Search

Background: A variety of interventions are available to support the caregivers of dementia patients. For the purposes of service planning, we developed an instrument to assess the needs of these caregivers and to determine whether needs are met. The reliability and validity of this new instrument was also investigated.Methods: The development of the Carers' Needs Assessment for Dementia (CNA-D), was based on in-depth interviews and a focus group. The combined inter-rater and test-retest reliability was investigated among 45 dementia caregivers. Correlations of the CNA-D with the Zarit Burden Inventory were used to analyze concurrent validity. Content validity was investigated by performing a separate survey among 40 caregivers and 40 professionals.Results: The CNA-D is a semi-structured research interview including 18 problem areas. For each problem area, the CNA-D offers several possible interventions. The relevance of the problem areas and the interventions (content validity) was confirmed by most of the study participants. Significant positive associations were found between the total score of the Zarit Burden Inventory and the number of problems and the number of unmet needs according to the CNA-D. The agreement between the interviewers was "excellent" (kappa above 0.75) in 73.7% of the problem areas and in 69.9% of the interventions.Conclusions: The CNA-D is a valid and reliable instrument for comprehensively assessing the needs of dementia caregivers. [ABSTRACT FROM AUTHOR]

Purpose: While the General Health Questionnaire (GHQ) has an excellent screening performance among outpatients and in the community, its accuracy to detect mental disorders among non-psychiatric inpatients was reported to be lower. The aim of the present study was to compare the criterion validity of different scoring methods, i.e. the Bimodal scoring, Likert scoring, Modified Likert scoring and Chronic scoring, of the 30-, 20- and 12-item version of the GHQ., Methods: The GHQ was available from 511 inpatients recruited from surgical, medical, gynaecological and physical rehabilitation wards. The Clinical Interview Schedule was performed for psychiatric case-identification and was used as external care criterion., Results: Sensitivities of all versions were between 0.612 and 0.701, and specificities between 0.601 and 0.759. The Overall Misclassification Rate (OMR) varied for the Bimodal and the Modified Likert scoring method between 0.257 and 0.281, for the Likert and the Chronic scoring method between 0.325 and 0.386. Overall, the Bimodal and the Modified Likert scoring method showed significantly better specificity and OMR than the Likert and the Chronic scoring method, while we could not find any differences for sensitivity., Conclusions: Overall, the Bimodal and the Modified Likert scoring method seem to be more accurate than the Likert and the Chronic scoring method. Nevertheless, due to the high misclassification, none of these versions can be recommended for routine screening among non-psychiatric inpatients.

Objective: Several studies reported that general practitioners often do not recognize depressive disorders among their patients. Routine screening is a time-consuming procedure which might be improved by means of a two-step procedure. Using a very brief screening instrument in a first step reduces the number of patients needing a longer conventional screening in a second step. Only screening positives after this second step will be examined by the general practitioner (GP)., Methods: Based upon validity scores from published studies, the expected validity of such a two-step procedure is being investigated., Results: This two-step screening procedure decreases the overall number of screening positives who have to be examined for the presence of depression by the GP. While the combined sensitivity slightly decreases, the combined specificity increases., Conclusions: The proposed method allows for a practicable routine screening for depression by the GP. The procedure might further be improved through the development of instruments optimized for the first and the second step.

Objective: The purpose of this study was to investigate differences between mothers and fathers of patients with schizophrenia or schizoaffective disorders concerning the time spent with the patients as well as other aspects of caring., Methods: 101 mothers and 101 fathers of the same patients suffering from schizophrenia or schizoaffective disorders according to ICD-10 were investigated., Results: The mean time spent in personal (i.e. face-to-face) or telephone contact with patients was significantly higher for mothers than for fathers. About the half of the mothers spent more time with the patients than the fathers, while 12% of fathers spent more time than the mothers. Among 40% of patients, mothers and fathers spent an equal amount of time for personal or telephone contact with the patients. Concerning other aspects of caring (legal representative of the patient, payment for patient's costs, caring for the patient's household) we could not find any differences between mothers and fathers., Conclusions: Concerning several aspects we could not confirm that mothers are more involved into the patients' care than the fathers. These findings are in contrast to the usual assumptions about familial caregivers based on the traditional gender-specific role models.

Objective: The aim of the present study was to estimate the need for psychiatric consultation services and psychiatric inpatient referral among inpatients of non-psychiatric hospital departments, and to assess the actual utilization of these services., Methods: The study was carried out among 728 inpatients of physical rehabilitation wards, medical, surgical, and gynecological wards in Austrian hospitals. Psychiatric case identification was performed by research psychiatrists using the Clinical Interview Schedule (CIS). Diagnoses were given according to DSM-III-R. The assessment of need for consultation and inpatient referral was based on the clinical judgments of research psychiatrists., Results: Overall, 34.2% of the inpatients were cases according to the CIS-criteria, 51.8% of them needing either psychiatric consultation or inpatient referral according to research psychiatrists. In 66.7% of those for whom research psychiatrists had stated a need, this need was not met ("unmet need"), while only 33.3% of them had their need met. In contrast, a psychiatric consultation was performed among 5% of those patients not needing psychiatric services according to the research psychiatrists ("overprovision"). Variables of the health care system (i.e. department type and catchment area of the hospital) were among the predictors for "met needs"., Conclusion: The rate of actual psychiatric consultations and admissions to psychiatric wards was markedly lower than the need according to research psychiatrists' judgment.

Objective: For the purpose of service planning, an instrument was developed for the systematic assessment of interventions needed by the caregivers of schizophrenia patients., Method: The development of this instrument was based on in-depth interviews and focus groups. It consists of 18 areas describing common problems of schizophrenia caregivers. For each of these problem areas several possible interventions are offered. Concurrent validity, inter-rater and retest reliability were tested among 50 caregivers., Results: The kappa values for the inter-rater reliability are predominantly excellent (kappa > 0.75). The values for the retest reliability show a wide range between excellent (kappa > 0.75) and fair agreement (kappa 0.40-0.60). The significant correlations found between summary scores of this new instrument and several sub-scales of the Family Problem Questionnaire support the assumption that the concurrent validity is satisfactory., Conclusion: These results suggest that this instrument is both valid and reliable.

Objective: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes., Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used., Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables., Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

Little is known about the long-term impact of cardiac transplantation on activity and modifications of endothelin (ET)-1 system, vascular endothelial growth factor (VEGF), and mitochondrial metabolism and morphology in patients with ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM). Messenger RNA (mRNA) expression levels of ET-1, endothelin converting enzyme (ECE)-1, VEGF-C, carnitine palmitoyltransferase (CPT)-1, and carnitine acetyltransferase (CARAT), as well as the number of normal, edematous, and degenerated mitochondria were assessed in left ventricular biopsies of 21 patients with DCM and 20 with ICM (New York Heart Association class III-IV) before and up to 3 months after cardiac transplantation. Cardiac samples of donated, nonfailing hearts served as controls (n=10). In cardiac biopsies of both ICM and DCM patients, ET-1, VEGF-C, CPT-1, and CARAT mRNA were up-regulated, whereas ECE-1 mRNA was down-regulated (P<0.05). Degenerated mitochondria had the highest number in both groups, followed by normal and edematous mitochondria. After cardiac transplantation, in ICM patients impaired gene expression levels decreased to, or below, normal levels, and the number of normal mitochondria increased (P<0.05). In implanted hearts of DCM patients, however, up-regulated ET-1 transcript levels persisted and the number of normal mitochondria decreased, whereas the number of degenerated mitochondria increased (P<0.05), and edematous mitochondria remained unchanged in number. These results show that cardiac transplantation corrects the impaired hemodynamic and echocardiographic parameters in both groups, whereas in DCM, the molecular pathology of ET-1 system and mitochondria persists. Therefore, it is more likely that these changes are the cause rather than a consequence of DCM.

An attempt was made to improve the validity of the 30-item General Health Questionnaire by excluding items. This exclusion was performed by using correlations of sum-scores with an external case criterion. This hierarchical approach based on subsets of items (stepwise hierarchical variable selection) resulted in a 9-item questionnaire whose discriminating performance was significantly better than that of the original version.

An algorithm is given in order to quantify the similarity of a couple's test profile in the Giessen-Test as concerns that 16 typical test profiles discovered by Brähler and Brähler (1993). The German Giessen-Test is a personality-inventory based on psychoanalysis. The Euklidian distance was chosen as a measuring unit. The identification of that typical test profile to which any couple belongs succeeds very easily, a task which is otherwise only possible with difficulty. However, any allocation is merely for reasons of description, not based on statistical decisions. As a special service, the respective computer programme is placed at everyone's disposal.