Treatment of the aged mentally ill: further unmasking of the effects of a diagnosis of chronic brain syndrome

Nurses' Diagnostic Stereotyping of the Elderly

This study experimentally tested three behaviors thought to underlie the clinical decision-making process that permits the systematic labeling of the elderly as senile; namely, when compared to a younger person with identical neuropsychiatric symptoms, an older person will more likely be given a diagnosis of organic brain syndrome, will more likely be given a poor prognosis for recovery, and will more likely be given palliative rather than interventive treatment. The study also examined the impact of contact with older patients on the making of these clinical decisions. Subjects were the entire nursing staff (N = 186) of a general hospital in a northeastern American city. One-half of the sample responded to a vignette of a young person and one-half to a vignette of an old person with identical signs of emotional, behavioral, and perceptual disorder. The results support the notion that clinical decisions tend to be biased against old age and thus contribute to inappropriate labeling of the elderly. Results also suggest that when compared to subjects having little contact with old patients, those having considerable contact were more likely to believe that all patients, regardless of age, have an organic, incurable, and untreatable illness.

House-Tree-Person Projective Technique: A Validation of its Use in Occupational Therapy

The purpose of this study was to determine if the House-Tree-Person Projective Technique (H-T-P) was a valid and efficient method for identifying a problem list for occupational therapy (OT) treatment. In order to do this, a comparative study using blinded procedures was carried out. Forty acute psychiatric clients were administered the H-T-P by a trained research officer who knew nothing about the clients. They were also given an OT assessment by their therapist and a nursing evaluation by their assigned nurse. In each case, a problem list was generated. These were compared for percentage agreement between problems, percentage of problems accounted for and the length of time required to generate the various lists. The percentage agreement between H-T-P and Nursing and between H-T-P and OT generated problem lists was 32.88 and 47.18, respectively. Percentage of problems accounted for was 66.42 and 75.19, respectively. The differences were discussed. The time required to administer the H-T-P was considerably less than administration time for the traditional occupational therapy assessment. In conclusion, the H-T-P was found to be a valuable screening tool.

Senile confusion: assessment with a new stimulus recognition test

There is a need for rapid and convenient assessment instruments to test the aged for senile confusion due to organic brain syndrome (OBS). The Mental Status Questionnaire (MSQ) and the Face-Hand Test (FHT) have certain limitations. A valid instrument must measure short-term memory loss and recognition. Sixty-two patients were examined in 17 different trials of the Stimulus Recognition Test (SRT), which involves 10 items. Each item classified the patients according to staff ratings (P less than .001), MSQ MSQ scores (P less than .005), and FHT scores (P less than .005). The composite MSQ score on a scale of 0--10 also served to separate the patients according to staff ratings (P less than .005). The SRT scores correlated .81 to .67 with the MSQ and FHT scores. The SRT does not show the same false positive patterns as the MSQ and FHT. For that reason, it constitutes a useful diagnostic supplement. Suggestions for further research are made.