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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

New concepts about the pathogenesis and pathophysiology of Parkinson's disease have emerged. For these concepts to be useful, they must be understood, and for them to be applied, the psychology of the patient and the patient's family must be understood. The initial consultation is crucial in establishing a successful relationship between a patient, family, and physician. This consultation is analyzed and ways of avoiding errors and misconceptions delineated. Emphasis is placed on imaginitive questioning using the format of the ADL portion of the UPDRS in establishing the diagnosis and following treatment. The rational for starting treatment with selegiline at this time is discussed in the context of the role that increased MAO-B activity plays in the progression of Parkinson's disease. After making the diagnosis and starting treatment with selegiline, deciding when to start levodopa is the next crucial decision. Often as important as deciding when to start levodopa is overcoming the resistance of the patient to accept this treatment. The next crucial decision occurs after the patient develops response fluctuations on levodopa. A format for assessing the fluctuations is presented, and the merits of different treatments, including selegiline, dopamine agonists (bromocriptine and pergolide), and sustained-release or controlled-release levodopa preparations (Sinemet CR), discussed. The management of patients with depression, sleep problems, and advanced disease including postural instability and mental changes are reviewed.
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PMID:An integrated approach to patient management in Parkinson's disease. 135 53

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 and March 1991. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions for these patients were analyzed in this study. The results of the study are summarized as follows: 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3%, health perception, 68.2% self concept, 62.5%, and sleep and rest 62.5%. Looking at the nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 63.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL score at discharge was 19.78 +/- 8.23, and after 3 months 19.01 +/- 8.12. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did not deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight but not statistically significant decrease in the quality of life scores between the two test times (147.83 at discharge and 143.02 at the three month period).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A study of home care needs of patients at discharge and effects of home care--centered on patients discharged from a rural general hospital]. 149 45

PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 community-dwelling individuals, aged 65 and over, was randomly selected from electoral lists of 37 parishes of Gironde after stratification by age, sex, and size of urban unit; 68.9 percent agreed to participate. Baseline information was obtained from a one-hour home interview. Health measures included ADL, IADL, mobility, Rosow scale, and two subjective health assessments. Depressive symptomatology was assessed by the CES-D scale and cognitive functioning by Folstein's MMS. Dependence rates vary from 9.7 percent to 71.9 percent according to the indicator under consideration. Cross-sectional correlations with dependence are significant for age, sex, education, rural setting, joint pain, dyspnea, hearing and visual impairment, MMS score, and depression. In logistic regressions, only dyspnea, MMS score, and depression are always significantly correlated with dependence, whichever the indicator.
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PMID:Health measures correlates in a French elderly community population: the PAQUID study. 153 80

Using data from 441 newly admitted nursing home residents, we examined whether the diagnoses of mental illnesses, as well as other resident characteristics, were associated with use of physical restraints in both high restraint and low restraint use homes. Predictors of restraint use during both the first month and the first year of admission were inability to transfer and having a combination of severe ADL and cognitive impairment. Other predictors were wandering, inability to dress, symptoms of depression, and severity of cognitive impairment.
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PMID:Mental illness and the use of restraints in nursing homes. 157 7

Three studies were conducted on elderly patients with dementia. A case of control study on life styles before falling ill revealed that "intake of sweets" was significantly associated with clinically diagnosed dementia of the Alzheimer's type. Evaluation of treatments of outpatients suggests that proper care and some kinds of neuroleptics are useful for alleviation of abnormal behavior such as agitation, wandering, hallucination, insomnia and depression, but not for improvement of cognitive function and memory. A study on caregivers of elderly demented patients was undertaken to determine the relationship between the components of burden and symptoms of patients. Insomnia and abnormal behavior of patients correlated with physical and mental components of the burden of caregivers. Memory disturbance, psychological symptoms and deterioration in ADL correlated with physical burden. These studies indicate that symptoms accompanying dementia such as insomnia, wandering, hallucination and agitation should be the treated intensively for the purpose of improvement of the quality of the lives of patients and caregivers.
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PMID:[Prevention and treatment of dementia: what should we do today?]. 194 24

Most explanatory research into the utilization of home care for the elderly has been carried out in a cross-sectional design with multiple regression as the main method of analysis. For methodological reasons we chose another design in a project called 'Professional home care and informal help for the elderly', which has been conducted in the northern part of the Netherlands. Two types of causal variables were distinguished to detect influencing factors on professional home care utilization among the elderly, other than physical limitation: person-bound variables and social network variables. A Mokken Scale analysis for Polychotomous items (MSP) was used to measure the level of physical limitation and a matching procedure to compare 'users' and 'non-users' of professional home care. With regard to person-bound variables, sex, whether or not a person was living alone and the level of the elderly person's income appeared to play a role in the utilization of home care: the user group comprised significantly more women, more elderly living alone and more persons on a low income. Contrary to the findings in other Dutch research, depression and feelings of loneliness did not seem to discriminate between the two groups. With regard to social network variables, the size and structure of the social network was more or less identical in both groups. The non-users network lives slightly closer. In general, the small differences found between the groups were to the non-users' advantage. Moreover, the non-users received more informal and private care with ADL and IADL activities.
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PMID:Factors influencing professional home care utilization among the elderly. 200 25

We examined differences in stressors and well-being for caregivers who care for a relative with dementia at home and those who had placed their relative in a nursing home. The groups did not differ in depression or somatic complaints, but nursing home caregivers had fewer social and interpersonal disruptions. Controlling for caregiving problems, nursing home caregivers reported more stressors due to ADL (activities of daily living) assistance, their relatives' behavioral and cognitive functioning, and lack of caregiving support from family and friends.
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PMID:Stressors and well-being among caregivers to older adults with dementia: the in-home versus nursing home experience. 204 94

The purposes of this study are to delineate a profile of the state of a stroke patient's adaptation at 3 months after hospitalization and to explore the relationship between the level of adaptation and the variables which influence the adaptation of hemiplegic patients. To these ends, theoretical framework was derived basically from the stress adaptation model. The basic assumption underlying the level of adaptation is influenced by the presenting focal, contextual and residual stimuli. This group of stimuli is further operationalized and represented by a perception of stress, which is the perceived effect of the disability and by the mediating variables such as sociodemographic factors as an external conditioning variables and perceived social support and hardiness personality characteristics as an internal intervening variables. The dependent variables in this study is the level of physical, psychological and social adaptation and is hypothesized to be a function of the interaction between 3 sets of variables namely, the perceived disability effect, external conditioning variables and internal intervening variables. A total of fourty three subjects from 3 general hospitals in Seoul were observed and interviewed with the aid of 7 structured instruments. The data were collected twice on each subject: first, at the pre-discharge period and at 3 months post-discharge from hospital for the second time. The study was carried out for the period from February to August, 1988. The instruments used for the study include 4 existing scales and 3 scales developed by the researcher for this study. They are: 1) The ADL dependency scale and the scale of the clinical physical functions for the assessment of physical adaptation. 2) the SDS (self report of depression) to measure the level of psychological adaptation. 3) The scale for the amount of social activities for the measurement of the level of social adaptation. 4) The scale for the perceived effect of disability for the measurement of the focal stimuli. 5) The health related hardiness scale and the perceived interpersonal support self evaluation list (ISEL) for the measurement of the hardiness personality character and the perceived social support. The data obtained were analyzed using percentage, one way ANOVA, Pearson coefficients correlation and stepwise multiple regression. The findings provide valuable information about the present level of physical adaptation at 3 months after discharge. The patient revealed a decreased ADL dependency and lowered limitation of physical function as compared with pre-discharge state. Psychologically, the average degree of depression at follow up was within normal range of depression.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A study of factors influencing the state of adaptation of hemiplegic patients]. 236 4

Dutch researchers found a twice as high prevalence of depression among older users of professional home care compared to non-users. They concluded that depression might be a causal factor in the demand for professional home care. One of our research-questions in a project called 'Professional home care and informal help for the elderly' is the replication of this study: in which way is depression related to professional home care utilization among the elderly? To answer this question we compared a subsample of 60+ years old people, who just received professional home care with a subsample of 60+ years old who didn't get professional home care with more or less the same need of care based on physical handicaps (difficulties in performing a number of ADL- and household activities). Although we also found a positive correlation between depression and physical limitations, our results didn't support another hypothesis: the difference of depression between users and non-users. This difference may be caused by a different research-design and the accuracy in the analysis.
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PMID:[Depressive symptoms, invalidity and the use of professional home care by the elderly; replication and variations]. 252 94

The present study examined the effects of depression and injury level (paraplegics/quadriplegics) on respondents' daily activity (ADL) patterns for 53 spinal cord injured (SCI) persons living in the community. This investigation involved the administration of the Beck Depression Inventory, the Clinical Depression Measure, the Multiple Affect Adjective Check List, and the Activity Pattern Indicators. The first issue of interest was the incidence of clinical depression in this community-based sample. Evidence of clinical depression was found in only 15% of the sample, with 45% of respondents showing evidence of mild depression. A second issue concerned the independent and/or interactive effects of depression and injury levels across several different types of ADL. Independent depression effects were found for personal activities, such that mildly depressed respondents reported fewer personal activities than nondepressed individuals. Independent injury level effects were found for overall frequency of activities, with quadriplegics achieving lower scores than paraplegics. Interactive effects were obtained between depression and injury level for work and travel. For each of these activities, similar levels were found for nondepressed quadriplegic, mildly depressed quadriplegic, and mildly depressed paraplegic respondents, all of whom were less active than nondepressed paraplegics. These results suggest that for some activities depression may play as important a role in long-term rehabilitation as degree of disability.
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PMID:Depression and activity patterns of spinal cord injured persons living in the community. 359 45


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