Use of psychiatric medication in three Arctic nursing homes: association with dementia and psychiatric symptoms

Aims.To examine stigma- and knowledge-related barriers to help-seeking among members of the general population.Methods.In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed.Results.A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health.Conclusions.Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.

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The Outcomes of a Person-centered, Non-Pharmacological Intervention in Reducing Behavioral and Psychiatric Symptoms in Residents With Advanced Dementia in Australian Rural Nursing Homes

10.21203/rs.3.rs-38968/v1 ◽

2020 ◽

Author(s):

Vivian Isaac ◽

Abraham Kuot ◽

Mohammad Hamiduzzaman ◽

Edward Strivens ◽

Jennene Greenhill

Keyword(s):

Nursing Homes ◽

Psychiatric Symptoms ◽

Trial Registration ◽

Advanced Dementia ◽

Aggressive Behaviors ◽

Rural Nursing ◽

Stress Threshold ◽

Progressively Lowered Stress Threshold ◽

Stress Inventory ◽

Rural Australia

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with advanced dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with advanced dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focusing on the theory and delivery of the Progressively Lowered Stress Threshold principles and a music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. Triangulation using post- intervention qualitative evaluation from 13 focus group discussion and 38 staff interviews. This study adheres to the CONSORT guidelines.ResultsMean age of residents with advanced dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was comparable reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing behavioral and psychiatric symptoms in advanced dementia with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

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The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes

International Journal of Geriatric Psychiatry ◽

10.1002/gps.1749 ◽

2007 ◽

Vol 22 (9) ◽

pp. 843-849 ◽

Cited By ~ 245

Author(s):

Geir Selbæk ◽

Øyvind Kirkevold ◽

Knut Engedal

Keyword(s):

Nursing Homes ◽

Psychotropic Drugs ◽

Psychiatric Symptoms

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THE IMPACT OF MUSIC AND MEMORYSM ON RESIDENT MOOD, BEHAVIORS, AND USE OF MEDICATIONS IN NURSING HOMES

Innovation in Aging ◽

10.1093/geroni/igz038.2682 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S731-S732

Author(s):

Debra Bakerjian ◽

Kristen Bettega ◽

Ana Marin-Cachu ◽

Leslie Azzis ◽

Sandra Taylor

Keyword(s):

Nursing Homes ◽

Psychiatric Symptoms ◽

Baseline Survey ◽

Music Program ◽

Randomized Design ◽

Level Information ◽

Quasi Experimental ◽

And Behaviors ◽

Cluster Randomized ◽

The Impact

Abstract The numbers of Americans with dementia are projected to increase by 44.8% by 2025. Many of these patients are cared for in nursing homes (NH), 70% of NH residents with dementia have been reported to have significant behavioral or psychiatric symptoms (BPSD) that are often challenging to manage. Historically, the first lines of treatment for BPSD has been antipsychotic medications; however, serious adverse effects have been associated with these drugs. Our main aim was to study the effects of Music and MemorySM (M&M), a personalized music program, on improving behaviors and reducing antipsychotics and other medications in residents with dementia in participating NHs. This 3-year, quasi-experimental, mixed methods study used a cluster, randomized design in three phases. We used the Qualtrics Research Suite to create and disseminate a baseline survey and a 4-part quarterly survey thereafter. The quarterly survey collected select resident MDS data including diagnoses, medication use, pain, falls, mood and behaviors; how M&M was being implemented; resident use of M&M; organization level information. We also downloaded NH 5-Star quality rating quarterly. A total of 265 NH and 4,109 residents participated in the study. We found the odds of antipsychotic use declined by 11%, antianxiety medications by 17%, and antidepressants by 9% per quarter. The odds of residents exhibiting aggressive behaviors declined by 20% per quarter, depressive symptoms by 16% and residents reporting pain by 17%. Our findings indicate that M&M provides substantial benefit to NH residents, particularly in reduction of psychoactive medications and improving mood and behaviors.

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A Survey of Practitioner’s Knowledge of Psychiatric Medication Costs

Kansas Journal of Medicine ◽

10.17161/kjm.v6i3.11447 ◽

2013 ◽

Vol 6 (3) ◽

pp. 89-93

Author(s):

Deepak Rajpoot ◽

Albert B Poje ◽

Larry Carver ◽

Jyoti Rajpoot ◽

Ravi Rajpoot ◽

...

Keyword(s):

Internal Medicine ◽

Psychiatric Symptoms ◽

Psychiatric Training ◽

Psychiatric Medication ◽

Training Experience ◽

Internal Medicine Training ◽

Medication Costs ◽

Accurate Knowledge ◽

Contemporary Medicine ◽

Attending Physicians

Introduction. Escalating medical costs continue to be an issue facing contemporary medicine. One factor contributing to this escalation may be physicians’ knowledge of medication costs. As physicians increasingly face opportunities to treat a variety of symptoms and conditions in a single patient, including co-morbid psychiatric disorders or complications, accurate knowledge of medication costs becomes increasingly important. Methods. Resident and attending physicians (N = 16) across the disciplines of internal medicine, psychiatry, and combined internal medicine/psychiatry from a large, mid-western medical school were surveyed on the costs of several medications that are used to manage physical and psychiatric symptoms. Results. Differences were found in the perceived estimated cost of medications among practitioners particularly with specialty internal medicine training as compared to those with additional psychiatric training/experience. Trends also were noted across practitioners with psychiatric and internal medicine/psychiatry training. Conclusions. The breadth of training and experience can affect accuracy in estimating anticipated costs of medication regimens.

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Dementia Syndromes in Nursing Home Patients

International Psychogeriatrics ◽

10.1017/s1041610292001078 ◽

1992 ◽

Vol 4 (2) ◽

pp. 241-252 ◽

Cited By ~ 7

Author(s):

M. Andersson ◽

C. G. Gottfries

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Depressed Mood ◽

Long Term Care ◽

Psychiatric Symptoms ◽

The Elderly ◽

Minor Importance ◽

Term Care ◽

Nursing Home Patients

Patients (n = 191) living in four comparable somaic nursing homes (NH) (nursing homes for physical illness) were studied in order to evaluate dementia syndromes. Dementia and symptoms of depressed mood occurred frequently (72% and 63%, respectively). Dementia was often undiagnosed at admittance. Neither the length of time spent in institutions, nor marital status, age, or sex seemed to be of more than minor importance to the prevalence of dementia syndromes. Concerning functional impairment, convergence of findings across the societies studied indicates that psychiatric symptoms and psychopathology are intrinsic parts of long-term care of the elderly.

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Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes

BMC Psychiatry ◽

10.1186/s12888-020-03033-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daya Ram Parajuli ◽

Abraham Kuot ◽

Mohammad Hamiduzzaman ◽

Justin Gladman ◽

Vivian Isaac

Keyword(s):

Nursing Homes ◽

Qualitative Data ◽

Psychiatric Symptoms ◽

Aged Care ◽

Psychotropic Medications ◽

Care Homes ◽

Pharmacological Intervention ◽

Post Intervention ◽

Rural Nursing ◽

Limited Effectiveness

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration ANZCTR, ACTRN12618000263291. Registered on 20th February 2018.

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Neuropsychiatric Lupus in an Adolescent Presenting with Bipolar Disorder with Catatonic Features

European Psychiatry ◽

10.1016/s0924-9338(09)70803-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

A. Alao ◽

C. Chung

Keyword(s):

Family History ◽

Pediatric Patients ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Psychiatric Disease ◽

African American Female ◽

Neuropsychiatric Lupus ◽

Psychiatric Medication ◽

Bipolar I Disorder ◽

Neuropsychiatric Manifestations

Case presentation:We describe a 15-year-old African American female with a family history positive for Bipolar I disorder and schizophrenia who presented with symptoms consistent with an affective disorder. The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic workup, which revealed cerebral vasculitis. Neuropsychiatric lupus (NPSLE) was diagnosed and, following treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy.Conclusion:Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in 80-91% of adults and up to 95% of pediatric patients with SLE. In the case we described, diagnosis was hindered by the patient's presentation of what appeared to be isolated psychiatric symptoms and her strong family history of psychiatric disease. Thus, given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent may indeed be the initial manifestations of SLE.

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Psychiatric consultation in the nursing home: reasons for referral and recognition of delirium

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2017.71 ◽

2017 ◽

Vol 36 (2) ◽

pp. 121-127

Author(s):

L. Wilson ◽

C. Power ◽

R. Owens ◽

B. Lawlor

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Psychiatric Symptoms ◽

Psychological Symptoms ◽

Psychiatric Nursing ◽

Nurse Specialist ◽

Prescribing Practices ◽

Common Diagnosis ◽

Psychiatric Problems ◽

Hospital Psychiatry

ObjectiveTo describe the behavioural and psychiatric problems found in nursing home psychiatric referrals in the Dublin South city area.MethodsWe undertook two consecutive surveys of nursing home referrals to the St James’s Hospital psychiatry of old age service over a 2-year period. During the second survey a new clinical nurse specialist was specifically appointed to manage the seven nursing homes included in the study.ResultsThe most common reason for referral during survey one was uncooperative/aggressive behaviour (22%). For survey two, patients were most commonly referred for low mood (31%) or agitation (29%). During survey one, the majority of patients assessed were diagnosed with behavioural and psychological symptoms of dementia (41%). This was also a prevalent diagnosis during survey two, affecting 27% of those referred. Only 7% of patients were considered to be delirious during survey one. This rose to 31% the following year making it the most common diagnosis during survey two. Over the 2-year study period, 7% of referred patients were diagnosed with depression. In terms of prescribing practices, the discontinuation rate of antipsychotic mediation following psychiatric input was 13% in survey one. By survey two, this had risen to 47%.ConclusionsDelirium is often undetected and untreated in nursing homes. Residents presenting with psychiatric symptoms should undergo routine bloods and urinalysis prior to psychiatric referral. Dedicated input from trained psychiatric nursing staff can lead to both an improvement in the recognition of delirium and reduced prescribing rates of antipsychotic medication.

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The Nexus of ‘Music, Mind, and Well-being’: Effects of Harmony in the Bush Music Intervention for Residents with Advanced Dementia in Australian Rural Nursing Homes

10.21203/rs.3.rs-67641/v1 ◽

2020 ◽

Author(s):

Mohammad Hamiduzzaman ◽

Abraham Kuot ◽

Jennene Greenhill ◽

Edward Strivens ◽

Daya Ram Parajuli ◽

...

Keyword(s):

Nursing Homes ◽

Qualitative Data ◽

Psychiatric Symptoms ◽

Behavioural Change ◽

Well Being ◽

T Test ◽

Advanced Dementia ◽

Music Intervention ◽

Time Points ◽

Rural Nursing

Abstract BackgroundPersons with dementia often show aggression, depression, and anxiety and these symptoms and behaviours escalate overtime without treatment. Music has been found to be useful for managing these symptoms and behaviours and can significantly improve well-being. This paper reports the effect of music on residents with advanced dementia in rural nursing homes, as a key part of the Harmony in the Bush study.MethodsWe conducted a quasi-experimental research in five Australian rural nursing homes. Managers of nursing homes were contacted to select residents with advanced dementia, resulted in 74 residents who participated in person-centred music and culturally-appropriate group music sessions. Staff (104) and musicians (6) participated in 65 interviews and 20 focus groups. One-Way ANOVA and paired-samples t-test were performed to understand Music in Dementia Assessment Scale (MiDAS) scores. Qualitative data were thematically analysed.ResultsSeventy-four residents participated in an average of 9.5 [SD 4.73] person-centred music sessions and most of them were female (n = 52/70%). Analysis revealed the overall mean effect of the person-centred music at two-time points as 67% [during-70% {351.22 (SD:93.51)}; and after-63% {315.09 (SD:98.52)}]. The residents with (moderate to severe) pain, anxiety, sadness, and agitation at pre-intervention, presented an improvement in their levels of interest, response, initiation, involvement, and enjoyment at different time-points. The t-test showed that the MiDAS sub-categories’ mean scores differed significantly between the time-points: interest [t = 2.75, p = 0.001]; response [t = 2.94, p = 0.005]; initiation [t = 2.41, p = 0.019]; and involvement [t = 2.78, p = 0.007]. Additionally, the residents were observed at post-intervention with a reduction of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%); and an improvement in relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data were behavioural change, meaningful interaction, being initiative, increased participation, and contentment.ConclusionFindings suggest the music intervention probably reduce the residents’ psychiatric symptoms and behaviours and improve well-being.Clinical RegistrationThe study is registered with the Australian and New Zealand Clinical. Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p; http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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