Diagnosis Of Organic Brain Syndrome Research Articles

Off-Label Use of Antipsychotic Medications in the Department of Veterans Affairs Health Care System

This study aimed to determine the prevalence of prescribing antipsychotics to adults without schizophrenia or bipolar disorder and to identify factors associated with such off-label use. Patients with at least one prescription for an antipsychotic medication from the Department of Veterans Affairs (VA) during fiscal year (FY) 2007 were identified in national VA administrative databases. Rates of off-label antipsychotic use were determined along with average doses. Multivariate logistic regression models identified sociodemographic and clinical characteristics associated with off-label use. Of the 279,778 individuals in FY 2007 who received an antipsychotic medication, 168,442 (60.2%) had no record of a diagnosis for which these drugs are approved. The most common mental illness diagnoses among patients given prescriptions for antipsychotics off label were posttraumatic stress disorder (PTSD, 41.8%), minor depression (39.5%), major depression (23.4%), and anxiety disorder (20.0%). Among VA patients with mental illness other than schizophrenia or bipolar disorder, the proportion who received prescriptions for antipsychotic medications ranged from a low of 9.1% among patients with adjustment reaction; to about 20% for those with depression, dementia, or PTSD; and to a high of 40.7% among patients with other psychoses. Doses were low, with over half of patients who received off-label quetiapine, risperidone, or first-generation antipsychotics receiving doses below those recommended for schizophrenia. In logistic regression models, patients diagnosed as having other psychosis or dementia had the highest odds of receiving an antipsychotic medication off label. Off-label use of antipsychotic medications was common. Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness for off-label usage, they should be used with greater caution.

Failure to Record Delirium as a Complication of Intra-aortic Balloon Pump Treatment: A Retrospective Study

This study was conducted to determine whether or not diagnosis and treatment of delirium among patients treated with the intra-aortic balloon pump (IABP) correlates with the recording of this complication on discharge records. Since prior episodes of delirium are one of the few clear risk factors for future episodes of delirium, accurate recording of delirium on the discharge summary and list of discharge diagnoses is useful to clinicians. A retrospective review of the charts of all patients (N = 198) who underwent placement of an IABP during 1988; assessment of the type and frequency of medical and neuropsychiatric complications during IABP treatment; and comparison of chart review findings with the Massachusetts General Hospital's computer-generated lists of discharge diagnoses for the same IABP-treated patients was completed. Only 12% of patients diagnosed and treated for delirium had delirium recorded as a discharge diagnosis. In contrast, 44% and 52% of patients who had been diagnosed and treated for cerebrovascular accident and pneumonia, respectively, had these diagnoses recorded among the discharge diagnoses. Receiving a discharge diagnosis of organic brain syndrome increased the likelihood that delirium was recorded as a discharge diagnosis. Delirium is underdiagnosed as a complication associated with IABP-treatment and is under-reported on the list of discharge diagnoses, even when it is diagnosed. Further study is warranted to determine if making the diagnosis of delirium during a patient's hospital course and recording it is a complication at the time of discharge is translated into a higher level of preparedness by physicians during subsequent hospitalizations.

A cluster of unexplained deaths in a nursing home in Florida.

In the two-week period November 13-27, 1984, 12 patients died in a 54-bed nursing home in Florida; based on previous mortality patterns, 2.5 deaths would have been expected for the whole month. There was no similar increase in deaths in November 1984 and no comparable monthly death rate for any of 69 nursing homes in the same county from 1976-84. Comparison of the 12 deaths in November with 28 deaths that occurred during the previous 10 months and with 31 surviving patients who were continuously present in the nursing home between November 12-28, 1984 revealed that the patients who died in November were more likely to have had onset of the terminal event during the night shift, had a recent visitor, and had an admitting diagnosis of organic brain syndrome. The abrupt increase in the death rate for November 1984 was not associated with a measurable change in population characteristics, an outbreak of infectious disease, or changes in procedures or the environment. Reviews of employee schedules revealed a consistent and strong association between the duty times of two nurses and the onsets of the terminal episode and the times of patient deaths. Continuing epidemiologic surveillance of adverse outcomes in nursing homes is recommended.

Mental disorder among nursing home patients: Preliminary findings from the national nursing home survey pretest

AbstractNinety‐six per cent of mentally ill elderly persons who are not in the community reside in nursing homes, yet the mental health care they receive here is minimal or unavailable. Data are presented from the 1984 pretest of the National Nursing Home Survey. Five hundred and twenty‐six patients in 112 nursing homes in four US metropolitan areas were sampled. Overall, the prevalence of mental disorder was found to be 68%; 39% of the patients had a diagnosis of organic brain syndrome (OBS) and 29% had other mental disorders (OMD). Only about one‐third (31%) of residents had no mental disorder. These three patient groups, those with OBS, those with OMD, and those with no mental disorder, were compared on demographic, clinical, and treatment characteristics. The authors conclude that the balance between the Federal and State roles in financing care for the mentally ill in nursing homes needs to result in a more equitable system of care which does not discriminate against the mentally ill. Further, the mental health service system needs to assume greater responsibility for this population. While signnificant attention is given to residents' physical needs, behavioural and emotional problems are seriously neglected.

Diagnosis of organic brain syndrome: An emergency department dilemma

Delirium and dementia frequently pose a diagnostic dilemma for clinicians in the emergency department. The overlap of symptoms between organic brain syndrome and functional psychiatric illness, coupled with a dramatic presentation, often leads to a premature psychiatric diagnosis. In this paper, the authors discuss those symptoms of organic brain syndrome that most frequently generate diagnostic confusion in the emergency department and result in a misdiagnosis of functional illness.

An open dose finding study of melperone in treatment of agitation and irritability associated with dementia.

Seventeen older patients with a diagnosis of Organic Brain Syndrome were placed on a four-week trial of melperone for treatment of behavioural disturbances associated with dementia. Efficacy evaluation of the drug revealed improved ratings of the patients in the areas of agitation/irritability, anxiety, unsociability, and mental alertness. Thirteen of the fourteen patients who completed the trial were rated generally as showing at least minimal improvement while on the drug. There were no serious side effects noted, with drowsiness the most frequent finding. These favourable results are suggestive of the usefulness of this drug, and point to the need for double-blind, comparative studies.

Nurses' Diagnostic Stereotyping of the Elderly

This study experimentally tested three behaviors thought to underlie the clinical decision-making process that permits the systematic labeling of the elderly as senile; namely, when compared to a younger person with identical neuropsychiatric symptoms, an older person will more likely be given a diagnosis of organic brain syndrome, will more likely be given a poor prognosis for recovery, and will more likely be given palliative rather than interventive treatment. The study also examined the impact of contact with older patients on the making of these clinical decisions. Subjects were the entire nursing staff (N = 186) of a general hospital in a northeastern American city. One-half of the sample responded to a vignette of a young person and one-half to a vignette of an old person with identical signs of emotional, behavioral, and perceptual disorder. The results support the notion that clinical decisions tend to be biased against old age and thus contribute to inappropriate labeling of the elderly. Results also suggest that when compared to subjects having little contact with old patients, those having considerable contact were more likely to believe that all patients, regardless of age, have an organic, incurable, and untreatable illness.

Individual differences in cognitive functioning in the elderly - phenomena and interpretation.

Residents (N = 27) of a Jewish home for the aged were given a battery of twenty-five tests of cognitive abilities. Participants included people carrying a diagnosis of organic brain syndrome. Subsets of tests were designed to measure immediate sequential memory, ability to handle categories, and ability to execute motor patterns. There were marked individual differences among participants. Poorer performance was associated with carrying a diagnosis of organic brain syndrome and with a number of other background variables. There was empirical evidence that immediate sequential memory and ability to handle categories can be discriminatively measured. A wide variety of qualitative behavioral phenomena was described. The findings were interpreted in terms of an information-processing model.

Early signs of organicity in art work

Na differential diagnosis in psychiatry is complete without evaluating the patient for signs of organic brain syndrome (OBS). For the purposes of this paper OBS is defined as: “a general der~gement of cerebral metabolism which produces a diffuse dysfunction or lowering of the function of brain tissue” (Engel & Romano, 1959). In its most obvious form symptoms may include disorientation, memory loss, labile affect, lowering of intellectual ability, hallucinations, and deterioration to more primitive activity. Much attention has been focused recently upon the function of psychiatry within the medical environment (Moore, 1978), including consideration of psychiatry as a primary care specialty (Fink & Oken, 1976). A significant contribution, psychiatry offers the medical disciplines its expertise in diagnosis of OBS. Specifically, early detection of organicity increases the chance of arresting the progression or perhaps even reversing the syndrome.

Memory for a geometrical configuration in the cognitively impaired elderly.

The objective of this study was to analyze the mnemonic reconstruction of a complex spatial configuration in a group of 10 men and women, 70-88 years, with a diagnosis of organic brain syndrome and 10 controls matched for age, sex and educational background. A Piagetian model of a geometrical configuration with contingent and non-contingent properties was used to establish a heirarchical order of memorial organization for spatial structures. Subjects were evaluated one hour and one week after learning in reconstruction tasks. Although individuals with dementia performed more poorly than the age-matched controls, the hierarchy of chosen characteristics reflected a schematic progression in the organization of spatial memory in both groups.

The Usefulness of a Psychological Test Battery

This paper discusses the usefulness of a battery of psychological tests administered to a group of psychiatric geriatric patients in New York and London, as an assessment of cognitive impairment. Two of the tests, the Paired Associate Learning Test, and the Digit Copying Test, were highly related to the diagnosis of organic brain syndrome or functional disorder made independently by a psychiatrist in a clinical interview. Prognostic predictions in disagreement cases were no better or no worse by psychiatric diagnosis than by psychological tests. Compared to a simple clinical test of disorientation derived from the psychiatric interview, psychological tests were more highly correlated to independent measures of patients' self-care capacity and duration of hospitalization, but equally related to psychiatric diagnosis. The verbal subtest proved to be the more useful of the psychological tests given. The logistics and difficulties of administering psychological tests to this specialized population are discussed, e.g. patients' physical limitations, communication problems; as well as efforts in this study to minimize these problems.

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

Papaverine--hepatotoxic or not?

ABSTRACT: Papaverine hydrochloride (Pavabid) has been recommended in geriatric practice for increasing cerebral blood flow and improving mental functioning. However, reports of hepatotoxicity as indicated by physical signs and symptoms and elevated levels of serum alkaline phosphatase, serum glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase led to this study. Thirty patients (age range, 52 to 88 years) with a primary diagnosis of organic brain syndrome were studied. Each was treated with papaverine. The foregoing tests were performed before medication and after two, four, six and eight weeks of therapy. Papaverine was discontinued in 53 per cent of the cases by the end of the sixth week because of abnormal results with the liver function tests, yet none of the patients had nausea, vomiting, jaundice or dark urine. The physiological meaning of these findings is open to more than one interpretation; hence no explanation is offered. However, the question of whether or not papaverine is truly hepatotoxic must be considered.