Psychiatric treatment for geriatric patients: "pub" or drug?

Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes?

The aim of this paper is to identify positive psychological concomitants of moderate alcohol consumption. Current research and public-health perspectives on alcohol emphasize harms disproportionately relative to benefits. The major exception is research establishing beneficial effects of moderate drinking on cardiovascular health and overall mortality. In addition, much observational and experiential data suggest the widespread prevalence of positive drinking experiences. This paper is one of the first attempts since 1985 to codify such benefits in epidemiological terms. Methodological difficulties in accomplishing this include defining moderate drinking, controlling for confounding variables, and establishing causality. Nonetheless, evidence of psychological benefits has been found in experimental, observational, interview, self-report, correlational, and some prospective research. These positive findings are in the areas of subjective health, mood enhancement, stress reduction, sociability, social integration, mental health, long-term cognitive functioning, and work income/disability. Problem drinkers and alcoholics also seek mood and other benefits from alcohol, but are more likely to drink to counteract negative feelings and to support their egos than are social drinkers. It is as yet impossible to determine to what extent moderate alcohol consumption causes positive psychological outcomes and to what extent it is part of a complex pattern of mutually reinforcing variables.

Reversed ethanol effects on potassium conductances in aged hippocampal dentate granule neurons

The effect of low dose (20 mM) ethanol superfusion on the membrane and synaptic properties of dentate granule neurons was studied in hippocampal slices from young-mature (6-8 months) and old (25-29 months) Fischer-344 rats. In young neurons, ethanol hyperpolarized the resting membrane potential (RMP) and prolonged the post-spike train afterhyperpolarization (AHP). By contrast, ethanol depolarized old neurons and decreased their AHPs, in addition to reducing IPSP amplitudes and spike frequency adaptation. These effects can be explained by ethanol-enhancing potassium conductance (gK) in young neurons and diminishing gK in old neurons.

Procedural and methodological parameters in behavioral-gerontological research: a review

This article analyzes the behavioral-gerontological research published before 1984. The 151 studies located were classified into three main categories: observation, assessment, and intervention. Each study and each category were examined for variations in the behavioral procedures employed, and in the scientific research methods used to collect and analyze data. The survey indicated several serious problems in the research. Much of the behavioral-gerontological research focuses on institutionalized elderly, and tends to perpetuate a passive, helpless role on the part of the elderly in the treatment process. Less than 20 percent of the studies focused on observation or assessment, and most of these were found to be flawed. The intervention studies were also problematic; the majority of them were of short duration and had only one treatment phase which did not vary substantially during the study period. Most also failed to provide for interobserver agreement, generalization, maintenance, and follow-up assessments. Finally, the implications of these findings for future psychological research with the elderly are discussed.

Pharmacologic treatment of agitation associated with dementia

Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.

The psychological benefits of moderate alcohol consumption: a review of the literature

A review of the literature on the positive psychological benefits of light and moderate alcohol consumption suggests the following: (1) Alcohol in moderate amounts is effective in reducing stress. This has been found in both physiologic and self-report measures. (2) Low and moderate doses of alcohol have been reported to increase overall affective expression, happiness, euphoria, conviviality and pleasant and carefree feelings. Tension, depression and self-consciousness have been reported to decrease with equal doses. (3) Low alcohol doses have been found to improve certain types of cognitive performance. Included here are problem-solving and short-term memory. (4) Heavy drinkers and abstainers have higher rates of clinical depression than do regular moderate drinkers. (5) Alcohol in low and moderate doses has been effective in the treatment of geropsychiatric problems. As indicated in the text, results from many of the studies reviewed suggest that light or moderate drinking may be beneficial to psychological well-being. Liber (N. Engl. J. Med., 310(13) (1984) 846) has commented that the subject of control of alcohol intake evokes strong emotional responses, which can overshadow a logical assessment of whether or not to include 'healthy' drinking in a dietary plan. It is hoped that this review of data from available research can help provide a basis for making such an assessment.

Medical psychology in exercise and sport

Several psychological outcomes that accompany acute and chronic exercise have medical significance. Transient reductions in somatic tension and subjective anxiety appear most reliable. Symptom abatement in moderate depression can occur with chronic exercise in a manner comparable to psychotherapy and may offer a better prognosis in some instances. Other cognitive, behavioral, and perceptual events associated with exercise may assist in managing mental health, and exercise has been successfully used as a therapeutic adjunct in a variety of psychiatric disorders. Regular exercise may also complement treatments designed to manage aspects of coronary-prone behavior and psychoendocrine responsivity to mental stress. The lack of strict experimental control or effective placebo contrasts in most exercise studies precludes a convincing argument that exercise causes the psychological outcomes observed. Rather, expectancy of benefits, generalized treatment or attention effects, social reinforcement, and past history or selection bias represent likely alternatives. These competing explanations do not discount, however, that many individuals benefit in a clinically significant way. Exercise offers a low-cost alternative or adjunct with side effects that appear largely health-related. Although the effective psychological dosage or modality has not been quantified, current physiologic guidelines of the American College of Sports Medicine (large muscle rhythmic activity, for 20 to 60 minutes, 3 to 5 days per week at 60 to 80 per cent age-adjusted maximal heart rate), or a weekly caloric cost of 2000 kcal, should be effective with little medical risk. However, no evidence confirms that an increase in metabolic or psychoendocrine tolerance to exercise is necessary or sufficient for psychological outcomes to occur. Although biologic adaptations are known to follow exercise training and subside with diminished activity, there is currently no objective evidence that habitual exercise leads to dependence. If exercise has use in managing subjective or somatic symptoms, these may return during periods of exercise abstinence. Moreover, despite popular hypotheses concerning endorphins and biogenic amines, no direct relationships have yet been shown between exercise-induced mood swings and peripheral biochemical events. A proportion of habitual runners have reported acute episodes of euphoria-like states during or following exercise, but this remains a subjective and unpredictable event that may be related to psychophysiologic relaxation or acute changes in self-esteem.(ABSTRACT TRUNCATED AT 400 WORDS)

The effects of rearranging ward routines on communication and eating behaviors of psychogeriatric patients

Several aspects of ward routine were changed to study the effects of environmental manipulation on the behavior of 21 psychogeriatric patients. Furniture was rearranged to be more conductive to conversation (i.e., grouped around tables instead of along corridor walls), and mealtime routines were changed to allow patients more time to eat, more freedom in choosing the composition of the meal, and more pleasant surroundings. Patients were divided into experimental and control groups, and data were collected on the frequency of verbal and tactile communication and degree of skill in eating behavior. Following baseline, environmental changes were introduced across behaviors. Results show that the frequency of communication increased for the experimental group, as compared to both baseline and the control group. Eating behavior also improved significantly for the experimental group. The study shows that minor changes in the physical environment can promote therapeutic change in the behavior of patients diagnosed as senile dementia.

Social issues in geriatric psychiatry

In the past decade significant advances have been made in caring for the emotional problems of the elderly. The evolution of the multidisciplinary team and easier access to health care play important roles. Of seminal importance is the emergence of the psychogeriatrician and the establishment of psychogeriatric units. Treatment of the elderly should extend beyond the confines of the hospital to include families, community agencies and community resources.

The social hour for geropsychiatric patients

This study was an attempt to evaluate the effects of a controlled alcohol intake in the socialization of a group of geropsychiatric patients in a clinical setting. Although 47 patients of the Geriatric Unit were involved at various times, 16 remained in the study for the entire eight weeks. The Social Hour consisted of a half-hour session every weekday. The alcohol served was whisky, gin, vodka, and wine. Soft drinks were available for those who preferred them. Each patient was rated on a 5-point scale with regard to ward and off-ward activities. A planned four-week placebo period met with so much negativism that it had to be shortened to three days. According to our observations, the socialization process was increased significantly for these mentally ill geriatric patients during this type of Social Hour.

Patient outcome as a measure of quality of nursing home care

One thousand males transferred from a general medical hospital into 40 community nursing homes were classified by their physicians as to expectations of outcome within six months and measured on physical functioning at the time of their transfer. They were followed up six months later and retested on functional status. Subjects were classified on follow-up as improved, the same deteriorated, or dead. They were also classified as discharged from the nursing home, still in the home, or readmitted to the hospital. Nursing homes were measured every six months on structural variables. Outcomes of the patients were related to the nursing home characteristics by multivariate analysis of variance, controlling for expected outcome, age, and diagnoses of cancer and chronic brain disease. Homes with more RN hours per patient were associated with patients being alive, improved, and discharged from the home. Better ratings on meal services were related to being alive and improved. A higher professional staff-to-patient ratio, better medical records, and more services were related to being discharged from the nursing home.