A national survey of psychiatrists' attitudes towards the physical examination.

BACKGROUND: Studies have shown that most psychiatric patients do not receive a thorough physical examination (PE). AIM: To explore factors contributing to the underperformance of the PE on psychiatric patients. METHOD: All psychiatrists in the UK who were registered or affiliated to the Royal College of Psychiatrists were invited to complete an online survey regarding their attitudes towards PEs in psychiatry. RESULTS: Responses from 15% of the psychiatrists showed that most (89%) believe that the PE is important. The majority (61%) indicated that their PE skills had diminished since working in psychiatry and this was reported more by senior psychiatrists than junior trainees (64% vs. 49%). Most respondents considered that the PE should not be done by another type of health professional (45% vs. 28%). CONCLUSIONS: Likely reasons for poor performance of PEs include shortage of time and equipment, challenges associated with agitated and uncooperative patients, the perceived incongruence of the PE with the patient's presenting symptoms and a degree of skill atrophy, especially in senior psychiatrists which is leading to lack of supervision of junior trainees in this area. Further research is needed to investigate if strategies addressing these factors would improve the standard of PEs on psychiatric patients

Multi-sensory therapy in psychiatric care

Given the ever-increasing popularity of this new activity, it is important that further systematic research is undertaken to provide evidence regarding the efficacy of multi-sensory therapy in all of the fields of care in which it is currently being used. It remains to be established whether conventional relaxation techniques or other approaches (such as enhancing the sensory experiences of the everyday environment) could be as effective in achieving the same benefits. The reported benefit that multi-sensory therapy may be useful in reducing behavioural problems has important implications in view of the limited efficacy of pharmacological treatment for these symptoms (Schneider, 1996), which have been shown (e.g. Kaufer et al, 1998; Haupt & Kurz, 1993) to cause the most distress in cares of those with dementia and contribute greatly to the decision to place patients in long-term residential care. Some people fell that the current lack of empirical evidence fails to justify the widespread use and expense of multi-sensory facilities and there is a clear need to prove that patients do benefit from multi-sensory therapy and are not just passive recipients of the intervention (Woodrow, 1998). It is perhaps worth noting, however, that many interventions (such as reminiscence, reality orientation and validation therapy) which are long-established and widely used in dementia care also lack a background of rigorous research evidence. The research literature into the relative merits of multi-sensory therapy may not be substantial, but it does indicate support for the large amount of anecdotal evidence which claims that this activity is an effective and appropriate therapeutic intervention for people in mental health care

A survey of psychiatrists' attitudes towards the physical examination

Background: Studies have shown that most psychiatric patients do not receive a thorough physical examination (PE). Methods: Psychiatrists working with Leicestershire Partnership NHS Trust were surveyed to determine factors influencing the performance of PEs, including their attitudes toward conducting them. Results: Responses from 118/192 (61%) psychiatrists showed that most (96%) believe that the PE is important. The majority (72%) indicated that their PE skills had diminished since working in psychiatry and this was reported more by senior psychiatrists compared to junior trainees (85% vs 40%). 77% considered that a patient’s mental state should have a bearing on the type of PE the psychiatrist performs. Conclusions: Likely reasons for poor performance of PEs include: shortage of time and equipment, challenges associated with agitated or uncooperative patients, and possibly a degree of skill atrophy, especially in senior psychiatrists. Further research is needed to investigate if strategies addressing these factors would improve the standard of PEs on psychiatric patients

Screening for depression in older people on acute medical wards: the validity of the Edinburgh Depression Scale

Background: depression is common in people with poor physical health, particularly within the acute medical in-patient setting. Co-morbid depression contributes to poor outcomes, and screening for depression in acute medical in-patients has been advocated. The Edinburgh Depression Scale (EDS) has been validated in a variety of general hospital patient groups, but not previously in older acute medical in-patients. Methods: one hundred and eighteen patients aged 65 and older on acute medical wards were assessed using a standardised diagnostic interview (Present State Examination—Schedules for Clinical Assessment in Neuropsychiatry) to identify depression according to ICD-10 criteria. They subsequently completed the EDS. The performance characteristics at a range of thresholds were compared, and receiver operating characteristic curve analysis was performed. Results: the optimal EDS cut-off for identifying ICD-10 depressive episode was 7/8, with a sensitivity of 88%, specificity of 77%, positive predictive value of 52% and negative predictive value of 96%. The area under the receiver operating characteristic curve was 0.91. Conclusion: the EDS was shown to be a useful instrument for detecting clinical depression in older people on acute medical wards in this study. Its performance was equivalent to other validated screening instruments in this population. Our findings add further weight to using the EDS as a screening instrument for depression in multiple general hospital settings

Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions.

BACKGROUND: depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). METHODS: one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). RESULTS: a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. CONCLUSION: the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases

Screening for depression in older adults in a general hospital setting: the validity of NICE guidance on using two questions

Background: Depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). Methods: 118 patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination – Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently participants completed the two depression screening questions and the 15 item version of the Geriatric Depression Scale (GDS-15). Results: A threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) 49%, and negative predictive value (NPV) 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV 62%, and NPV 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV 71%, and NPV 94%. Conclusion: The two depression questions perform well as an initial screening process for noncognitively impaired older people in the acute medical setting. A positive response to either question would indicate further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false positive cases

Driving Cessation in Younger People with Cognitive Impairment and Dementia

Background: Although driving by persons with dementia is an important public health concern, little is known about driving cessation in younger people with dementia. We aimed to determine the prevalence and factors affecting driving cessation in individuals with and without dementia in patients attending memory clinic for under 65 years of age in an European setting. Methods: Subjects were consecutive patients assessed at a specialist memory service at a university teaching hospital between 2000-2010. The data collected included demographic, clinical, standardized cognitive assessments as well as information on driving. Dementia diagnosis was made using ICD 10 criteria. Results: Of the 225 people who were or had been drivers, 32/79 (41%) with Young-Onset Dementia (YOD) stopped driving compared to 25/146 (17%) patients who had cognitive impairment due to other causes. Women were more likely to cease driving and voluntarily than men (p <0.001). Diagnosis of YOD was associated with driving cessation (1.1925, 95% CI 0.5703-1.8147, p= 0.0002), and was mediated by impairment in praxis with the highest indirect mediation effect (0.7536, 95% CI 0.1834-1.401, p= 0.0099). Conclusions: YOD diagnosis, female gender and impairment in praxis have higher probability for driving cessation in those under 65 years of age with cognitive impairment