aspects of dementia, and a wait-list control. Training consisted of 10 one-hour sessions taught by a clinical psychologist using prepared materials. Patient measures, which were taken at baseline and at 4 three-week intervals, included patient symptomatology (depression, agitation, behavioral symptoms), as reported by the staff caregivers, and positive and negative facial expressions of emotion elicited during a face-to-face interview and coded by trained research staff. Results indicated that positive affect increased sharply during the first 6 weeks after intervention in the nonverbal group, with the placebo and wait-list controls showing no change. There was also a decline in negative affect across time for all groups. Effects with respect to patient symptomatology did not reach significance. Caregivers in both training groups showed a decline in symptomatology, whereas the wait-list control group did not.

Focus on geriatric psychiatry: schizophrenia in later life: clinical symptoms and social well-being.

The number of persons aged 55 and older with a diagnosis of schizophrenia is projected to double over the next 20 years. A tripartite classification system of early-onset schizophrenia, late-onset schizophrenia, and very-late-onset schizophrenia-like psychosis has been proposed. This column reviews recent findings on the outcome and associated features of clinical symptom and social well-being categories for older adults with early-onset schizophrenia.

Aging and Homelessness

Aging homeless persons have been largely neglected in the gerontological and homeless literature. This article presents an overview of homelessness and aging within the context of a testable, provisional model for explaining homelessness in this population. The author proposes 16 individual and 5 structural and programmatic variables that contribute to the etiology and sustenance of homelessness among aging persons.

Clinical use of network analysis for psychiatric and aged populations.

Despite a recent renewal of interest in natural community support networks and self-help groups, there currently exist no systematic therapeutic approaches for working with network systems. Over the past two decades advances in the field of social network analysis have laid the groundwork for its conversion to a clinical tool. This paper illustrates how network analysis can provide quantitative and qualitative data useful in therapeutic interventions and agency planning decisions.

The biomedicalization of psychiatry: A critical overview

The biomedical model currently dominates psychiatric clinical practice and research. Unfortunately, this dominance had led increasingly to biological reductionism. This paper examines the historical and sociopolitical underpinnings of the biomedical model, and illustrates some of the common scientific distortions of reductionistic thinking. These observations are applied to recent directions in mental health policy and are used to provide a basis for alternative perspectives of mental illness and psychiatric research.

Health Education: Panacea, Pernicious or Pointless?

As a consequence of the frustrations spawned by the escalating costs and the low returns of disease-oriented medicine, health education has begun to be touted as an antidote to the nations health ...

Relation between premorbid personality and patterns of emotion expression in mid‐ to late‐stage dementia

Twenty‐seven nursing home patients with mid‐ to late‐stage dementia participated in a study of the relation between preillness personality, as indexed by attachment and emotion regulation style, and current emotional behavior. Preillness measures were completed by family members and current assessments of emotion were supplied by nursing home aides and family members; in addition, emotion was coded during a family visit using an objective coding system for facial emotion expressions. Attachment style was found to be related to the expression of positive affect, with securely attached individuals displaying more positive affect than avoidantly attached individuals. In addition, high ratings on premorbid hostility were associated with higher rates of negative affect and lower rates of positive affect. These findings indicate that premorbid aspects of personality show continuity over time, even in mid‐ to late‐stage dementia.

Racial Differences in Neuropsychiatric Symptoms Among Dementia Outpatients

This study, based on evaluations of 240 outpatients with Alzheimers disease or multi-infarct dementia, examines whether race has any independent effects on the prevalence and levels of related neuropsychiatric symptoms. After the authors controlled for 14 potentially confounding variables, race had a significant independent effect on the levels of psychotic and depressive symptoms, the former being greater among blacks and the latter among whites. There were no differences in symptoms between U.S.-born African Americans and African Caribbeans. Although it is likely that racial differences reflect variations in symptoms brought in for evaluation, the absence of intraracial differences suggests the possibility of an underlying biological process.