Sarah Baillon

The spectrum of suicidal ideation in Great Britain: comparisons across a 16–74 years age range

BACKGROUND Previous studies have examined suicidal ideation in older populations and emphasized the strong association with the presence of psychiatric disorder. However, associations with the presence of psychiatric disorder across the age range are unclear. Representative epidemiological estimates are needed. METHOD In a national survey of psychiatric morbidity in Great Britain, 8580 randomly selected adults were interviewed. Three questions were asked to assess suicidal ideation, and psychiatric disorder was identified using the revised Clinical Interview Schedule (CIS-R). RESULTS Suicidal ideation was up to three times commoner in younger adults than in those aged 55-74 years but the odds of depression in those with suicidal thoughts was significantly greater in the older age group (p<0.01). Tiredness with life (p<0.01) and thoughts of death (p<0.01) were also more strongly associated with depression in the older age group. Other major associations of suicidal ideation for all ages were: smaller social support group, being divorced or separated, poor self-rated general health, and limitations in activities of daily living (ADL). Being single was an important factor for younger age groups, and widowhood for older people. Life events were also important in younger people, but not in those aged 55-74 years. CONCLUSIONS Suicidal thoughts and death wishes are comparatively more unusual in older people; however, they are more likely to be associated with clinical depression. In terms of suicide prevention this study emphasizes the importance of improving rates of recognition and treatment of depression in older people.

The influence of limitation in activity of daily living and physical health on suicidal ideation: results from a population survey of Great Britain

BackgroundStudying suicidal ideation (SI) has methodological advantages over examining completed suicide and may provide useful insight into suicidal behaviour. SI is not only strongly associated with mental disorder (particularly depression), but also disability. This article explores the relationship between SI and disability in greater detail.MethodsIn the survey of psychiatric morbidity in Great Britain, 8,580 randomly selected adults were interviewed. Three questions were asked to assess SI, and a set of questions identified ADL limitation.ResultsData was available on SI and ADL limitation in 8,513 of those surveyed. The independent association between SI and specific ADL limitations was greatest in older people. The strength of association between SI and ADL limitation increased with the number of domains of ADL affected and was of similar magnitude for most individual domains. In those with limitation in ADL, limited social support remained independently associated with SI.ConclusionsDisability is an important independent correlate of suicidal ideation, particularly in older people. Preventative programmes need to be considered for disabled older people.

Factors that contribute to stress in care staff in residential homes for the elderly

The present study assessed symptoms of stress and stressful events, as well as job satisfaction and attitudes towards the elderly and the home, in care staff in three Local Authority Social Services residential (Part III) homes for the elderly in Leicester. These homes have been reported as caring for a highly dependent group of residents (Neville et al., 1995). From the pattern of the care staff’s responses on both the Stressful Events Questionnaire and the Minnesota Satisfaction Questionnaire, it was indicated that organizational factors are identified as being as stressful as aspects of caring for the residents and managing their behaviour. Staff in these homes indicated favourable attitudes towards the elderly and towards caring for confused residents in the home. It is suggested that with increasingly high levels of dementia (82%) and dependency in the resident group, the homes’ structure in terms of staff group, training and support has not sufficiently responded to the increasing demands on the staff, which may significantly contribute to the reported high levels of stress and low job satisfaction.

A Pilot Study of the Physiological and Behavioural Effects of Snoezelen in Dementia

Recent interest in the use of Snoezelen as an intervention for agitated behaviour in patients with dementia remains supported by limited evidence of efficacy. This pilot study aimed to develop an approach for assessing the effects of Snoezelen on agitated behaviour in patients with dementia and its comparability with an existing control intervention. Ten patients with dementia were randomised to receive a 4-week course of either Snoezelen or reminiscence therapy. The therapeutic effects were assessed using the Agitation Behaviour Mapping Instrument (ABMI) and the Cohen-Mansfield Agitation Inventory (CMAI) and by heart rate recording. Differences in dementia severity between the two groups hindered direct comparison of outcomes. Both interventions were well tolerated and the majority of both Snoezelen and reminiscence sessions were rated positively. The ABMI ratings suggested that Snoezelen might have reduced agitated behaviour during and immediately after the session but that this effect was short-lived. The CMAI scores indicated reduced agitated behaviour during the intervention period. Heart rate data showed both decreases and increases during the sessions for different participants. With minor modifications, the measures used will be appropriate for a full-scale comparative trial. Both interventions may have helpful short-term effects and while for some patients the sessions are primarily relaxing, for others they may have a more stimulating effect.

Worry content across the lifespan: an analysis of 16- to 74-year-old participants in the British National Survey of Psychiatric Morbidity 2000

BACKGROUND Previous studies suggest that worry content and prevalence may vary as a function of age, but evidence is limited. METHOD Cross-sectional national survey of 8580 householders in Great Britain aged between 16 and 74 years. This analysis examined the relationship between age, worry content (relationships/family, financial/housing, work, health, miscellaneous), common mental disorders, and functional limitation, adjusting for other sociodemographic factors. RESULTS Overall, the prevalence of worries declined with age. However, with the exception of worry about relationships, the strength of associations between worry types and mental disorder either remained constant or increased in the older age groups. Compared to the 16-24 years reference group, worries about relationships/family, finances/housing and work were lower in the 55-74 years age groups. Financial/housing worries were increased in the 25-44 years group, and health worries were increased in the 25-64 years groups. There were independent associations between all worry items and the categories of mental disorder. All worry types apart from miscellaneous worries were independently associated, positively or negatively, with functional limitation. CONCLUSIONS Worry content in the general population varies as a function of age, gender, marital status, and educational attainment. All categories of worry are more prevalent in individuals with common mental disorders. The lower prevalence of worries and their stronger association with mental disorder in old age emphasize the clinical significance of these symptoms in this age group.

Therapeutic potential of cannabinoids in neurodegenerative disorders: a selective review.

The endocannabinoid system (ECS) is now recognised as an important modulator of various central nervous system processes. More recently, an increasing body of evidence has accumulated to suggest antioxidant, anti-inflammatory and neuroprotective roles of ECS. In this review we discuss the role and therapeutic potential of ECS in neurodegenerative disorders such as Alzheimers disease (AD), Parkinsons disease, multiple sclerosis, Huntingtons disease, Tourettes syndrome, brain ischemia and amyotrophic lateral sclerosis (ALS). Elements of the ECS, such as fatty acid amide hydrolase or the cannabinoid receptors are now considered as promising pharmacological targets for some diseases. Although still preliminary, recent reports suggest that modulation of the ECS may constitute a novel approach for the treatment of AD. There are windows of opportunity in conditions caused by acute events such as trauma and ischemia as well in conditions that may involve altered functionality of the target receptors of the ECS, such as in AD. The ECS changes in Parkinsons disease could be compensatory as well as pathogenic of the illness process and needs further understanding and clinical studies are still in the preliminary stage. There is not enough evidence to support use of cannabinoids in treating Huntingtons disease, tics and obsessive compulsive behaviour in Tourettes syndrome. Evidence on therapeutic use of cannabinoids in multiple sclerosis and ALS is currently limited. A major challenge for future research is the development of novel compounds with more selectivity for various components of the ECS which could target different neurotoxic pathways and be used in combination therapy.

Early Frontal Executive Impairment as a Predictor of Subsequent Behavior Disturbance in Dementia

OBJECTIVE To determine the extent to which frontal executive impairment early in the course of dementia is predictive of subsequent disturbed behavior. METHODS This was a prospective follow-up study set in the Memory Clinic, Leicester, United Kingdom. A patient cohort (N = 42) diagnosed with mild to moderate dementia was followed up between three and six years after initial assessment. Executive function at baseline was assessed using the The Cambridge Examination for Mental Disorders of the Elderly-Revised (CAMCOG-R) Executive Function score. Disturbed behavior and caregiver distress at follow-up were assessed on the Neuropsychiatric Inventory (NPI), Cohen-Mansfield Agitation Inventory (CMAI), and Dementia Apathy Interview and Rating (DAIR). RESULTS After adjustment, the Executive Function score at baseline was predictive of disturbed behavior and caregiver distress (NPI, CMAI, DAIR) at follow up, with higher levels of executive impairment associated with higher levels of disturbance/distress. Baseline measures of global cognitive impairment (Mini-Mental State Exam, CAMCOG) were not predictive of subsequent disturbed behavior or caregiver distress. CONCLUSION Executive impairments identifiable relatively early in the clinical course of dementia are predictive of disturbed behavior and associated caregiver distress at long-term follow-up, which supports the view that executive dysfunction is important in the etiology of these problems.

Pattern of Smell Identification Impairment in Alzheimer’s Disease

Olfactory dysfunction in general, and impaired odor identification in particular, have been reported in Alzheimers disease (AD). Olfactory testing may be a useful diagnostic aid for AD, but the types of odor most commonly affected need to be identified. This study aimed to determine pattern and types of odor affected in AD with the goal of improving clinical applicability. 54 outpatients with mild to moderate AD and 40 age and gender-matched non-demented controls (NDC) were tested using British version of University of Pennsylvania Smell Identification Test (UPSIT; Sensonics, Inc., Haddon Heights, NJ) and data analyzed to identify an optimal subset of UPSIT to best differentiate AD patients from controls. AD subjects had significantly lower UPSIT total scores than NDC. Random Forest with backward elimination identified 12 UPSIT items which accurately differentiated AD patients compared to controls (sensitivity, 0.89 and specificity, 0.83, positive predictive value of 0.889, and negative predictive value of 0.833). The 12 smell items found to be most affected in AD subjects reflects important attributes such as safety and food, known to be affected in people with AD and that has the potential to impair activities of daily living. The 12 items of British UPSIT most affected in AD subjects provides a potential brief scale for early detection of AD in clinical settings. Independent replication is needed to validate these findings.

Screening for depression in Parkinson's disease: the performance of two screening questions

BACKGROUND the study objective was to evaluate the validity of the two questions recommended by the UK. National Institute for Health and Clinical Excellence for depression screening in Parkinsons disease (PD). METHODS one hundred and twenty patients attending a PD out-patient clinic were interviewed in a standardised manner using relevant sections of the Present State Examination- Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to Diagnostic and Statistical Manual (4th edition) criteria. Participants then completed the two depression screening questions and the 15-item Geriatric Depression Scale (GDS-15). RESULTS sensitivity, specificity, positive and negative predictive values of the two questions and GDS-15 for major and minor depression combined were calculated for different cut-off scores and a receiver operating characteristics (ROC) analysis was conducted. A threshold of one or more positive responses to the two screening questions gave a sensitivity of 100% and specificity of 84% (positive predictive value 54%, negative predictive value 100%). The area under the ROC curve was 0.95. The optimal cut-off for the GDS-15 was 5/6, which gave a sensitivity of 84% and specificity of 89% (positive predictive value 59%, negative predictive value 97%), and the area under the curve was 0.92. CONCLUSION this study shows that the two depression screening questions can be used as an initial screen for depression in patients with PD who have no significant cognitive impairment. A positive response to either of the questions would indicate that further diagnostic assessment may be warranted.

A descriptive survey of acute bed usage for dementia care in old age psychiatry.

To examine the reasons why patients are admitted to acute dementia care assessment beds in one large district health authority (Leicestershire).