Justin Sauer

Assessing the Prevalence of Depression in Punjabi and English Primary Care Attenders: The Role of Culture, Physical Illness and Somatic Symptoms:

Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.

Anticholinergic effect on cognition (AEC) of drugs commonly used in older people

Use of anticholinergic drugs in older people is associated with increased risk of cognitive decline and of dementia and death.

The pharmacological management of Alzheimer's disease: Alzheimer's disease

The final article in the current series on the major psychiatric drug groups, produced in association with the College of Mental Health Pharmacy. In this article, the authors discuss the use of cognitive enhancers in Alzheimers disease (AD) and other dementias and provide an overview of new treatments in development.

Dementia in a Black and minority ethnic population: characteristics of presentation to an inner London memory service

Aims and method To examine data on referrals to an inner-city London memory service to explore any differences in referral rates, cognitive assessments and stages of dementia at presentation between ethnic groups. Results African–Caribbean patients were well represented in the memory service. They were diagnosed with dementia on average 4.5 years younger than their White British counterparts and were more likely to be diagnosed with a vascular or mixed type dementia. However, scores on initial cognitive testing were significantly lower in the African–Caribbean group, possibly representing more advanced disease at presentation. Clinical implications Initiatives to access Black and minority ethnic populations earlier in the course of their illness should be considered. Professionals need to consider the potential for cultural bias in memory testing and diagnosing dementia in these populations, and the importance of cultural competency in assessments.

Veiled Communication: Is Uncovering Necessary for Psychiatric Assessment?

Facial expressions are significant to decipher information during a dialogue and more so in a clinical consultation. Veils (Niqab) worn by Muslim women may pose a clinical dilemma for the psychiatric assessment especially if clinicians are not aware of their religious significance. To investigate whether clinical judgment is affected if full facial expressions are not accessible, we conducted an email survey of psychiatrists and psychologists across the world who frequently work in these situations. Of 25 colleagues contacted 16 responded and 11 of them agreed for their comments to be included in the study. Nine out of 11 believed clinical assessment may be compromised, although respondents were aware of cultural sensitivity around the issue. Two out of 11 however, felt fully able to assess the mental state of a veiled woman. Some professionals reported that they feel unable to assess or treat if the request to take the veil off is declined. This small survey demonstrates the diverse opinions on whether unveiling is necessary for psychiatric assessment. Further qualitative examination of this area is needed to develop wider consensus and guidance to mental health care professionals who may be dealing with these groups.

Drug treatments in post-traumatic stress disorder

As our understanding of post-traumatic stress disorder (PTSD) improves, so too should our psychopharmacological approaches to treating this common and sometimes disabling condition. Treatment with drugs can lead to improvement in PTSD. The most effective drugs seem to be those that have their action on the serotonergic system, such as the selective serotonin reuptake inhibitors and the monoamine oxidase inhibitors. Higher dosages and longer periods of treatment seem to be required in many cases for adequate therapeutic response. Here we examine the main groups of agents used in the pharmacological treatment of this disorder. With a background of relatively few randomized therapeutic trials and others beset by limitations, it remains difficult currently to draw confident conclusions in the approach to drug management.

OPTIMISING FALLS RISK ASSESSMENT IN MEMORY SERVICES: INVESTIGATING SYSTEM-WIDE INTEGRATION OF FALL PREVENTION EVIDENCE INTO PRACTICE

demonstrated across age groups. Conclusions: In carers of people with dementia, the HADS measures three factors of anxiety, depression and negative affectivity. This has implications for interpretation of a commonly used clinical instrument and may enhance understanding of previous clinical trial results, which have use the HADS as a primary outcome but interpreted it as a one or a two-factor measure. The depression subscale of the HADS can detect and measure depression, but the HADS anxiety and negative affectivity scales are not useful in this group. Measurement invariance results suggest the HADS can be used to measure differences in depression across gender and kinship but not across age groups.