Development and validation of a geriatric depression screening scale: A preliminary report

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Background Subjects with a mild cognitive impairment (MCI) have a memory impairment beyond that expected for age and education yet are not demented. These subjects are becoming the focus of many prediction studies and early intervention trials. Objective To characterize clinically subjects with MCI cross-sectionally and longitudinally. Design A prospective, longitudinal inception cohort. Setting General community clinic. Participants A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease (AD), all from a community setting as part of the Mayo Clinic Alzheimer's Disease Center/Alzheimer's Disease Patient Registry, Rochester, Minn. Main Outcome Measures The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the Mini-Mental State Examination, Wechsler Adult Intelligence Scale–Revised, Wechsler Memory Scale–Revised, Dementia Rating Scale, Free and Cued Selective Reminding Test, and Auditory Verbal Learning Test. Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria, respectively. Results The primary distinction between control subjects and subjects with MCI was in the area of memory, while other cognitive functions were comparable. However, when the subjects with MCI were compared with the patients with very mild AD, memory performance was similar, but patients with AD were more impaired in other cognitive domains as well. Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD. Conclusions Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD. They appear to constitute a clinical entity that can be characterized for treatment interventions.

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Mild Cognitive Impairment: Clinical Characterization and Outcome

Rapid progress in deciphering the biological mechanism of Alzheimer's disease (AD) has arisen from the application of molecular and cell biology to this complex disorder of the limbic and association cortices. In turn, new insights into fundamental aspects of protein biology have resulted from research on the disease. This beneficial interplay between basic and applied cell biology is well illustrated by advances in understanding the genotype-to-phenotype relationships of familial Alzheimer's disease. All four genes definitively linked to inherited forms of the disease to date have been shown to increase the production and/or deposition of amyloid β-protein in the brain. In particular, evidence that the presenilin proteins, mutations in which cause the most aggressive form of inherited AD, lead to altered intramembranous cleavage of the β-amyloid precursor protein by the protease called γ-secretase has spurred progress toward novel therapeutics. The finding that presenilin itself may be the long-sought γ-...

Alzheimer's Disease: Genes, Proteins, and Therapy

Part I. Experimental Studies: 2. Experiment in psychology 3. Experiments on perceiving III Experiments on imaging 4-8. Experiments on remembering: (a) The method of description (b) The method of repeated reproduction (c) The method of picture writing (d) The method of serial reproduction (e) The method of serial reproduction picture material 9. Perceiving, recognizing, remembering 10. A theory of remembering 11. Images and their functions 12. Meaning Part II. Remembering as a Study in Social Psychology: 13. Social psychology 14. Social psychology and the matter of recall 15. Social psychology and the manner of recall 16. Conventionalism 17. The notion of a collective unconscious 18. The basis of social recall 19. A summary and some conclusions.

Remembering. A Study in Experimental and Social Psychology, Cambridge (University Press) 1964.

We found an inverse relation between physical aggression by patients and physician staffing—when more physicians were available, physical aggression decreased. Episodes of nonphysical aggression increased with higher levels of psychiatrist staffing, but were not related to general physician staffing.

http://jaapl.org/content/jaapl/19/1/49.full.pdf

Physician staffing and patient violence.

Alzheimer's Disease Research: Ethical and Legal Issues

aDepartment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California bVeterans Affairs Palo Alto Health Care System, Palo Alto, California cSan Francisco Veterans Affairs Medical Center, San Francisco, California dDepartments of Psychiatry and Neurology, University of California San Francisco, San Francisco, California eDepartment of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois fDepartment of Anesthesiology Perioperative and Pain Medicine, Stanford University, Stanford, California ‡Ms Varias and Dr van Roessel are co–first authors. §Drs Clark and Rodriguez are co–last authors. *Corresponding author: Carolyn I. Rodriguez, MD, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, Stanford, CA 94305 (carolynrodriguez@stanford.edu). J Clin Psychiatry 2020;81(4):20l13393

/pdf/does-nitrous-oxide-help-veterans-with-posttraumatic-stress-1gvrjuxxyz.pdf

Does Nitrous Oxide Help Veterans With Posttraumatic Stress Disorder? A Case Series

Schizophrenic patients admitted to an acute inpatient unit were evaluated with the Comprehensive Psychopathological Rating Scale (CPRS), items reflecting hostility from the same scale, the Eysenck Personality Questionnaire (EPQ), and the Socialization and Self-Control scales of the California Psychological Inventory (CPI). Incidents of violent and nonviolent suicidal behavior and suicidal ideation before admission, and assaultiveness against self subsequent to admission were recorded. It was determined that behavioral ratings of degree of schizophrenic symptoms on the CPRS are more highly likely than ratings of hostility to correlate with self-directed violence before and subsequent to admission. Personality measures that reflect violence toward others (Psychoticism on the EPQ and Socialization on the CPI) also correlate with violence toward self. Language: en

Correlations of self-directed violence in acute schizophrenics with clinical ratings and personality measures.

The purpose of this study was to assess whether pharmacy database information from US Department of Veterans Affairs (VA) medical centers could be used to screen for areas of higher Parkinson's disease prevalence in patients exposed to pesticides. The authors used pharmacy data sets and compared the use of antiparkinsonian medications at 2 VA medical centers in California: one in Palo Alto, near the ocean, and one in Fresno, downwind from extensively farmed parts of the Central Valley. They found that patients at Fresno had higher odds ratios (1.5-1.8) for the use of Parkinson's disease medications than patients at Palo Alto. These data are consistent with the observations of prior epidemiologic studies and suggest that VA pharmacy databases can prioritize locations for further epidemiologic research. However, a thorough exploration of alternative explanations is needed to reach definitive conclusions regarding the findings suggested by this method.

Jerome A. Yesavage

Papers

Physician staffing and patient violence.

Alzheimer's Disease Research: Ethical and Legal Issues

Does Nitrous Oxide Help Veterans With Posttraumatic Stress Disorder? A Case Series

Correlations of self-directed violence in acute schizophrenics with clinical ratings and personality measures.

Use of a VA Pharmacy Database to Screen for Areas at High Risk for Disease: Parkinson’s Disease and Exposure to Pesticides: