Pathways to care for people for dementia: an international multi-centre study

Objective: the aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: we recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries. The WHO “Encounter Form”, a standardized schedule that enables data concerning basic socio-demographic, clinical and pathways data to be gathered, was completed for each participant. Results: the median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy and practical advice) were delivered in less than 3% of situations. The analyses of the ‘pathways diagram’ revealed that the path of PwD to receiving care is complex, diverse across countries, and that there are important barriers to clinical care. Conclusions: the study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally and internationally

Panic Disorder Induced by a "Herbal" Product Containing Sibutramine: Case Series with Review of Literature

Sibutramine is a serotonin and noradrenaline reuptake inhibitor which has been used for weight loss in obese patients. There are slimming products on the market claiming to be 'natural' which nevertheless contain sibutramine. In this report, we present three cases where panic attacks were associated with the use of a product and persisted even long after its discontinuation

TREATMENT OF INSOMNIA WITH HYPNOTICS RESULTING IN IMPROVED SEXUAL FUNCTIONING IN POST-MENOPAUSAL WOMEN

Background: This study sought to determine whether trazodone used in hypnotic doses, compared to the hypnotic agent zopiclone, had any specific positive effect on sexual function in non-depressive post-menopausal women with insomnia. Subjects and methods: Fifty (50) subjects participated in the study. Insomnia and sexual performance were evaluated before and after 4 weeks of hypnotic treatment. Results: At week four, both treatments improved sleep quality to a similar degree. Sexual function also improved significantly with both treatments, with no significant difference between the groups. Conclusions: In post-menopausal women, sexual problems and sleep problems may be related and solving sleep problems may help sexual functioning, independently of depression

TREATMENT OF INSOMNIA WITH HYPNOTICS RESULTING IN IMPROVED SEXUAL FUNCTIONING IN POST-MENOPAUSAL WOMEN

Background: This study sought to determine whether trazodone used in hypnotic doses, compared to the hypnotic agent zopiclone, had any specific positive effect on sexual function in non-depressive post-menopausal women with insomnia

Interpersonal communication in and through family: structure and therapy in Turkey

It is essential for professionals in the mental health sector to identify and understand the different family models and the effects of social transformations. Historically and at present, however, Turkish families live in a ‘culture of relatedness’, with emotional and/or material interdependence between generations. Marriage and family therapy is a newly emerging discipline in Turkey. Although studies on family structure and common problems in families have been made, data on the practice of family therapy are limited. To our knowledge, this is the first paper aiming to describe the practice of family therapies in Turkey, situating them against a backdrop of sociological and social/psychological studies in family structure

The inquiry nature of primary schools and students' self-directed learning knowledge

Item does not contain fulltextBACKGROUND: A reliable and valid global staging scale has been lacking within dementia care. OBJECTIVE: To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. METHODS: The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the project's steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedule's inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. RESULTS: Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. CONCLUSION: The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed