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High levels of homocysteine are associated with cerebrovascular disease, monoamine neurotransmitters, and depression of mood. A plausible hypothesis for these associations is that high homocysteine levels cause cerebral vascular disease and neurotransmitter deficiency, which cause depression of mood. The homocysteine depression hypothesis, if true, would mandate inclusions of imaging studies for cerebrovascular disease and measures of homocysteine, folate, and B12 and B6 vitamins in the clinical evaluation of older depressed patients. Longitudinal studies and clinical trials should be designed to challenge the hypothesis.

A study on elderly patients with diabetes mellitus and the patterns of their executive and visuospatial dysfunctions is presented. Such cognitive deficits are likely to impair activities of daily living in these patients. The study is based on data from three homecare agencies in Massachusetts.

Postmenopausal hormone therapy and cognitive function in healthy older women have been studied based on data from the Nurses' Health Study, an ongoing prospective cohort study. Neither current nor long-term hormone users show better performance on an overall measure of cognition or on three test of verbal memory than never users. Current hormone users scored significantly better than never users on the test of verbal fluency, having a 30% decrease in risk of a low score on the verbal fluency test.

Objective: The purpose of this pilot study was to gain information about attitudes of individuals with bipolar disorder and their spouses toward some of the ethical and social issues arising from rapidly advancing genetic research on bipolar disorder. Method: Patients with bipolar disorder and their unaffected spouses were asked to answer questionnaires assessing their knowledge and attitudes about treatment response rates for bipolar disorder, probability of inheritance, genetic testing, disclosure of genetic information, abortion, marriage, and childbearing. Results: The overwhelming majority of the patients and spouses said that they would take advantage of genetic tests for bipolar disorder if such tests were to become available. Most patients and spouses agreed that the benefits of knowing whether one carries a gene for bipolar disorder would outweigh the risks. The decisive majority of respondents also felt that they would not abort a fetus that carried a gene for bipolar disorder. Furthermore, most patients and spouses agreed that the knowledge that one of them carried a gene for bipolar disorder would not have deterred them from marriage or childbearing. Conclusions: The results of this study suggest that most individuals believe that they would benefit from the use of genetic testing for bipolar disorder if it were to become available. Follow-up studies using a broader patient sample and nonclinical control groups would be useful in further evaluating the issues addressed in this pilot study.

Objective: Evidence suggests that the neuropathology of Huntington's disease, a neuropsychiatric disorder due to a mutation on chromosome 4, results from excessive activation of glutamate-gated ion channels, which kills neurons by oxidative stress. Therefore, the authors hypothesized that [Alpha]-tocopherol, which reduces oxyradical damage to cell membranes, might slow the course of Huntington's disease. Method: A prospective, double-blind; placebo-controlled study of high-dose d-[Alpha]-tocopherol treatment was carried out with a cohort of 73 patients with Huntington's disease who were randomly assigned to either d-[Alpha]-tocopherol or placebo. Patients were monitored for changes in neurologic and neuropsychologic symptoms. Results: Treatment with d-[Alpha]-tocopherol had no effect on neurologic and neuropsychiatric symptoms in the treatment group overall. However, post hoc analysis revealed a significant selective therapeutic effect on neurologic symptoms for patients early in the course of the disorder. Conclusions: Antioxidant therapy may slow the rate of motor decline early in the course of Huntington's disease.

Objective: The aims of this study were to estimate the prevalence and investigate the comorbidity and potential consequences of DSM-III personality disorders in the community. Method: A total of 810 adults were examined in the second stage of the Eastern Baltimore Mental Health Survey in 1981, part of the National Institute of Mental Health Epidemiologic Catchment Area program. The subjects were directly examined by psychiatrists using a semi-structured method that allowed diagnosis of all DSM-III personality disorders as well as other DSM-III psychiatric disorders. Results: The prevalence of personality disorders in these adults was 5.9% (9.3% when provisional cases were included). Men had higher rates than women, and subjects who were separated or divorced had the highest rates. There was little comorbidity among specific personality disorders. Subjects with personality disorders were significantly more likely to have a history of sexual dysfunctions, alcohol use disorders, and drug use disorders as well as suicidal thoughts and attempts. In addition, they reported significantly more life events in the past year. Among subjects with any axis I disorder, those with personality disorders were judged by the psychiatrists to be more in need of treatment; however, only 21% were receiving treatment. Conclusions: Personality disorders are relatively common in the community. They are associated with axis I disorders and life events. Only one-fifth of the individuals who qualify for diagnoses of personality disorders in the community are receiving treatment.

The Mental Alteration Test may be an effective method for evaluation of cognitive impairment in patients with HIV infection. Cognitive impairment is a common complication of HIV infection. Researchers compared the Mental Alteration Test to the Mini-Mental State Exam (MMSE) and the parts A and B of the Trailmaking Test in 62 patients with HIV infection. The patients' scores on The Mental Alteration Test were similar to those on the MMSE and part B of the Trailmaking Test. A score below 15 on the Mental Alteration Test was most effective for detection of abnormal cognitive function. Patient scores were reproducible and reliable with the Mental Alteration Test and it was easy to administer. Patients with an abnormal score on the Mental Alteration Test should have further evaluation for cognitive impairment.

Objective: The aim of this study was to assess the relationships between specific personality disorders and DSM-III axis I conditions in a community sample. Method: A total of 810 subjects were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey, part of the Epidemiological Catchment Area Program of the National Institute of Mental Health. A semistructured examination, the Standardized Psychiatric Examination, was employed to assess axis I and axis II conditions. Scales for compulsive and antisocial personality disorders were derived from DSM-III criteria. The relationships between scores on these personality disorder scales and the presence of generalized anxiety disorder, alcohol use disorders (alcohol abuse and alcohol dependence), and simple phobia were evaluated by using logistic regression. Results: Higher compulsive personality scores were associated with a greater odds of generalized anxiety disorder and simple phobia but a smaller odds of alcohol use disorders. In contrast, higher antisocial personality scores were associated with a greater odds of alcohol use disorders but a smaller odds of generalized anxiety disorder. There was no relationship between antisocial personality scores and simple phobia. Conclusions: Personality disorders have specific relationships to axis I conditions, which suggests different vulnerabilities but also different protective influences.

Alzheimer's disease, a type of dementia, is characterized in part by delusions, hallucinations, and behavioral changes. Psychotic symptoms in Alzheimer's patients have been associated with poorer cognitive performance and more rapid cognitive decline. Aggressive outbursts, in the forms of physical violence, are reported by caregivers of Alzheimer's patients as well; sometimes aggressive patients are also abused by their caregivers. In the present study, data were collected on 181 patients with probable Alzheimer's disease who had been assessed every six months for up to 4.5 years. Summary notes were reviewed for each clinic visit, and the symptoms of delusions, hallucinations, misidentifications, and physical aggression were noted. In 43.5 percent of the cases, delusions were present, and in 29.6 percent, physical aggression was observed. The most common delusions were of persecution, and delusions frequently preceded episodes of violent behavior. While delusions were significantly associated with violence, it accounted for only 3.5 percent of the variance under statistical analysis. This suggests that there are other variables related to physical aggression as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

A family history study was performed to investigate the relationship between Alzheimer's disease with depression and a family history of affective disorder. Depression often accompanies Alzheimer's disease, but it is not known if this is merely a response to the dementia or if it is a part of a major affective disorder. Affective disorders and dementia can coexist; depression may be the result of dementia, or cognitive disturbances may result from depression. Forty-one patients who were diagnosed with probable Alzheimer's disease and who experienced one episode of depression were assessed, along with 71 Alzheimer's patients who were not depressed. The 41 depressed patients met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, third edition, (DSM-III) for major a depressive episode, and had no history of depression. For each of these patients, two first-degree relatives were interviewed and assessed for symptoms of depression, also using the DSM-III criteria. Data were analyzed and an association was found between the Alzheimer's patients with depression and a higher incidence of depression in first- and second-degree relatives. About half of the patients with depression had one or more relative with major depression, compared with only 11 percent of the Alzheimer's disease patients without depression. These results suggest that there is a genetic relationship between a family history of depression and the depression which may occur in Alzheimer's disease. Further investigation of this feature in Alzheimer's disease may provide a useful model for studying aspects of depression and its progression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dementia is a term used to describe a broad impairment of intellectual (cognitive) functioning that is usually progressive and interferes with normal activities. Delusions are described as false beliefs that are brought about without appropriate external stimuli. Residents of nursing homes commonly have diagnoses of dementia with attendant behavioral problems. Studies have demonstrated delusions to be part of senile dementia, and when treated, behavior problems often subside. This study was done to assess the prevalence of delusions among newly admitted nursing home residents, how patients with delusions differ from nondelusional patients in behavior and functioning, whether the nursing staff can recognize delusions and knows how to treat them, and what illnesses delusions are associated with. Psychiatrists examined 125 nursing home residents within four weeks of their admission. The patient's behavior before nursing home placement was determined by an interview with a family member. Behavior and function in the nursing home was assessed by an interview with a nursing assistant. Almost 85 percent of the subjects had a psychiatric disorder, and dementia was seen in 67.2 percent. Twenty-six of these residents had delusions, and the family had recognized this in 64 percent of the cases. Even so, only six of the delusional patients had seen a psychiatrist in the year before admission. The nursing staff identified delusions in only five of these patients. The delusional patients did not differ from the nondelusional residents in their need for assistance with daily activities. They did, however, have more behavior problems before and after admission to the nursing home, and were also more cognitively impaired. Most of these patients were not receiving proper treatment for their symptoms, and in fact were often given medications which could make their conditions worse. The authors suggest that the behavior problems associated with delusions and dementia could be diagnosed and treated before or after placement, if these elderly patients receive skilled geriatric psychiatric evaluations, along with interviews with family members regarding symptoms that are manifest prior to this evaluation. Also, nursing home staff members need to be taught to recognize delusions and understand their clinical importance so referrals occur in a timely manner. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chronic migraine headache sufferers have been described clinically to be ambitious, success oriented, conscientious, perfectionistic, obsessive, emotional, rigidly moralistic, tense, of above-average intelligence, and frequently angry, resentful and hostile. To verify these reports this study selected 162 migraine sufferers and 162 control subjects from the general population and assessed their personalities and psychological distress levels. The initial screening interview discerned the frequency of headaches, their characteristics and precipitants, and whether treatment had been sought. The Eysenck Personality Questionnaire was used to assess psychoticism (tough-mindedness), neuroticism (emotionality), extraversion and dissimulation (pretense). The General Health Questionnaire was used to detect psychological distress suggestive of emotional disorders. The migraine and control groups differed dramatically on the neuroticism scale, indicating that the migraine group members were more tense, anxious, and depressed than the controls. The migraine sufferers also scored significantly higher on the psychoticism scale indicating that they described themselves as less interpersonally sensitive, more hostile, and unique from their peers. Migraine sufferers also scored significantly lower on the lie scale suggesting that they are less defensive and more self-critical and willing to admit the truth about themselves than the controls, but this could also suggest hypervigilance and perfectionism out of which ordinary experiences are interpreted as abnormal. These results suggest a modal personality described as unguarded, anxiety prone, depressive, lacking in interpersonal warmth, and somewhat alienated from peers. The General Health Questionnaire results indicated that the migraine sufferers also experienced significant psychological distress. They scored higher than the control subjects on all the symptom scales, including anxiety, depression, and impaired social functioning. According to the criteria for emotional disorder, approximately 61 percent of the migraine group and 25 percent of the control group qualified for this description. This rate among the control group is consistent with levels found in other community samples. (Consumer Summary produced by Reliance Medical Information, Inc.)

The most common cause of dementia (mental impairment) among the 1.5 million patients in nursing homes in the United States is Alzheimer's disease. The dementia of Alzheimer's disease is considered untreatable, but these patients often have associated treatable conditions such as depression. This study was undertaken to evaluate the extent to which treatable conditions occurred before, and contributed to, institutionalization. Previous studies have been done to find factors that predict institutionalization, but none have assessed patients before they were admitted to nursing homes. If treatable conditions are predicting factors for institutionalization, then treating these conditions might prevent or delay unnecessary placements. Psychiatrists examined and interviewed 210 possible or probable Alzheimer's outpatients and their caregivers at six-month intervals between 1984 and 1987. When 25 (12 percent) of the patients had been admitted to nursing homes, the researchers matched them to 25 noninstitutionalized patients to compare data. The institutionalized group had not been ill longer than the control group, but they did score higher on the Hamilton depression scale, the Brief Psychiatric Rating Scale, and the behavior disorder, activities of daily living, and orientation subscales of the Psychogeriatric Dependency Rating Scales on their last examination before being placed. There were no significant differences on any measure of cognition (mental processing) between the two groups. These results show that potentially treatable psychiatric symptoms such as depression and agitation are among the predictors for nursing home placement, and suggest that psychiatric intervention and treatment may prevent or delay placement. The results of this study agree with earlier studies which have found behavioral, not cognitive, disorders to be the greatest risk factor for institutionalization among Alzheimer's patients. (Consumer Summary produced by Reliance Medical Information, Inc.)