Age Psychiatry Services Research Articles

Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review.

To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.

Brain Morphometric Correlates of Depressive Symptoms among Patients with and without Dementia

Introduction: Findings regarding brain morphometry among patients with dementia and concomitant depressive symptoms have been inconsistent. Thus, the aim of the present study was to test the hypothesis that dementia and concomitant depressive symptoms are associated with structural brain changes in the temporal lobe measured with structural magnetic resonance imaging (MRI). Methods: A sample of 492 patients from Norwegian memory clinics (n = 363) and Old Age Psychiatry services (n = 129) was studied. The assessment included the Cornell Scale for Depression in Dementia (CSDD), Instrumental Activities of Daily Living Scale, Mini Mental State Examination, and MRI of the brain, processed with FreeSurfer to derive ROI measures of cortical thickness, volume, and area using the Desikan-Killiany parcellation, as well as subcortical volumes. Dementia was diagnosed according to ICD-10 research criteria. Correlates of brain morphometry using multiple linear regression were examined. Results: Higher scores on the CSDD were associated with larger cortical volume (β = 0.125; p value = 0.003) and area of the left isthmus of the cingulate gyrus (β = 0.151; p value = <0.001) across all patients. Inclusion of an interaction term (dementia × CSDD) revealed a smaller area in the left temporal pole (β = −0.345; p value = 0.001) and right-transverse temporal cortex (β = −0.321; p value = 0.001) in patients with dementia and depressive symptoms. Discussion/Conclusion: We confirm the previous findings of structural brain changes in temporal regions among patients with dementia and concomitant depressive symptoms. This may contribute to a better understanding of the mechanisms underlying depression in dementia. To the best of our knowledge, this is the largest study conducted on this topic to date.

Diagnosis of Alzheimer's disease before dementia: A study of UK psychiatrists

AbstractBackgroundAlzheimer’s disease (AD) is increasingly conceptualised as a continuum spanning presymptomatic, symptomatic pre‐dementia and dementia stages. With potential disease modifying treatments emerging, this study explored the views of clinicians working in Old Age Psychiatry in the UK regarding the diagnosis of symptomatic AD before dementia, including the role of biomarkers, and the preparedness of services to deliver future disease modifying treatments.MethodThis study, conducted by the Royal College of Psychiatrists and Alzheimer's Research UK, used a two‐stage quantitative and qualitative approach consisting of an online survey (n=493) followed by focus groups (n=42) of clinicians.ResultConceptualising AD as a continuum was considered a helpful framework for thinking about disease pathology, progression and treatment. However, translating this framework into clinical practice generated a number of challenges including uncertainties about diagnostic nomenclature and criteria with at least seven diagnostic terms possible. Overall, terms referencing “mild cognitive impairment” were considered more helpful than those explicitly stating AD. Hesitancy to reference AD at this stage was influenced by concerns about the accuracy of diagnostic criteria, limitations linked to biomarkers and potential negative impacts on individuals, especially in the absence of disease modifying treatments. Access to biomarkers other than CT was sub‐optimal, 96% of responders reported insufficient or no access to CSF and 93% to PET Aβ, limited access negatively impacted on the clinician’s confidence in their utility (P&lt;0.001).Psychiatrists indicated that it was important their services offer disease modifying treatments if licensed but recognised that services faced significant challenges to be prepared, including capacity, resources and staff expertise.ConclusionDiagnosing AD before the onset of dementia is likely to become increasingly relevant if new treatments are licensed, but this study highlights a number of important challenges to achieve this including concerns about the reliability and validity of the diagnostic criteria and access to key biomarkers. There was a clear view that Old Age Psychiatry services should be able to provide any future treatments alongside their usual care but recognition that this would require better access to biomarkers, clearer diagnostic criteria, up‐skilling of staff and changes to training as well as changes to care pathways.

An audit of lithium prescribing practices in an old age psychiatry service highlighting renal impairment in this cohort

AimsTo compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-West of Ireland among adults aged 65 years and over with best practice guidelines.MethodReview of the literature informed development of audit standards for Lithium prescribing. These included National Institute for Clinical Excellent (NICE) 2014 guidelines, The British National Formulary (2019) and Maudsley Prescribing Guidelines (2018). Data were collected retrospectively, using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years or more and prescribed Lithium over the past one year.ResultAt the time of the audit in February 2020, 18 patients were prescribed lithium, 67% female, average age 74.6 years. Of those prescribed Lithium; 50% (n = 9) had a depression diagnosis, 44% (n = 8) had bipolar affective disorder (BPAD) and 6% (n = 1) had schizoaffective disorder.78% (n = 14) of patients were on track to meet, or had already met, the NICE standard of 3-monthly serum lithium level. Lithium levels were checked on average 4.5 times in past one year, average lithium level was 0.61mmol/L across the group and 39% (n = 7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).83% (n = 15) of patients met the NICE standards of 3 monthly renal tests, thyroid function test was performed in 89% (n = 16) and at least one serum calcium level was documented in 63% (n = 15). Taking into consideration most recent blood test results, 100% (n = 18) had abnormal renal function, 78% (n = 7) had abnormal thyroid function and 60% (n = 9) had abnormal serum calcium.Half (n = 9) were initiated on lithium by POA service and of these, 56% (n = 5) had documented renal impairment prior to initiation. Of patients on long term lithium therapy at time of referral (n = 9), almost half (n = 4) had a documented history of lithium toxicity.ConclusionThe results of this audit highlight room for improvement in lithium monitoring of older adults attending POA service. Furthermore, all patients prescribed lithium had impaired renal function, half had abnormal calcium and two fifths had abnormal thyroid function. This is an important finding given the associations between those admitted to hospital with COVID-19 and comorbid kidney disease and increased risk of inpatient death.Our findings highlight the need for three monthly renal function monitoring in older adults prescribed lithium given the additive adverse effects of increasing age and lithium on the kidney. Close working with specialised renal services to provide timely advice on renal management for those with renal impairment prescribed lithium is important to minimise adverse patient outcomes.

Investigation of risk of dementia diagnosis and death in patients in older people's secondary care mental health services.

ObjectivesPrevious studies have shown increased rates of death and dementia in older people in specific serious mental illnesses (SMI) such as bipolar disorder or depression. We examined the rates of death and dementia in older people referred into a secondary care psychiatric service across a range of SMIs.MethodsWe used an anonymised dataset across 6 consecutive years with 28,340 patients aged 65 years and older from a single secondary care psychiatric trust in the United Kingdom.We identified deaths and incident dementia in patients with bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders. We compared mortality and dementia rates between these diagnostic groups and in different treatment settings. We also examined mortality rates and dementia rates compared with general population rates.ResultsPatients with schizophrenia showed the highest hazard rate for death compared to other groups with SMIs (hazard ratio, 1.58; 95% confidence interval (CI), 1.18–2.1, with anxiety group the reference). Survival was reduced in patients referred to liaison psychiatry services. There were no significant differences between the SMI groups in terms of rates of dementia. However, risks of death and dementia were significantly increased compared to the general population (standardized mortality rates with 95% CI, 2.6(2.0–3.3), 3.5(2.6–4.5), 2.5(2.0–3.0) and 1.8 (1.4–2.2) and standardized dementia incidence rates with 95% CI, 2.7(1.5–4.1), 2.9(1.5–4.7), 3.8(2.6–5.2) and 4.3 (3.0–5.7) for bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders respectively.ConclusionsOlder adults referred into an old age psychiatry service show higher rates of dementia and death than those reported for the general population.

Patients with young-onset dementia in an older people's mental health service.

Currently, no separate service exists for patients with young-onset dementia in Cambridgeshire. These patients are managed together with late-onset dementia patients within old age psychiatry services. To inform service design, we sought to characterise young-onset dementia patients in our population. We first analysed service-level data and supplemented this with a detailed case review of 90 patients. Young-onset dementia remains a relatively rare condition. Only a small proportion of those referred for assessment receive a diagnosis of dementia. Data collected on presenting complaints, comorbidities, medication and Health of the Nation Outcome Scales scores associated young-onset dementia with a greater incidence of depression than late-onset dementia. Outcomes in the two groups did not appear to differ. The data presented here do not suggest a need to create a separate service. Practitioners should be aware of the increased incidence of depression observed in this group.

Old age psychiatry services in the UK responding to COVID-19.

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Risky drinking and dual diagnosis in older people under a UK community old age psychiatry service

PurposeThe assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue.Design/methodology/approachDrinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over.FindingsIn total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol.Research limitations/implicationsGiven the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted.Practical implicationsGreater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment.Originality/valueThere is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.

An Australian study of delusional disorder in late life.

There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic use and treatment outcomes in patients with DD aged 65 years and older. Secondarily, we sought to examine associated clinical features and socio-demographic variables. This descriptive study reviewed all consecutive cases of DD referred to an Australian old age psychiatry service over a 12-year period. Fifty-five patients were assessed in the inpatient and/or community setting, with data verified from a review of all individual medical records. Data were collected with respect to antipsychotic use, outcomes, and clinical features. Socio-demographic variables of DD cases were compared to a non-matched comparison group (n=278) and an age and gender matched comparison group with a 1:1 ratio (n=55). The predominant type of DD was persecutory (87%). Non-prominent hallucinations were experienced by 18%, and depressive symptoms occurred in 22%. There was a statistically significant association between having DD and social isolation (χ2= 11.04 (DF=1) p<0.001; McNemar's test p<0.001). Atypical antipsychotic medication was prescribed in 32 cases, with follow-up permitted in 51 of the 55 cases (mean duration 36.6 months). Sustained recovery occurred in 20%, and improvement in an additional 35% of the study sample. Four patients subsequently developed dementia, and two developed mild cognitive impairment. Clinical improvement, including sustained recovery, occurred in more than half of those with late life DD. The majority of those who improved (96%) received atypical antipsychotics.

Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT.

Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter. Treatment safety and cost-effectiveness were also investigated. Three-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial. Participants who received at least one dose of study treatment were included in the intention-to-treat analyses. Secondary care specialist old age psychiatry services in 25 NHS mental health trusts in England and Scotland. Patients meeting diagnostic criteria for VLOSLP and scoring > 30 points on the Brief Psychiatric Rating Scale (BPRS). Participants were randomly assigned to three arms in a two-stage trial: (1) 100 mg of amisulpride in both stages, (2) amisulpride then placebo and (3) placebo then amisulpride. Treatment duration was 12 weeks in stage 1 and 24 weeks (later reduced to 12) in stage 2. Participants, investigators and outcome assessors were blind to treatment allocation. Primary outcomes were psychosis symptoms assessed by the BPRS and trial treatment discontinuation for non-efficacy. Secondary outcomes were extrapyramidal symptoms measured with the Simpson-Angus Scale, quality of life measured with the World Health Organization's quality-of-life scale, and cost-effectiveness measured with NHS, social care and carer work loss costs and EuroQol-5 Dimensions. A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points; p = 0.0002). In stage 2, BPRS scores improved by 1.1 point in those who continued with amisulpride but deteriorated by 5.2 points in those who switched from amisulpride to placebo, a difference of 6.3 points (95% CI 0.9 to 11.7 points; p = 0.024). Fewer participants allocated to the amisulpride group stopped treatment because of non-efficacy in stages 1 (p = 0.01) and 2 (p = 0.031). The number of patients stopping because of extrapyramidal symptoms and other side effects did not differ significantly between groups. Amisulpride treatment in the base-case analyses was associated with non-significant reductions in combined NHS, social care and unpaid carer costs and non-significant reductions in quality-adjusted life-years (QALYs) in both stages. Including patients who were intensive users of inpatient services in sensitivity analyses did not change the QALY result but resulted in placebo dominance in stage 1 and significant reductions in NHS/social care (95% CI -£8923 to -£122) and societal costs (95% CI -£8985 to -£153) for those continuing with amisulpride. The original recruitment target of 300 participants was not achieved and compliance with trial medication was highly variable. Low-dose amisulpride is effective and well tolerated as a treatment for VLOSLP, with benefits maintained by prolonging treatment. Potential adverse events include clinically significant extrapyramidal symptoms and falls. Trials should examine the longer-term effectiveness and safety of antipsychotic treatment in this patient group, and assess interventions to improve their appreciation of potential benefits of antipsychotic treatment and compliance with prescribed medication. Current Controlled Trials ISRCTN45593573 and EudraCT2010-022184-35. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 67. See the NIHR Journals Library website for further project information.

Survey of aged psychiatry services' support of older Australians with very severe, persistent behavioural symptoms of dementia.

To map the provision of community, acute, non-acute and residential care-based state-funded mental health services to older people with severe, persistent behavioural symptoms of dementia. An electronic survey was completed in 2015 by senior representatives of aged persons' mental health services across Australia's six states. Jurisdictions varied widely in the number, geographic spread and make-up of aged persons' mental health community teams when adjusted for aged population; their number of acute and non-acute beds, and especially in the provision of specialist residential beds or partnerships with non-government providers. There is no nationally accepted pathway ofcare for this vulnerable group or understanding of what constitutes an adequate statewide mental health service.

Antipsychotic treatment of very late-onset schizophrenia-like psychosis (ATLAS): a randomised, controlled, double-blind trial

SummaryBackgroundVery late (aged ≥60 years) onset schizophrenia-like psychosis occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy and risks of antipsychotic treatment. We investigated whether low-dose amisulpride (100 mg daily) is superior to placebo in reducing psychosis symptoms over 12 weeks and whether any benefit is maintained by continuing treatment after 12 weeks.MethodsThe ATLAS double-blind controlled trial enrolled participants from 25 old age psychiatry services in the UK. Eligible participants (ie, those with a diagnosis of very late-onset schizophrenia-like psychosis and a Brief Psychiatric Rating Scale [BPRS] score of ≥30, without cognitive impairment) were randomly assigned (1:1:1) to one of three groups in a two-stage trial: amisulpride in stage 1 and 2 (group A), amisulpride then placebo (group B), or placebo then amisulpride (group C). Treatment (100 mg oral amisulpride daily vs placebo) was given for 12 weeks in stage 1 and, initially, 24 weeks then reduced to 12 weeks in stage 2. Participants, investigators, and outcome assessors were masked to treatment allocation. Primary outcomes were psychosis symptoms assessed by the BPRS at 4, 12, and 24, or 36 weeks, and trial treatment discontinuation for non-efficacy. The primary, secondary, and safety endpoints were all analysed in participants given at least one dose of study treatment in modified intention-to-treat analyses. This study is registered with EudraCT, number 2010-022184-35, and ISRCTN, number ISRCTN45593573.FindingsBetween Sept 27, 2012, and June 28, 2016, we recruited 101 participants. 92 (91%) of 101 participants took trial medication, of whom 59 (64%) completed stage 1 and 34 (58%) of these 59 participants completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7·7 points (95% CI 3·8–11·5, p=0·0002) greater with amisulpride (mean 11·9 points [SE 1·3]) than with placebo (4·2 points [1·0]). In stage 2, BPRS scores improved by a mean of 1·1 points (1·6) from 12 weeks to the final assessment in those who continued amisulpride but deteriorated by 5·2 points (2·0) in those who switched from amisulpride to placebo (difference 6·3 points [95% CI 0·9–11·7], p=0·024). Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyramidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C). No deaths were related to treatment.InterpretationLow-dose amisulpride is effective and well tolerated as a treatment for very late-onset schizophrenia-like psychosis, with benefits maintained by prolonging treatment.FundingUK National Institute for Health Research.

Do clinicians assess patients' religiousness? An audit of an aged psychiatry community team.

To determine the frequency and quality of religious history taking of patients by clinicians working in an old age psychiatry service. A retrospective audit of 80 randomised patient files from the Koropiko Mental Health Services for Older People (MHSOP) in Middlemore Hospital, Auckland, New Zealand. A total of 66 clinical records were available for analysis. A religious history was taken in 33/66 (50%) patients. However, when such histories were evaluated using the FICA assessment tool, only 10/33 (30.3%) histories contained detailed information regarding the patient's religiousness. The infrequency and low quality of religious histories discovered in this audit suggest that clinicians need more training in taking a religious history from patients.

Community mental health teams for older people in England: Variations in ways of working.

Integrated community mental health teams (CMHTs) are a key component of specialist old age psychiatry services internationally. However, in England, significant shifts in policy, including a focus on dementia and age inclusive services, have influenced provision. This study portrays teams in 2009 against which subsequent service provision may be compared. A bespoke national postal survey of CMHT managers collected data on teams' structure, composition, organisation, working practices, case management, and liaison activities. A total of 376 CMHTs (88%) responded. Teams comprised a widespread of disciplines. However, just 28% contained the full complement of professionals recommended by government policy. Over 93% of teams had a single point of access, but some GPs bypassed this, and 40% of teams did not accept direct referrals from care homes. Initial assessments were undertaken by multiple disciplines, and 71% of teams used common assessment documentation. Nevertheless, many social workers maintained both NHS and local authority records. In 92% of teams, nominated care coordinators oversaw the support provided by other team members. However, inter-agency care coordination was less prevalent. Few teams offered the range of outreach/liaison activities anticipated in the national dementia strategy. Compared with previous studies, teams had grown and changed, with a clear increase in non-medical practitioners, particularly support workers. Measures to facilitate integrated care within CMHTs (eg, common access and documentation) were widespread, but integration across health and social care/primary and secondary services was less developed. Consideration of barriers to further integration, and the impact of current reforms is potentially fruitful.

The Clinical and Service Outcomes of Unilateral and Bilateral ECT Electrode Placements in Australian Aged Psychiatry Services

The aim of the study was to determine whether depressed aged inpatients treated with brief pulse unilateral electroconvulsive therapy (ECT) differed from those treated with bilateral (bitemporal or bifrontal) ECT with respect to numbers of treatments, length of hospital admission, changes in scores on depression and cognitive scales, and serious adverse effects. An audit of routinely collected data regarding 221 acute ECT courses in 7 public aged psychiatry services in Victoria, Australia. Patients given unilateral, bifrontal, and bitemporal treatments were similar with respect to personal, clinical, and treatment characteristics. Most treatments were administered in line with local clinical guidelines and were rated as effective. Psychiatrists preferred unilateral ECT in the first instance with stimulus dosing based on patients' seizure thresholds. Approximately a quarter of unilateral courses were switched later to bitemporal placement, most probably because of insufficient progress. Bilateral treatments were associated with a larger number of treatments, less improvement in scores on mood and cognitive scales, and more refusals to continue treatment than unilateral-only ECT. Brief pulse unilateral ECT proved more effective than bitemporal and bifrontal ECT for most aged patients, especially when coupled with stimulus dosing based on seizure threshold.

Old and new reasons for specialization

Mental illness is one of the largest areas of activity in the health service, with mental disorders of the elderly an important part of it. This substantial ageing of the population is a new phenomenon, occurring over the last century. It has given prominence to mental illness in old age. There is a growing interest in making decisions about how many and which services to provide to the older community.The expertise of old age psychiatry services lies in the care and treatment of people with complex mixtures of psychological, cognitive, functional, behavioral, physical and social problems usually relating to ageing. Current evidence suggests specialist old age services are best equipped to diagnose and treat mental illness in our ageing population. However, the specialists should be integrated optimally into a service system to the benefit of the elderly. It will be crucial to improve access of older patients to the services. The service system and the partners in the system differ to those for younger adult psychiatric patients. Thus, not only knowledge and skills underline the necessity of specialization but also the increasingly complex health service structures of modern societies.Disclosure of interestThe author has not supplied his declaration of competing interest.

Agreement and conversion formula between mini-mental state examination and montreal cognitive assessment in an outpatient sample

AIMTo explore the agreement between the mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA) within community dwelling older patients attending an old age psychiatry service and to derive and test a conversion formula between the two scales.METHODSProspective study of consecutive patients attending outpatient services. Both tests were administered by the same researcher on the same day in random order.RESULTSThe total sample (n = 135) was randomly divided into two groups. One to derive a conversion rule (n = 70), and a second (n = 65) in which this rule was tested. The agreement (Pearson’s r) of MMSE and MoCA was 0.86 (P < 0.001), and Lin’s concordance correlation coefficient (CCC) was 0.57 (95%CI: 0.45-0.66). In the second sample MoCA scores were converted to MMSE scores according to a conversion rule from the first sample which achieved agreement with the original MMSE scores of 0.89 (Pearson’s r, P < 0.001) and CCC of 0.88 (95%CI: 0.82-0.92).CONCLUSIONAlthough the two scales overlap considerably, the agreement is modest. The conversion rule derived herein demonstrated promising accuracy and warrants further testing in other populations.

Infectious Disease Week San Diego, California, 7–11 October

British Journal of Hospital MedicineVol. 76, No. 11 Clinical NewsInfectious Disease Week San Diego, California, 7–11 OctoberWayne KuznarWayne KuznarSearch for more papers by this authorWayne KuznarPublished Online:9 Nov 2015https://doi.org/10.12968/hmed.2015.76.11.620AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Møller H, Gildea C, Meechan D, Rubin G, Round T, Vedsted P (2015) Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study. BMJ 351: h5102 (doi: https://doi.org/10.1136/bmj.h5102) Crossref, Medline, Google ScholarKhunti K, Mani H, Achana F, Cooper N, Gray LJ, Davies MJ (2015) Systematic review and meta-analysis of response rates and diagnostic yield of screening for type 2 diabetes and those at high risk of diabetes. PLoS ONE 10(9): e0135702 (doi: https://doi.org/10.1371/journal.pone.0135702) Crossref, Google ScholarAbdul-Hamid WK, Lewis-Cole K, Holloway F, Silverman AM (2015) Comparison of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey. Br J Psychiatry (doi: https://doi.org/10.1192/bjp.bp.114.145706) Crossref, Medline, Google ScholarMuckli L, De Martino F, Vizioli L et al. (2015) Contextual Feedback to Superficial Layers of V1. Curr Biol 25(20): 2690–5 (doi: https://doi.org/10.1016/j.cub.2015.08.057) Crossref, Medline, Google ScholarZhang Y, Peloquin C, Dubreuil M, Roddy E, Lu N, Neogi T, Choi HK (2015) Sleep apnea and the risk of incident gout: a population-based body mass index-matched cohort study. Arthritis Rheumatol (doi: https://doi.org/10.1002/art.39330) Crossref, Google ScholarGomes B, Calanzani N, Koffman J, Higginson IJ (2015) Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Medicine 13: 235 (doi: https://doi.org/10.1186/s12916-015-0466-5) Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 November 2015Volume 76Issue 11ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 9 November 2015 Published in print 2 November 2015 Information© MA Healthcare LimitedPDF download

Diagnostic Accuracy of Tests for Polyuria in Lithium-Treated Patients.

In lithium-treated patients, polyuria increases the risk of dehydration and lithium toxicity. If detected early, it is reversible. Despite its prevalence and associated morbidity in clinical practice, it remains underrecognized and therefore undertreated. The 24-hour urine collection is limited by its convenience and practicality. This study explores the diagnostic accuracy of alternative tests such as questionnaires on subjective polyuria, polydipsia, nocturia (dichotomous and ordinal responses), early morning urine sample osmolality (EMUO), and fluid intake record (FIR). This is a cross-sectional study of 179 lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed the tests after completing an accurate 24-hour urine collection. The diagnostic accuracy of the individual tests was explored using the appropriate statistical techniques. Seventy-nine participants completed all of the tests. Polydipsia severity, EMUO, and FIR significantly differentiated the participants with polyuria (area under the receiver operating characteristic curve of 0.646, 0.760, and 0.846, respectively). Of the tests investigated, the FIR made the largest significant change in the probability that a patient experiences polyuria (<2000 mL/24 hours; interval likelihood ratio, 0.18 and >3500 mL/24 hours; interval likelihood ratio, 14). Symptomatic questioning, EMUO, and an FIR could be used in clinical practice to inform the prescriber of the probability that a lithium-treated patient is experiencing polyuria.

Risk factors for polyuria in a cross-section of community psychiatric lithium-treated patients.

Polyuria increases the risk of dehydration and lithium toxicity in lithium-treated patients. Risk factors have been inconsistently described and the variance of this adverse effect remains poorly understood. This study aimed to establish independent risk factors for polyuria in a community, secondary-level lithium-treated sample of patients. This was a cross-sectional study of the lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed a 24-hour urine collection. Urine volume and the presence of polyuria were the outcomes of interest. The relationship between outcome and the participant's demographic and clinical characteristics was explored with univariable and multivariable analysis. A total of 122 participants were included in the analysis, with 38% being diagnosed with polyuria. Female gender and increased body weight independently predicted the presence of polyuria (standardized regression coefficient 1.01 and 0.94, respectively; p=0.002 and p=0.003, respectively). Female gender and increased body weight, lithium dose, and duration of lithium treatment independently predicted higher 24-hour urine volumes (standardized regression coefficients 0.693, p<0.0005; 0.791, p<0.0005; 0.276, p=0.043; 0.181, p=0.034, respectively). Of three different weight metrics, lean body weight was the most predictive. Female gender and increased body weight explain part of the variance of this adverse effect. Both risk factors offer fresh insights into the pathophysiology of this potentially reversible and dangerous adverse effect of lithium treatment. Future research should focus on understanding the differences between the genders and between different body compositions in terms of lithium pharmacokinetics and pharmacodynamics.