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3 results

  • Chapter 12 - Depression and Associated Disorders

  • Edited by George Tadros, Aston University, Birmingham, George Crowther, Leeds and York Partnership NHS Foundation Trust, Leeds
  • Book:
    Handbook of Old Age Liaison Psychiatry
    Published online:
    04 April 2024
    Print publication:
    11 April 2024, pp 157-182

  • Summary

    An admission to hospital can be extremely distressing, and a life-changing event. This is particularly true for older people with multiple co-morbidities and complex social needs. It is perhaps unsurprising, then, that mood disorders are common in older people in hospital. A mood disorder can also precipitate a hospital admission, for instance through self-neglect or self-harm. When in hospital, altered mood states can impact a person’s ability to engage with the treatment and are associated with worse outcomes.

    This chapter describes the prevalence and aetiology of depression, mania, and their associated disorders in a general hospital setting. It goes on to consider the challenges of assessment in this environment, in particular the impact of the admission, morbidity, and medical interventions on a person’s mood state.

    It concludes by describing non-pharmacological and pharmacological treatment strategies for managing elevated and depressed mood in a hospital setting, where people may be physically compromised and the environment may not be ideal for meaningful therapeutic engagement.

  • Chapter 10 - Management of Violence in Acute Medical Hospital Settings

  • from Section 3 - Violence in Different Settings
  • Edited by Masum Khwaja, Imperial College of Science, Technology and Medicine, London, Peter Tyrer, Imperial College of Science, Technology and Medicine, London
  • Book:
    The Prevention and Management of Violence
    Published online:
    09 May 2023
    Print publication:
    11 May 2023, pp 155-165

  • Summary

    Violence in the acute hospital sector is a common occurrence; however, it is often poorly understood and managed when compared to violence in other healthcare or institutional settings. Aetiological factors, the victim profile and perpetrator profiles vary when compared to other settings. There are particular challenges when considering risk assessment and how violence is managed in these settings. We explore these challenges in the context of staffing, training, environmental factors and the medical model of care. The milieu of an emergency department with high-turnover acute healthcare delivery and the impact this has on violence and its management are also explored. We aim to describe the extent of the problem and provide recommendations specific to the challenges faced in the acute hospital setting, with learning being applied from outside sectors. The topical subject of acute behavioural disturbance/excited delirium is also discussed.

  • Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study

  • J. B. Hessler, M. Schäufele, I. Hendlmeier, M. N. Junge, S. Leonhardt, J. Weber, H. Bickel
  • Journal:
    Epidemiology and Psychiatric Sciences / Volume 27 / Issue 3 / June 2018
    Published online by Cambridge University Press:
    09 January 2017, pp. 278-287
  • Aims.

    Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care.

    Methods.

    Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses.

    Results.

    Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups.

    Conclusions.

    BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.