The DSM-5 criteria, level of arousal and delirium diagnosis: Inclusiveness is safer

© 2014 European Delirium Association et al.; licensee BioMed Central Ltd. Background: Delirium is a common and serious problem among acutely unwell persons. Alhough linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity.Discussion: Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises 'consciousness' as 'changes in attention'. It should be recognised that attention relates to content of consciousness, but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested.Summary: Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation

Das ganze Spektrum: Die Frühgeschichte der Deutschen Sammlung von Mikroorganismen (DSM)

Der zunächst in den USA formulierte Anspruch einer „Allgemeinen Mikrobiologie“ wurde begleitet vom Anlegen nationaler Mikrobensammlungen, so auch für die Bundesrepublik Deutschland. Rekonstruiert wird die Frühgeschichte (ca. 1960 –1979) der Deutschen Sammlung von Mikroorganismen (DSM, heute DSMZ) mit den zentralen Akteuren Hans Günter Schlegel, Norbert Pfennig und Otto Kandler und ihren mikrobiellen Objekten. Die Sammlungsgeschichte leistet den erstmaligen Nachweis der dezentralen Sammlungsstruktur. Die Technikgeschichte fragt mit dem Konzept „Technik als Erwartung“ nach Interessenslagen und Imaginationen der Großforschung im Atom- und Biotechnologie-Zeitalter. Gezeigt wird zudem wissenschaftsphilosophisch, wie die Mikrobiologie ihre Objekte mit Hilfe der Sammlung und des Konzepts Kultivierung doppelaspektiv konfigurierte, so dass Bio- und Technosphäre als ein riesiger Stoffwechsel organologisch-technologisch (Ernst Kapp) vereinheitlicht werden konnten. Dabei traten Spannungen auf Sammlungsebene auf, was wie und in welcher Quantität gesammelt werden soll, die am Beispiel des Zielkonflikts Biotechnologie versus Taxonomie nachgezeichnet werden. Dies ermöglicht, die nahezu tragische Geschichte der frühen DSM als positive wie negative Technikgeschichte zu erzählen.When scientists in the USA envisioned a “General Microbiology”, this was enabled by setting up national microbe banks, as happened in West Germany. This article reconstructs the early history (ca. 1960 –1979) of the German Collection of Microorganisms (DSM, today DSMZ) with key scientific actors Hans Günter Schlegel, Norbert Pfennig, and Otto Kandler and their microbial objects. Collection history provides first evidence of the decentralized structure. Based on the concept “technics as expectation”, history of technology asks for interests and imaginations of large-scale research in the nuclear and biotech-age which has been relevant for research on microbes. Furthermore, by adding a perspective from philosophy of science, it is shown how microbiology configured its objects by means of collecting and cultivating: results were double-aspective entities that conceptually helped to unify bio- and technosphere as a huge metabolism within one organ projection (Ernst Kapp) of planetary scope. Among the occurring tensions on the level of collecting is the one between biotechnological and taxonomical objectives: what, how, and how much to collect. This allows for narrating the almost tragic story of the early DSM as both positive and negative history of technology

It still matters: Preference in visual appearance of stimuli among people in the late stages of dementia

© Springer International Publishing AG, part of Springer Nature 2018. Introduction: This study aims to examine the emotional response towards visual stimuli in people with an advanced stage of dementia. Methods: One-to-one interview sessions were conducted with nineteen (17 females and two males) nursing home residents to investigate their response toward different visual stimuli. Fifteen positive images selected from the International Affective Picture System (IAPS) were used as visual stimuli. Participants’ attitude and attention toward each stimulus was rated using the Observational Measurement of Engagement Tool (OME); their difficulty in recognising each stimulus was rated via a 3-point scale. Results: Stimuli contained children’s faces received significantly higher attitude and attention scores than all the other stimuli (p < 0.05). Stimuli containing animals received the 2nd highest attitude and attention scores. Stimuli contained human faces or animals appeared to be more recognisable, especially the ones include children’ faces. A strong, positive correlation between the attitude and recognisable ranking was identified, which was statistically significant (p = 0.000). The similar results have been found between the attention and recognisable ranking (p = 0.002). Discussion: The results of this study reveal that the people with moderate or severe stages of dementia still respond strongly to Kindchenschema (baby-schema). It provides designers with better insights into how to develop products/interventions for people with dementia, in particular for those in the advanced stage

Exploring the Feasibility of Using Affective Pictures to Elicit Positive Emotion with Nursing home Residents with Dementia

Positive emotion has been found to have benefit in people with dementia. This study investigates the feasibility of using affective pictures to elicit positive emotion from nursing home resident with dementia. Sixteen nursing home residents (12 female and 4 male) with a diagnosis of mild to moderate degree of dementia have been recruited in this study. Fifteen pictures from International Affective Picture System (IAPS) have been selected to use in this study. These pictures were classified to three sets, based on their reported arousal and valence ratings: (a) excitement: high arousal and high valence; (b) pleasure: median arousal and high valence; and (c) relaxation: low arousal and high valence. During the experiment, one researcher showed the pictures to the participants, and a second researcher recorded their response to these pictures via the attitude item of Observational Measurement of Engagement (OME). participants showed their most positive attitude while they reviewed the (b) picture set (OME attitude score 5.5±0.73). Their attitudes to set (a) and set (c) were somewhat neutral (OME attitude scores 4.25±0.58 and 4.44±0.63). Although this research is still in progress and the data reported here is only the preliminary data, we found some pictures from IAPS can be used in eliciting positive emotion in people with dementia. The results also suggested that the selection of eliciting stimuli should be highly personalized

Using positive images to manage resistance-to-care and combative behaviors in nursing home residents with dementia: A pilot study.

This pilot study attempted to reduce resistance-to-care (RTC) and combative behaviors in nursing home residents with dementia by eliciting their positive affect. Four female residents with dementia were recruited from a nursing facility. Each resident was involved in one intervention trial and one control trial. The response of the residents was assessed by the Agitated Behavior Scale and the Observational Measurement of Engagement Tool. The distress level of the certified nursing assistants (CNAs) delivering the care was reported through the Distress Thermometer. Results showed that the residents displayed fewer behavioral symptoms in the intervention trial than in the control trial. The CNAs reported less distress in the intervention trial than in the control trial. These preliminary findings suggest that it might be feasible to use positive images to reduce residents' behavioral symptoms and decrease the distress of CNAs

The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer

Background: Delirium is a common and serious problem among acutely unwell persons. Alhough linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity. Discussion: Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises ‘consciousness’ as ‘changes in attention’. It should be recognised that attention relates to content of consciousness,but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested. Summary: Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation.status: publishe