Further change in the pattern of mental illness in the elderly

Article Abstract:

In 1955, M. Roth, in his Graylingwell study, described a diagnostic classification system which placed geriatric psychiatric patients into one of five groups: (1) affective (mood) psychoses; (2) late-onset paraphrenia (paranoid schizophrenia); (3) senile dementia (Alzheimer's type); (4) multi-infarct dementia (MID); and (5) acute confusional states. He tested this system by following a cohort of 143 geriatric patients, admitted to a psychiatric hospital from 1948 to 1949, and demonstrating outcome differences for the different groups after a two-year follow-up. To evaluate the validity of Roth's system over time, his cohort data were compared with a 1974 to 1976 cohort of 265 geriatric patients, and with a 1984 to 1986 cohort of 300 geriatric patients, similarly diagnosed and followed-up. Affective psychoses accounted for 30 percent of all admissions in the 1940s, but dropped down to 24 percent of admissions in the 1970s and to 15 percent in the 1980s. There was also a downward tend in admissions for paraphrenia from the 1970s to the 1980s. Admissions for dementia rose from 50 percent of all admissions in the 1940s to 76 percent in the 1980s. However, the prognosis for the dementias improved in terms of both discharge rates - which rose from 13 percent in the 1940s to 27 percent in the 1980s - and death rates, which fell significantly (from 61, to 27, to 11 percent). In general, there was a shift from admissions for mental diseases of unknown cause to admissions for organic disorders such as multi-infarct dementia. Admissions for confusional states did not change a great deal, but discharge rates increased significantly (from 58, to 62, to 91 percent). There was a general upward trend in survival across categories, thought to be related to recent improvements in geriatric services and in the availability of antibiotics and other modern drugs. Roth's system seems to have withstood time, since 90 percent of the two more recent cohorts could be diagnosed according to his criteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Prognosis, Dementia, Mentally ill aged, Mentally ill elderly

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Causal attributions and psychiatric symptoms in survivors of the Herald of Free Enterprise disaster

Article Abstract:

Post-traumatic stress disorder (PTSD) is characterized by chronic and severe symptoms of anxiety. As the name of the disorder implies, PTSD usually occurs after one is exposed to a major trauma. In the research into PTSD, guilt has been identified as possibly associated with the more severe and prolonged cases. Guilt may be the result, for example, of wondering why others died and not oneself, and may be related to causal attribution. Causal attribution is a measure of how much someone holds himself responsible for things that happen, as opposed to holding external forces responsible and feeling that one does not have much control at all. This study examined the relationship between causal attributions and psychiatric symptoms in survivors of the Herald of Free Enterprise disaster, a ferry that capsized in 1987 and killed 193 people. The subjects, 20 adult survivors, were interviewed two years after the disaster and their responses on a battery of psychosocial questionnaires were compared with statements they had made, in writing, regarding the accident within six months of the disaster. There were 10 men and 10 women, and seven subjects had lost someone in the accident. The results confirm that causal attribution is an important factor in determining the reactions of survivors of disasters. Specifically, those with more internal attributions, who felt they had control over events, had significantly higher levels of distress than those with more external attributions, who felt that the events of the disaster were more due to forces beyond their control. This is consistent with prior research in which perceived avoidability was related to poorer outcome in accident victims. The role of social support following disaster was brought to light as well. Discussing the events with others may provide an opportunity to reassess the situation and to feel less responsible for events that were out of one's ultimate control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Survival after airplane accidents, shipwrecks, etc., Survival, Causation, Causation (Philosophy), Disasters, Attribution (Social psychology), Attribution (Psychology)

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Vitamin deficiency and mental symptoms

Article Abstract:

Recent evidence linking vitamin deficiencies to psychiatric disorders is presented. Irritability, aggressive behavior, and personality change have been observed in patients with thiamine (B1) deficiencies and in adolescents who subsist on junk food that is deficient in vitamin B1. Several studies of hospitalized psychiatric patients have found high percentages of thiamine deficiencies, with a significant number of schizophrenic and alcoholic patients among those with this deficiency. Several studies have linked riboflavin (vitamin B2) deficiency to depression. Associations between pyridoxine (vitamin B6) deficiency and affective disorder have also been found. Pre- and post-menopausal depressed women have lower depression ratings after treatment with B6, while cobalamin (B12) deficiency has been associated with organic mental change in both females and males. A recent study of 285 hospitalized psychiatric patients found a relationship between red-cell folate (a coenzyme) deficiency and depression. Although classic syndromes related to vitamin deficiency (such as beri beri) are now rare in the UK and the US, recent studies indicate that subclinical deficiencies are not uncommon, particularly involving thiamine, riboflavin, pyridoxine, folic acid, and B12. While depression seems characteristic of most vitamin B deficiencies, with B12 deficiency organic psychosis is more common. Thiamine deficiency is associated with a great many mental symptoms, and is probably secondary to anorexia and malnutrition. Systematic long-term follow-up studies are needed to further assess the link between vitamin deficiencies and psychiatric disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Mental illness, Mental disorders, Vitamin deficiency, Avitaminosis

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