Monika Krautgartner

The Consequences of Non-Cognitive Symptoms of Dementia in Medical Hospital Departments

Objective: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes. Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used. Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables. Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

The "carers' needs assessment for Schizophrenia": an instrument to assess the needs of relatives caring for schizophrenia patients.

ObjectiveFor the purpose of service planning, an instrument was developed for the systematic assessment of interventions needed by the caregivers of schizophrenia patients.MethodThe development of this instrument was based on in-depth interviews and focus groups. It consists of 18 areas describing common problems of schizophrenia caregivers. For each of these problem areas several possible interventions are offered. Concurrent validity, inter-rater and retest reliability were tested among 50 caregivers.ResultsThe kappa values for the inter-rater reliability are predominantly excellent (kappa > 0.75). The values for the retest reliability show a wide range between excellent (kappa > 0.75) and fair agreement (kappa 0.40–0.60). The significant correlations found between summary scores of this new instrument and several sub-scales of the Family Problem Questionnaire support the assumption that the concurrent validity is satisfactory.ConclusionThese results suggest that this instrument is both valid and reliable.

Gender aspects of parents' needs of schizophrenia patients.

BackgroundMost studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients’ mothers.Methods101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.ResultsMothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers’ problems was predicted by not living with a partner and by a shorter duration of the patients’ illness. The number of mothers’ needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients’ illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.ConclusionsFathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer’s gender in clinical work.

Need and utilization of psychiatric consultation services among general hospital inpatients

ObjectiveThe aim of the present study was to estimate the need for psychiatric consultation services and psychiatric inpatient referral among inpatients of non-psychiatric hospital departments, and to assess the actual utilization of these services.MethodsThe study was carried out among 728 inpatients of physical rehabilitation wards, medical, surgical, and gynecological wards in Austrian hospitals. Psychiatric case identification was performed by research psychiatrists using the Clinical Interview Schedule (CIS). Diagnoses were given according to DSM-III-R. The assessment of need for consultation and inpatient referral was based on the clinical judgments of research psychiatrists.ResultsOverall, 34.2% of the inpatients were cases according to the CIS-criteria, 51.8% of them needing either psychiatric consultation or inpatient referral according to research psychiatrists. In 66.7% of those for whom research psychiatrists had stated a need, this need was not met (“unmet need”), while only 33.3% of them had their need met. In contrast, a psychiatric consultation was performed among 5% of those patients not needing psychiatric services according to the research psychiatrists (“overprovision”). Variables of the health care system (i.e. department type and catchment area of the hospital) were among the predictors for “met needs”.ConclusionThe rate of actual psychiatric consultations and admissions to psychiatric wards was markedly lower than the need according to research psychiatrists’ judgment.

P02-288 - Pain and depression in general hospital patients

Background Symptoms of physical pain can indicate a current depressive episode. The study aimed to assess pain symptoms among physically ill general hospital patients and to explore if pain symptoms are more prevalent among physically ill patients with a depressive episode than among those without a depressive episode. Methods Pain symptoms were assessed by a modified version of the Patient Questionnaire (Spitzer et al 1 ). Diagnosis of a current depressive episode was made by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version 2 ). Results Of the 290 patients included in the study 247 (85.2%) indicated at least one pain symptom. About a fifth of the patients suffered from a current depressive episode. Physically ill patients with depression suffered significantly more often from pain and reported significantly more often three or more symptoms of pain than those without depression. Headaches, stomach pain and chest pain were significant independent predictor variables for depression in a multiple logistic regression analysis controlled for age, gender and primary somatic diagnosis. Conclusion Patients in general hospital who suffer from pain symptoms should be checked physically and psychologically in order to detect a comorbid depressive episode. 1 Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:1749-56. 2 Wittchen, H.U., Pfister, H., 1997. DIA-X-Interviews. Manual fur Screening-Verfahren und Interview; PC-Programm zur Durchfuhrung des Interviews (Langs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt, Swets & Zeitlinger.

P4-172: Concurrent validity of the “Carers’ Needs Assessment Schedule for Dementia”

Background: Caregivers of dementia patients often suffer from numerous burdens. Several studies have shown that various interventions to caregivers are effective to reduce their burden and improve the patients’ outcome. A recently developed research instrument for assessing the needs of caregivers (“Carers’ Needs Assessment Schedule for Dementia” CNA-D) has been shown to have satisfactory inter-rater and retest reliability as well as content validity. Objective(s): The aim of the present study was to investigate concurrent validity of the CNA-D. Methods: Forty five relatives of dementia patients were enrolled for this study. To evaluate if plausible associations (i.e. indicators for concurrent validity) exist, two summary scores of the CNA-D were used: the number of moderate or serious problems among the carers and the number of interventions needed. Further the “Camberwell Assessment of Needs for the Elderly” (CANE) and the “General Health Questionnaire” (GHQ-12) were used. Results: The numbers of carers’ problems (CNA-D) were positively associated with the number of symptoms indicating anxiety disorders or depression (GHQ; r 0.625, p 0.000), the living situation of the patient (private household vs. nursing home; r 0.642, p 0.000) and the amount of time spent with the patient (r 0.330, p 0.040). Negative correlations were found with the extent of support the patient received from the private social network (r 0.430, p 0.005) or from professional services (r -0.384, p 0.012). Similar results were yielded for the number of interventions needed (CNAD). Conclusions: Overall, these results indicate that the concurrent validity of the CNA-D is satisfactory.