Background: Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care f

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Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

A new interview schedule for the diagnosis and measurement of dementia in the elderly is described. The schedule named the Cambridge Mental Disorders of the Elderly Examination (CAMDEX), consists of three main sections: A structured clinical interview with the patient to obtain systematic information about the present state, past history and family history; a range of objective cognitive tests which constitute a mini-neuropsychological battery; a structured interview with a relative or other informant to obtain independent information about the respondent's present state, past history and family history. The CAMDEX is acceptable to patients, has a high inter-rater reliability and the cognitive section has been shown to have high sensitivity and specificity.

CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia.

The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

Assessing Self‐maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living

• The Comprehensive Assessment of Symptoms and History was developed for research studies of schizophrenia spectrum conditions and affective spectrum conditions. It is designed to provide a comprehensive information base concerning current and past signs and symptoms, premorbid functioning, cognitive functioning, sociodemographic status, treatment, and course of illness. Because the information base is broad, it is not wedded to a specific diagnostic system but rather permits clinicians and investigators to make diagnoses using a wide range of systems, including Research Diagnostic Criteria,DSM-III, DSM-III-R, and theInternational Classification of Diseases. Given the fact that disorders in psychiatry are not defined at the etiological or pathophysiological level, diagnostic criteria are prone to ongoing revision as our knowledge base changes. Research strategies suggest that investigators should maintain a flexible database to permit them to adapt to changes in diagnostic systems, to do comparative nosological studies, and, ultimately, to develop new diagnostic systems based on knowledge concerning the underlying neurobiological nature of disorders. Because it provides a comprehensive information base, the Comprehensive Assessment of Symptoms and History facilitates research of this type. Extensive developmental work has been done with the Comprehensive Assessment of Symptoms and History, including interrater and test-retest reliability studies, validity studies, training programs, and data entry programs.

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The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology.

Objective. To design a brief cognitive screener with acceptable sensitivity and specificity for identifying subjects with cognitive impairmentDesign. Cohort one is assembled from a community-based survey coupled with a second-stage diagnostic evaluation using formal diagnostic criteria for dementia.

Six-item screener to identify cognitive impairment among potential subjects for clinical research.

The Comprehensive Assessment and Referral Evaluation (CARE) is a new assessment technique which is intended to reliably elicit, record, grade and classify information on the health and social problems of the older person. The CARE is basically a semi-structured interview guide and an inventory of defined ratings. It is designated comprehensive because it covers psychiatric, medical, nutritional, economic and social problems rather than the interests of only one professional discipline. The style, scope and scoring of the CARE makes it suitable for use with both patients and non-patients, and a potentially useful aid in determining whether an elderly person should be referred, and to whom, for a health or social service. The CARE can also be employed in evaluating the effectiveness of that service if given.

The Comprehensive Assessment and Referral Evaluation (Care)—Rationale, Development and Reliability:

Project psychiatrists interviewed 192 hospitalized mental patients, ages 20 to 59 years, with a structured mental state examination. Each patient received two diagnoses, one by the hospital and an independent one by the project. According to the hospital diagnoses, race and diagnosis were strongly associated: a diagnosis of schizophrenia rather than affective illness was given more frequently to blacks than whites. According to the project's diagnoses, race and diagnosis were independent. A comparison of the patterns of psychopathology exhibited by blacks and whites confirms the absence of any gross differences in abnormal behavior between them. When comparisons were made specific to depressives, however, blacks were found to have a quality to their depression different from whites.

Depression and Schizophrenia in Hospitalized Black and White Mental Patients

• We compared the joint frequencies and reliabilities of the following sets of criteria for the diagnosis of schizophrenia: the New Haven Schizophrenia Index; the Carpenter, Strauss, Bartko (4-, 5-, 6-, and 7-item) system; DSM-III ; Research Diagnostic Criteria (RDC; full and chronic); the Feighner system; and the 1975 criteria of Taylor and Abrams. The systems, of essentially equal reliability, varied sevenfold in their rates of diagnosing schizophrenia. Patients in whom schizophrenia was diagnosed by the lower-rate systems were likely to receive the same diagnosis by the higher-rate systems. This tends not to be the case when an affective syndrome is present.

Diagnostic criteria for schizophrenia: reliabilities and agreement between systems.

A sample of patients from a New York and a London mental hospital were compared so as to point out any differences between the two hospitals in the criteria associated with a hospital diagnosis of either schizophrenia or affective illness. Groups of patients with similar psychopathology tended to receive similar diagnoses, but a subgroup with marked mood disturbance and little disorganization tended to be called schizophrenic by the New York hospital staff and affectively ill by the London hospital staff.

Cross-National Study of Diagnosis of the Mental Disorders: Some Comparisons of Diagnostic Criteria from the First Investigation

• Seven systems for the diagnosis of schizophrenia were compared in their ability to predict short-term outcome at follow-up: (1) with each other, (2) with selected specific symptoms, and (3) with a simple additive composite symptom score. None of the systems nor the symptoms predicted strongly, but DSM-III and Schneiderian First Rank Symptoms and the composite score performed somewhat better than the other predictors.

Robert Simon

Papers

The Comprehensive Assessment and Referral Evaluation (Care)—Rationale, Development and Reliability:

Depression and Schizophrenia in Hospitalized Black and White Mental Patients

Diagnostic criteria for schizophrenia: reliabilities and agreement between systems.

Cross-National Study of Diagnosis of the Mental Disorders: Some Comparisons of Diagnostic Criteria from the First Investigation

Diagnosis of schizophrenia. Prediction of short-term outcome.