Schizophrenia and paranoid disorders in late life

Author(s):  
Barton W. Palmer ◽  
Gauri N. Savla ◽  
Thomas W. Meeks

Estimates of the point-prevalence of paranoia and other psychotic symptoms among persons age ⋚ 65 years have ranged from approximately 4 per cent to 6 per cent, and may be as high as 10 per cent among those age ⋚ 85 years. Although the majority of these symptoms occur as secondary psychoses in the context of Alzheimer’s disease or related dementias, the population of people with schizophrenia is ageing along with the general ‘greying’ of the industrialized world, and mental health care for older adults with schizophrenia is expected to be an increasingly important public health concern. This chapter covers clinical features, classification systems, diagnosis and differential diagnosis, epidemiology, aetiology, course and prognosis, treatment, and management.

Author(s):  
Colin A. Espie ◽  
Delwyn J. Bartlett

Most people's experiences of poor sleep are memorable, because sleeplessness and its daytime consequences are unpleasant. There are those, however, for whom insomnia is the norm. Persistent and severe sleep disturbance affects at least one in 10 adults and one in five older adults, thus representing a considerable public health concern. Sleep disruption is central to a number of medical and psychiatric disorders, and insomnia is usually treated by general practitioners. Therefore differential diagnosis is important, and respiratory physicians, neurologists, psychiatrists, and clinical psychologists need to be involved. The purpose of this chapter is to summarize current understanding of the insomnias, their appraisal, and treatment. Particular emphasis will be placed upon evidence-based practical management.


2019 ◽  
Vol 2 (1) ◽  
pp. 77-78
Author(s):  
Niresh Thapa ◽  
Muna Maharjan

Diabetes is an important public health concern which is increasing rapidly in developing countries. It is challenging to prevent and manage diabetes in a rural setting. The Integrated Diabetic Clinic is comprehensive diabetes care under one roof. Its aim is to provide efficient accessible and affordable comprehensive care. It will make a huge difference in the management of diabetes. This clinic will play a major role in unifying different aspects of health care under one roof and offer the most comprehensive and cost-effective accessible health care to minimize mortality and morbidity associated with diabetes.


2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Kara A. Zamora ◽  
Traci H. Abraham ◽  
Christopher J. Koenig ◽  
Coleen C. Hill ◽  
Jeffrey M. Pyne ◽  
...  

How to best engage rural veterans in mental health care is challenging and a topic of public health concern. Rural-dwelling veterans experience greater mental health burden and poorer outcomes than their urban counterparts, making rural veteran engagement in mental health care a public health concern. In this article, we describe how institutional notions of “patient engagement” align with or diverge from rural veteran patient experiences of engagement in mental health care. Using an adapted case study approach developed for our study, we detail the mental health care experiences of three rural-dwelling veteran participants. These case studies illustrate varied forms of mental health care engagement, including use of community resources and self-management activities, that might not be recognized by clinicians as contributing to mental health treatment. Our findings highlight how critical gaps in institutional definitions of care engagement fail to acknowledge veterans’ experiences.


2017 ◽  
Vol 41 (S1) ◽  
pp. S734-S734
Author(s):  
M.A. Dos Santos

IntroductionMental health care is indispensable, has an essential role in development, but mental health issues are a major public health concern worldwide. Sexual minorities, lesbian, gay and bisexual, suffer from prejudice and it determines health inequities, especially for their mental health.ObjectiveTo show the relation between discrimination and mental health issues in lesbian, gay and bisexual (LGB) people and to increase understanding of this serious neglected public health problem.MethodsThe search was conducted using Science Direct and Scopus, using the following keywords: “discrimination” and “mental health” and “lesbian” and “gay” and “bisexual”. Using the review of literature, documents in English (articles, official documents, editorial, reviews, clinical trials).DiscussionNumerous studies have identified highest risk behavior, as illicit drug use, sexual risk-taking behaviors and mental health issues among LGB people. Some previous studies propose that health and risk disparities between heterosexual and LGB identifying or behaving people are due to minority stress–that is, that the stigma, discrimination, and violence experienced, leading to stress, thus predisposing illness, disease (worse mental and physical health outcomes) and potentially substance use, which may be used to relieve or escape stress.ConclusionHealth professionals and healthcare organizations must cover these unmet mental health needs if they move to more integrated, coordinated models of care. Health educators should attend to the unique needs of each sexual orientation group when presenting sexual health information and health care providers should undergo diversity and sensitivity training to work more effectively with those groups.Disclosure of interestThe author has not supplied his/her declaration of competing interest.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 741-741
Author(s):  
Courtney Polenick ◽  
Vanessa Lee ◽  
Shreya Salwi ◽  
Nikita Daniel ◽  
Annie Zhou ◽  
...  

Abstract The COVID-19 pandemic may have adverse health implications, particularly among older adults with chronic conditions who are at increased risk of severe illness. This cross-sectional study examined the early health impacts of the pandemic among adults aged 50 and older with chronic conditions. Participants included 700 adults (M = 64.60 years, SD = 8.85, range = 50 – 94) from Michigan (82.4%) and 33 other U.S. states who reported at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020. Of these, 488 also provided open-ended responses. Individuals reported lower illness self-efficacy, less consumption of fruits, vegetables, and fried foods, and lower physical activity, along with greater alcohol use since the pandemic. About half (42.7%) reported worsened sleep. One in five (20.1%) reported at least some difficulty obtaining medications and over half (60.4%) reported at least some difficulty receiving routine care. Almost two-thirds (63.9%) had delayed preventative care and one in five (19.3%) had delayed essential medical treatment. Nearly half (42.6%) avoided contacting care providers about a physical health concern and one in eight (12.9%) avoided reporting mental health concerns. Qualitative data revealed that the pandemic has influenced how participants cared for their physical health through following guidelines related to COVID-19; coping with daily routine changes; greater awareness of self-care; mental health impacts; and health care disruptions. Older adults with chronic conditions report distinct pandemic-related challenges for self-care and health care that should be addressed in interventions to maintain their health and functioning.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Julia Anne Silano ◽  
Carla Treloar ◽  
Thomas Wright ◽  
Tracey Brown ◽  
Colette McGrath ◽  
...  

Purpose This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW). Design/methodology/approach By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee’s success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group’s audit were drawn by critically appraising the JHFMHN/CSNSW HRRG’s Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature. Findings The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings. Social implications Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large. Originality/value Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives.


2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng Wang ◽  
Peizhen Zhao ◽  
Mingzhou Xiong ◽  
Joseph D. Tucker ◽  
Jason J. Ong ◽  
...  

Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.


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