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Am J Psychiatry 1992; 149:1484-1491
Copyright © 1992 by American Psychiatric Association
Impact of psychiatric hospitalization on behavioral complications of Alzheimer's disease
GS Zubenko, J Rosen, RA Sweet, BH Mulsant and AH Rifai
Geriatric Health Services, University of Pittsburgh School of Medicine, PA.
OBJECTIVE: The authors conducted a prospective study of the clinical
utility of the four DSM-III-R subtypes of primary degenerative dementia of
the Alzheimer type (with delirium, with delusions, with depression, or
uncomplicated) and acute psychiatric hospitalization for treatment of these
subtypes. METHOD: The subjects were 120 consecutive inpatients with
Alzheimer's disease, most of whom had behavioral abnormalities. Each
subject received detailed physical, neurological, psychiatric, and mental
status examinations. The presence or absence of specific behavioral
problems was also documented. Patients were treated with medication,
psychotherapy, and behavioral techniques. RESULTS: While all patients could
be assigned to one of the four DSM-III-R behavioral subtypes, the
uncomplicated subtype did not accurately reflect the burden of behavioral
symptoms in the patients who did not have delirium, delusions, or
depression. Each behavioral subtype responded in a characteristic way to
inpatient treatment, as reflected by changes in scores on four psychometric
scales used to assess cognitive impairment, psychiatric symptoms severity,
and level of functioning at admission and at discharge, as well as by
changes in residential setting following hospitalization. Half of all
patients admitted from their homes and two-thirds of those with depression
were able to go home following discharge. CONCLUSIONS: Behavioral syndromes
in Alzheimer's disease should not be overlooked, because they have both
clinical and prognostic significance. Short-term psychiatric
hospitalization is effective and efficient for achieving the goal of
returning patients to their homes and for safely implementing specific
treatments in this frail population, and it may reduce the need for
institutionalization.
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