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Salime S, Clesse C, Jeffredo A, Batt M. Process of Deinstitutionalization of Aging Individuals With Severe and Disabling Mental Disorders: A Review. Front Psychiatry 2022; 13:813338. [PMID: 35401263 PMCID: PMC8987193 DOI: 10.3389/fpsyt.2022.813338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For more than 60 years, psychiatric services has gradually gone from an asylum model to a community model. This change has led to the emergence of a deinstitutionalization movement. This movement seems to have left behind long-term hospitalized aging individuals with severe and disabling mental disorders. The objective of this article is to conduct a review on the challenges and issues associated with the process of deinstitutionalization among hospitalized aging individuals with severe and disabling mental disorders. METHODS Using PRISMA statement, the research methodology was carried out in English and French in 16 databases with a combination of 3 lists of keywords. The selection process was then followed by a thematic analysis which aimed at categorizing by theme and classifying the writings selected. RESULTS A total of 83 articles published between 1978 and 2019 were selected and organized into six categories: (a) a forgotten population in research and health policies, (b) an economic presentation of the deinstitutionalization process, (c) an improvement in quality of life and global functioning for deinstitutionalized patients (d) from stigmatization to the rejection of elderly psychiatric inpatients from deinstutionalization process, (e) a difficult community-based care offer and a difficult epistemological identification, (f) from the lack of community services to the phenomenon of transinstitutionalization. The current state of scientific research, institutional policies and clinical practices associated with the deinstitutionalization process of SVPTSIH are then commented. CONCLUSIONS Recommendations are proposed to researchers and professionals concerned with the support of long-term hospitalized aging individuals with severe and disabling mental disorders.
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Affiliation(s)
- Samira Salime
- INTERPSY Laboratory, University of Lorraine, Nancy, France.,Hope 54 Association, Nancy, France
| | - Christophe Clesse
- INTERPSY Laboratory, University of Lorraine, Nancy, France.,Center for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine Dentistry, Queen Mary University of London, London, United Kingdom.,Psychiatric Hospital of Jury-les-Metz, Metz, France
| | | | - Martine Batt
- INTERPSY Laboratory, University of Lorraine, Nancy, France
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Locked in and Growing Old: The Psychiatric, Forensic, and Cognitive Correlates of 30 Years of Psychiatric Hospitalization. Am J Geriatr Psychiatry 2018; 26:188-197. [PMID: 29122420 DOI: 10.1016/j.jagp.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As the number of older adults in the United States continues to grow, the population of older adults with severe mental illness in institutional settings (OASIS) is expected to place a significant demand on healthcare resources. This study presents an update to research regarding the clinical characteristics of OASIS inpatients with histories of extensive hospitalization through the use of a newly developed psychiatric measure: the Clinician-Rated Dimension of Psychosis Symptom Severity. METHODS We investigated an OASIS sample (N = 55) with an average of nearly 30 continuous years of hospitalization at a forensic state psychiatric hospital. RESULTS The average OASIS patient exhibited the most prominent psychiatric symptoms via delusions and negative symptoms, received psychotropic medications at substantially higher doses than recommended therapeutic levels, rarely committed acts of institutional violence (IV), and performed more than two standard deviations below the normative mean on cognitive testing. More severe hallucination symptoms were associated with higher psychotropic medication dosage, and more severe depressive symptoms were associated with more IV incidents. OASIS inpatients performed moderately worse than general psychiatric inpatients in the areas of overall cognition, immediate memory, and delayed memory; older age was associated with poorer language and attention. No psychiatric or cognitive factors predicted IV incidents. CONCLUSION These results highlight the continued importance of understanding the psychiatric, forensic, and cognitive factors associated with aging in an institutional setting and how these factors among OASIS inpatients may vary from general psychiatric inpatients.
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Cort E, Meehan J, Reeves S, Howard R. Very Late-Onset Schizophrenia-Like Psychosis: A Clinical Update. J Psychosoc Nurs Ment Health Serv 2017; 56:37-47. [PMID: 28990640 DOI: 10.3928/02793695-20170929-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/07/2017] [Indexed: 11/20/2022]
Abstract
Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late-onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric-mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 37-47.].
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Izaute M, Jalenques I. Metamemory with ageing in schizophrenia: a first study. Psychiatry Res 2014; 219:703-6. [PMID: 25023367 DOI: 10.1016/j.psychres.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/31/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
The aim was to study metamemory during encoding in older schizophrenia patients. Thirteen older patients were compared to 13 healthy controls. Despite their memory impairment, older schizophrenia patients were able to assess the material accurately. They were not able, however, to adapt their learning time as efficiently as controls.
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Affiliation(s)
- Marie Izaute
- Clermont University, Blaise Pascal University, LAPSCO, F-63037 Clermont-Ferrand, France; CNRS, UMR 6024, LAPSCO, 34 avenue Carnot, F-63037 Clermont-Ferrand, France.
| | - Isabelle Jalenques
- CHU Clermont-Ferrand, Service de Psychiatrie de l׳Adulte A et Psychologie médicale, Pôle de Psychiatrie, F-63003 Clermont-Ferrand, France; Clermont Université, Université d׳Auvergne Clermont 1, UFR Médecine, Equipe d׳Accueil 7280, F-63001 Clermont-Ferrand, France
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Struble LM, Sullivan BJ, Hartman LS. Psychiatric disorders impacting critical illness. Crit Care Nurs Clin North Am 2013; 26:115-38. [PMID: 24484928 DOI: 10.1016/j.ccell.2013.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An astounding 30% to 50% of older patients who are hospitalized for a medical condition also have a psychiatric disorder. The intent of this article is to prepare acute care nurses to meet the mental health needs of older adults with a critical illness and prevent untoward sequelae of medical events. The authors discuss the importance of baseline assessment data, issues related to informed consent, manifestations of common psychiatric disorders that may be seen in older adults in the acute care setting, as well as strategies to improve patient outcomes.
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Affiliation(s)
- Laura M Struble
- Division of Acute, Critical and Long-Term Care, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
| | - Barbara J Sullivan
- Division of Acute, Critical and Long-Term Care, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109, USA
| | - Laurie S Hartman
- University of Michigan Hospitals and Health System, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109, USA
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Vahia IV, Lanouette NM, Golshan S, Fellows I, Mohamed S, Kasckow JW, Zisook S. Adding antidepressants to antipsychotics for treatment of subsyndromal depressive symptoms in schizophrenia: Impact on positive and negative symptoms. Indian J Psychiatry 2013; 55:144-8. [PMID: 23825848 PMCID: PMC3696237 DOI: 10.4103/0019-5545.111452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms. MATERIALS AND METHODS Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms. RESULTS There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores. CONCLUSIONS In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.
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Affiliation(s)
- Ipsit V Vahia
- Department of Psychiatry, University of California San Diego, California, USA ; Stein Institute for Research on Aging, University of California San Diego, California, USA
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Studying late-onset schizophrenia and non schizophrenia psychosis in elderly Egyptian patients. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000407866.00571.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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What do we know about neuropsychological aspects of schizophrenia? Neuropsychol Rev 2009; 19:365-84. [PMID: 19639412 PMCID: PMC2745531 DOI: 10.1007/s11065-009-9109-y] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/02/2009] [Indexed: 11/05/2022]
Abstract
Application of a neuropsychological perspective to the study of schizophrenia has established a number of important facts about this disorder. Some of the key findings from the existing literature are that, while neurocognitive impairment is present in most, if not all, persons with schizophrenia, there is both substantial interpatient heterogeneity and remarkable within-patient stability of cognitive function over the long-term course of the illness. Such findings have contributed to the firm establishment of neurobiologic models of schizophrenia, and thereby help to reduce the social stigma that was sometimes associated with purely psychogenic models popular during parts of the 20th century. Neuropsychological studies in recent decades have established the primacy of cognitive functions over psychopathologic symptoms as determinants of functional capacity and independence in everyday functioning. Although the cognitive benefits of both conventional and even second generation antipsychotic medications appear marginal at best, recognition of the primacy of cognitive deficits as determinants of functional disability in schizophrenia has catalyzed recent efforts to develop targeted treatments for the cognitive deficits of this disorder. Despite these accomplishments, however, some issues remain to be resolved. Efforts to firmly establish the specific neurocognitive/neuropathologic systems responsible for schizophrenia remain elusive, as do efforts to definitively demonstrate the specific cognitive deficits underlying specific forms of functional impairment. Further progress may be fostered by recent initiatives to integrate neuropsychological studies with experimental neuroscience, perhaps leading to measures of deficits in cognitive processes more clearly associated with specific, identifiable brain systems.
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Outcome among community dwelling older adults with schizophrenia: results using five conceptual models. Community Ment Health J 2009; 45:151-6. [PMID: 18787951 DOI: 10.1007/s10597-008-9161-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 08/26/2008] [Indexed: 11/27/2022]
Abstract
There have been few studies examining the outcome of schizophrenia in later life. Using five conceptual models, we test two hypotheses with respect to range of outcomes among older schizophrenia outpatients and how they compare to their age peers in the community. We operationalized five outcome measures from the following conceptual models: Remission, adapting criteria of Andreasen et al. (The American Journal of Psychiatry, 162:441-449, 2005); Recovery, adapting the criteria by Liberman et al. (International Review of Psychiatry, 14:256-272, 2002); Community Integration using the model of Wong and Solomon (Mental Health Services Research, 4:13-28, 2002); Subjective and Objective Successful Aging using the model of Rowe and Kahn (Science, 237:143-149, 1987). The schizophrenia (S) group consisted of 198 community-dwelling persons aged 55 and over who developed schizophrenia before age 45 and a community comparison (CC) group (N = 113). Remission and recovery criteria were met by 49 and 17% of the S group, respectively. There were significant differences between the S and CC groups in the distribution of community integration and successful aging scales: 41% of the CC group met at least 10 of 12 criteria versus 23% of the S group on the Community Integration Scale; 19% of the CC group met all six criteria vs. 2% of the S group on the Objective Successful Aging Scale; 27% of the CC group vs. 13% of the S group met all six criteria on the Subjective Successful Aging Scale. Correlations among the five outcome measures ranged from r = .19 to .48 (median value: r = .26 or 7% shared variance). There is wide variability in outcome in later life depending on which measure is used. Rather than one universal indicator, each measure offers a different perspective that can provide useful guidelines for researchers, clinicians, and policy makers.
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Abstract
OBJECTIVE Symptomatic remission has been reported in younger patients with schizophrenia. This study aims to determine the prevalence of symptomatic remission in older adults with schizophrenia. METHODS The Schizophrenia Group consisted of 198 persons aged 55+ years living in the community who developed schizophrenia before age 45 years. Our definition of remission was adapted from the criteria of the Remission in Schizophrenia Working Group. To attain remission, persons had to have scores of <3 on eight domains of the Positive and Negative Symptom Scale and no hospitalizations within the previous year. Using George's Social Antecedent Model, we examined the association of remission with 18 predictor variables. RESULTS Forty-nine percent of the sample met the criteria for symptomatic remission. In logistic regression analysis, four variables--fewer total network contacts, greater proportion of intimates, fewer lifetime traumatic events, and higher Dementia Rating Scale scores--were significantly associated with remission. CONCLUSIONS Remission rates were consistent with those reported in younger samples. Our findings suggest that symptomatic remission is an attainable goal and that treatments focused on those variables associated with remission may augment outcomes in older persons with schizophrenia.
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Vahia IV, Cohen CI. Psychosocial interventions and successful aging: new paradigms for improving outcome for older schizophrenia patients? Am J Geriatr Psychiatry 2007; 15:987-90. [PMID: 18056816 DOI: 10.1097/jgp.0b013e31815ae35c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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