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Esiwe C.,Lincolnshire Partnership NHS Foundation Trust | Baillon S.,University of Leicester | Rajkonwar A.,Tees | Lindesay J.,University of Leicester | And 2 more authors.
Age and Ageing | Year: 2015

Background: depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). Methods: one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). Results: a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. Conclusion: the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


Baillon S.,University of Leicester | Lindesay J.,University of Leicester | Prabhakaran P.,Worcestershire Health and Care NHS Trust | Hands O.,Leicestershire Partnership NHS Trust | And 9 more authors.
International Journal of Geriatric Psychiatry | Year: 2014

Objective: This study aimed to evaluate the Edinburgh Depression Scale (EDS) as a screening tool for use in a Parkinson's disease (PD) population. Many commonly used depression scales include items relating to somatic symptoms that also occur in PD, which could potentially result in inaccurate reporting of depressive symptoms. The EDS is a scale that incorporates no somatic items. Method: One hundred twenty patients attending specialist PD clinics were assessed using a standardised diagnostic interview (Present State Examination - Schedules for Clinical Assessment in Neuropsychiatry) to establish a diagnosis of DSM-IV depression. They later completed the EDS with another researcher who was blind to the results of diagnostic interview. A receiver operating characteristic curve analysis was carried out to identify the optimal threshold score on the EDS and the Brief EDS to identify any depressive disorder or major depression. The performance characteristics at a range of thresholds were compared. Results: A cut-off score of 10/11 gave maximal discriminant validity, with 74% sensitivity, 92% specificity and 64% positive predictive value for the identification of any depression according to DSM-IV criteria. Conclusions: This study suggests that the EDS is both a valid and potentially useful instrument that can be used as a quick self-completion questionnaire for screening for depression in people who have PD. © 2014 John Wiley & Sons, Ltd.


PubMed | Lincolnshire Partnership NHS Foundation Trust, University of Leicester, Tees, University of Swansea and Leicester General Hospital
Type: Journal Article | Journal: Age and ageing | Year: 2016

depression is common in people with poor physical health, particularly within the acute medical in-patient setting. Co-morbid depression contributes to poor outcomes, and screening for depression in acute medical in-patients has been advocated. The Edinburgh Depression Scale (EDS) has been validated in a variety of general hospital patient groups, but not previously in older acute medical in-patients.one hundred and eighteen patients aged 65 and older on acute medical wards were assessed using a standardised diagnostic interview (Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry) to identify depression according to ICD-10 criteria. They subsequently completed the EDS. The performance characteristics at a range of thresholds were compared, and receiver operating characteristic curve analysis was performed.the optimal EDS cut-off for identifying ICD-10 depressive episode was 7/8, with a sensitivity of 88%, specificity of 77%, positive predictive value of 52% and negative predictive value of 96%. The area under the receiver operating characteristic curve was 0.91.the EDS was shown to be a useful instrument for detecting clinical depression in older people on acute medical wards in this study. Its performance was equivalent to other validated screening instruments in this population. Our findings add further weight to using the EDS as a screening instrument for depression in multiple general hospital settings.


PubMed | Lincolnshire Partnership NHS Foundation Trust, University of Leicester, Tees and University of Swansea
Type: Journal Article | Journal: Age and ageing | Year: 2015

depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE).one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15).a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%.the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases.


Jordan A.,Northumbria Healthcare NHS Foundation Trust | Hughes J.,Northumbria Healthcare NHS Foundation Trust | Hughes J.,Newcastle University | Pakresi M.,Tees | And 2 more authors.
International Journal of Geriatric Psychiatry | Year: 2011

Objective: Studies suggest that pain is under-recognized and under-treated in those with severe dementia. Identifying pain is the first step in its effective management. Few studies have investigated the utility of behavioural pain tools in those with advanced dementia. Methods: Participants were nursing home residents with advanced dementia who were observed on three occasions using a pain assessment tool (PAINAD). Following further assessment, an appropriate management plan was formulated for those thought to be in pain. Participants who scored above the cutoff (two) on the PAINAD scale, but were felt not to be in pain, formed the false positive group. The pain and false positive groups were reassessed at 1 and 3 months. Results: Seventy-nine participants completed the study, with 39 participants scoring above two on the PAINAD. Of these, only 13 were assessed as being in pain. The other 26 participants who scored above the cutoff on PAINAD were not felt to be in pain. Instead, their behaviour had a psychosocial explanation, often to do with a lack of understanding as to what was happening to them. The sensitivity of PAINAD was 92%. In those with pain, a significant decrease was demonstrated in the PAINAD scores on intervention following treatment for pain (p=0.008). Conclusions: PAINAD is a sensitive tool for detecting pain in people with advanced dementia, but has a high false positive rate, frequently detecting psychosocial distress rather than pain. PAINAD can be used to assess whether pain management strategies have been successful. Copyright © 2010 John Wiley & Sons, Ltd.


de Silva P.N.,Tees
Progress in Neurology and Psychiatry | Year: 2013

The SBARD communication system is recommended by the NHS Institute for Innovation and Improvement for use in electronic documentation, letters and reports. Here, Dr de Silva describes how his Old Age Psychiatry team in Whitby applied SBARD and the resulting effect on quality of documentation. © 2013 John Wiley & Sons, Ltd.


PubMed | Tees
Type: Journal Article | Journal: International review of psychiatry (Abingdon, England) | Year: 2010

Improving pathways into care is an important part of government policy on delivering equitable care and treatment for the BME community. As part of EPIC Easington Mental Health services agreed to participate in the project to increase the level of self seeking behaviour at the point prior to accessing to our services for the Chinese community in order to reduce fear, increase satisfaction with services and ensure our workforce was capable of delivering appropriate and responsive care.A literature search, community development approach and clinical pathway of care identified the key aims of the project. Four work streams were identified each with agreed overall aims and outcomes with the project group steering implementation.There was recognition at commencement that key outcomes would be difficult to quantify and the project would continue outside the parameters however we were able to demonstrate improvement as a result of the project and identify key learning points.


PubMed | National University of Ireland, University of Liverpool and Tees
Type: Journal Article | Journal: Neuropsychology | Year: 2016

The notion that artistic capability increases with dementia is both novel and largely unsupported by available literature. Recent research has suggested an emergence of artistic capabilities to be a by-product of involuntary behaviour seen with dementia, as opposed to a progression in original thinking (de Souza, et al., 2010). A far more complementary explanation comes from Hannemann (2006), who suggests that art offers an outlet for dementia patients to refine and sharpen their cognitive abilities. As dementia severely impedes linguistic skills, non-verbal therapeutic methods such as painting can permit dementia patients to express themselves in a way not possible verbally. Fractal analysis has been used to determine the authenticity of major works of art. Taylor et al., (1999) found that through a fractal analysis of Jackson Pollocks paintings it was possible to distinguish authentic works from a large collection of fakes, demonstrating that when artists paint they instill within their work their own pattern of unique fractal behaviour. Can age-indexed variations in the fractal dimension of the works of artists anticipate specific cognitive deteriorations?To answer this question we analysed age-related variations in the fractal dimension of a large corpus of digital images (n = 2092) of work created by seven notable artists who experienced both normal ageing and neurodegenerative disorders.The results of our analysis showed that patterns of change in the fractal dimension of the paintings differentiated artists who suffered neurological deterioration from those of normal aging controls.These findings are of importance for two reasons. Our work adds to studies that demonstrate that fractal analysis has the potential to determine the provenance of paintings. Secondly, our work suggests that may be possible to identify a-typical changes in the structure of an artists work; changes that may be early indicators of the onset of neurological deterioration. (PsycINFO Database Record


Holmes J.,Medical Research Council Cognition and Brain science Unit | Hilton K.A.,Tees | Place M.,Northumbria University | Alloway T.P.,University of North Florida | And 2 more authors.
Frontiers in Human Neuroscience | Year: 2014

The purpose of this study was to compare working memory (WM), executive function, academic ability, and problem classroom behaviors in children aged 8–11 years who were either identified via routine screening as having low WM, or had been diagnosed with ADHD. Standardized assessments of WM, executive function and reading and mathematics were administered to 83 children with ADHD, 50 children with low WM and 50 typically developing children. Teachers rated problem behaviors on checklists measuring attention, hyperactivity/impulsivity, oppositional behavior, and difficulties associated with executive function in the classroom. The ADHD and low WM groups had highly similar WM and executive function profiles, but were distinguished in two key respects: children with ADHD had higher levels of rated and observed impulsive behavior, and children with low WM had slower response times. Possible mechanisms for these common and distinct deficits are discussed. © 2014 Holmes, Hilton, Place, Alloway, Elliott and Gathercole.

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