Principles and Practice of Geriatric Psychiatry, Second Edition

761 Pages·2002·18 MB·English

PrinciplesandPracticeofGeriatricPsychiatry.
Editors:ProfessorJohnR.M.Copeland,DrMohammedT.Abou-SalehandProfessorDanG.Blazer
Copyright&2002 JohnWiley&SonsLtd
PrintISBN0-471-98197-4 OnlineISBN0-470-84641-0
Principles and Practice of
Geriatric Psychiatry
PrinciplesandPracticeofGeriatricPsychiatry.
Editors:ProfessorJohnR.M.Copeland,DrMohammedT.Abou-SalehandProfessorDanG.Blazer
Copyright&2002 JohnWiley&SonsLtd
PrintISBN0-471-98197-4 OnlineISBN0-470-84641-0
Principles and Practice of
Geriatric Psychiatry
Second Edition
Edited by
John R. M. Copeland
Liverpool University Department of Psychiatry, Liverpool, UK
Mohammed T. Abou-Saleh
St George’s Hospital Medical School, London, UK
Dan G. Blazer
Duke University Medical Center, Durham, North Carolina, USA
JOHN WILEY & SONS, LTD
PrinciplesandPracticeofGeriatricPsychiatry.
Editors:ProfessorJohnR.M.Copeland,DrMohammedT.Abou-SalehandProfessorDanG.Blazer
Copyright&2002 JohnWiley&SonsLtd
PrintISBN0-471-98197-4 OnlineISBN0-470-84641-0
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PrinciplesandPracticeofGeriatricPsychiatry.
Editors:ProfessorJohnR.M.Copeland,DrMohammedT.Abou-SalehandProfessorDanG.Blazer
Copyright&2002 JohnWiley&SonsLtd
PrintISBN0-471-98197-4 OnlineISBN0-470-84641-0
Contents
List of Contributors xi 10 Neurophysiology of Ageing as Reflected by
Preface xix Electroencephalogram (EEG) and Event-related
Preface to First Edition xxi Potentials (ERPs) 57
D. H. R. Blackwood, W. J. Muir and H. Forstl
11 Pharmacokinetic and Pharmacodynamic
Considerations in Old Age Psychopharmacology 61
F. Schifano
PART A HISTORICAL BACKGROUND 1
BIII Psychology of Ageing
1 A Conceptual History in the Nineteenth Century 3 12 Normal Ageing—A Problematical Concept 65
G. E. Berrios D. B. Bromley
2 Scope and Development in the Twentieth Century 7 Cohort Studies 68
E. W. Busse P. Rabbitt
3 The Development in Britain 9 13 Chronological and Functional Ageing 71
Tom Arie J. M. Guralnik and D. Melzer
4a The Development in the USA, 1600–1900 13 Health Expectancy: Monitoring Changes in
Population Health 74
W. A. Achenbaum, C. Cederquist, V. Kahl
C. Jagger
and K. Rosenberg
14 Life Satisfaction 75
4b In the Beginning 15
L. K. George
The Late F. Post
BIV Sociology of Ageing
15 The Normal Aged among Community-dwelling
PART B NORMAL AGEING 17 Elders in the UK 79
C. Victor
B1 Theories of Ageing Do Life Events Seem Less Stressful to the Old? 82
5 General Theories of Aging 19 A. D. M. Davies
Support Networks 83
E. W. Busse
G. C. Wenger
16 World Statistical Trends and Prospects 87
BII Brain Ageing
G. C. Myers
6 Structural Changes in the Aging Brain 23
Demography of the Old: Implications of
G. Mazeika and P. M. Doraiswamy
Recent Trends 90
7 Anatomy of the Ageing Brain 25
E. Grundy
J. T. Campbell III and C. E. Coffey
8 Quantitative Structural Changes in the
Ageing Brain 45
PART C ABNORMAL AGEING 93
Bente Pakkenberg, Lisbeth Regeur and
Hans Jørgen G. Gundersen
17 The Influence of Social Factors on Mental Health 95
Potential Regeneration of the Ageing Brain 47
D. Mechanic and D. D. McAlpine
S. B. Dunnett 18 The Natural History of Psychiatric Disorders:
Hippocampal Changes and Memory Impairment Early-onset Disease in Late Life and
in Normal People 49 Late-onset Illness 99
J. T. O’Brien J. Hays
9 Neuroendocrinology of Ageing 51 19 Mortality and Mental Disorders 103
R. A. Burns and M. T. Abou-Saleh M. E. Dewey
vi CONTENTS
20 Long-term Outcome Studies of Psychiatric 31 Interviews Aimed at Differential Psychiatric
Disorders: Methodological Issues and Practical Diagnosis
Approaches to Follow-up 105 GMS–HAS–AGECAT Package 161
A. Stueve, J. Toner and A. V. Quismorio J. R. M. Copeland
CAMDEX 162
D. W. O’Connor
PART D DIAGNOSIS AND ASSESSMENT 109 32 Assessment of Daily Living 165
K. H. Asberg
DI Epidemiology, Diagnosis and Nosology 33 Rating Scales Designed for Nurses and
21 The Importance of Multidimensional Assessment Other Workers 169
in Clinical Practice 111 K. C. M. Wilson, B. Green and P. Mottram
34 Comprehensive Interviews
M. R. Eastwood and A. Desai
OARS Methodology 173
22 Classification of Dementia and Other Organic
G. G. Fillenbaum
Conditions in ICD-10 113
The Comprehensive Assessment and Referral
A. Jablensky and J. E. Cooper
Evaluation (CARE): An Approach to Evaluating
23 Psychiatric Diagnosis and Old Age: New
Potential for Achieving Quality of Life 174
Perspectives for ‘‘DSM-IV-TR’’ and Beyond 117
B. Gurland and S. Katz
E. D. Caine
DII Clinical Assessment
PART E ORGANIC DISORDERS 177
24 History and Mental Status Examination 123
H. N. Richards and G. J. Maletta
EI Delirium
25 The Physician’s Role 127
35 Delirium—An Overview 179
L. Young
A. F. Fairburn
Delirium in Institutions 182
DIII Standardized Methods and Rating Scales
B. Kamholz and C. Colenda
26 Needs and Problems 133
Prognosis of Delirium 183
B. J. Gurland
A. Treloar
27 Non-computerized Assessment Procedures:
EII Dementia
Fundamental Assessment Issues 137
36 Nosology of Dementia 185
P. Logue
I. Skoog and J. R. M. Copeland
Short Assessment Scales
Cross-national Inter-rater Reliability of
Mini-Mental State Examination 140
Dementia Diagnosis 189
J. Cockrell and M. Folstein
D. W. O’Connor
IQCODE: Informant Interviews 141
37 Early Detection 191
A. F. Jorm
S. Henderson
Staging Dementia 142
38 DementiaEpidemiology:PrevalenceandIncidence 195
B. Reisberg, G. Gandrota, A. Zaidi
A. F. Jorm
and S. H. Ferris
39 Case-control Studies 199
Psychogeriatric Assessment Scales 146
S. Henderson
A. F. Jorm
Results from EURODEM Collaboration on
28 Computer Methods of Assessment of
the Incidence of Dementia 200
Cognitive Function 147
L. J. Launer, for the EURODEM Incidence
T. W. Robbins and B. J. Sahakian
Research Group
29 The Assessment of Depressive States 153
MRC/DoH Cognitive Function and Ageing Study 202
T. R. Thompson and W. M. McDonald J. Nickson, C. F. M. McCracken and C. Brayne,
The Geriatric Depression Scale: on behalf of MRC CFAS
Its Development and Recent Application 157 40 The Epidemiology of Alzheimer’s Disease:
R. O’Hara and J. A. Yesavage An Update 205
Center for Epidemiologic Studies Depression Scale: L. J. Launer
Use among Older Adults 158 The Lundby Study, 1947–1997 208
D. G. Blazer P. Nettelbladt, O. Hagnell, L. O¨jesjo¨,
30 The Development of the EURO-D Scale 159 L. Otterbeck, C. Mattisson, M. Bogren,
M. Prince E. Hofvendahl and P. Tora¨ker
CONTENTS vii
Nutritional Factors in Dementia 210 EV Other Dementias
D. N. Anderson and M. T. Abou-Saleh 49 Neuropathology: Other Dementias 259
J. M. MacKenzie
EIII Alzheimer’s Disease
50a Dementia and Parkinson’s Disease 265
41 The Genetics of Alzheimer’s Disease 213
R. B. Godwin-Austen
B. L. Plassman and J. C. S. Breitner
Clinical Criteria for Dementia with Lewy Bodies 268
The Role of Presenilins in Alzheimer’s Disease 217
I. G. McKeith
D. M. A. Mann
50b Subcortical Dementia 269
Apolipoprotein-E (Apo-E) 218
J. R. Burke
D. G. Blazer
50c Early-onset Dementias 273
Down’s Syndrome and Alzheimer’s Disease:
G. Mazeika
Update 219
51a Creutzfeldt–Jakob Disease and Other
D. W. K. Kay and B. Moore
Degenerative Causes of Dementia 277
International Criteria for Alzheimer’s Disease
T. F. G. Esmonde
and Their Problems—ICD-10, DSM-IV and
51b Frontotemporal Dementia (Pick’s Disease) 281
NINCS–ADRDA 221
J. R. Hodges
K. Rockwood
52 Alcoholic and Other Toxic Dementias 285
42 The Neuropathology of Alzheimer’s Disease 223
E. M. Joyce
D. M. A. Mann
53 Reversible Dementias 289
Oxford Project to Investigate Memory and
M. Philpot and J. Pereira
Ageing (OPTIMA): A Longitudinal
Clinicopathological Study of Dementia
and Normal Ageing 227 EVI Clinical Diagnosis of the Dementias
A. D. Smith 54 Differential Diagnosis of Dementia 293
Consortium to Establish a Registry for C. Busby and A. Burns
Alzheimer’s Disease (CERAD) 228 55a Distinguishing Depression from Dementia 297
G. G. Fillenbaum and A. Heyman W. E. Fox and D. C. Steffens
43 Neurotransmitter Changes in Alzheimer’s Disease: 55b Benign Senescent Forgetfulness, Age-associated
Relationships to Symptoms and Neuropathology 229 Memory Impairment and Age-related Cognitive
P. T. Francis and E. K. Perry Decline 303
44 Antemortem Markers 233 K. A. Welsh-Bohmer and D. J. Madden
S. J. Van Rensberg, F. C. V. Potocnik
and D. J. Stein EVII Outcome of the Dementias and Subtypes
45 Clinical Features of Senile Dementia and 56 Minor Cognitive Impairment 305
Alzheimer’s Disease 237 K. Ritchie and J. Touchon
B. Pitt Alzheimer’s Disease—One or Several? 307
46 Assessment and Management of Behavioural and C. Holmes and A. H. Mann
Psychological Symptoms of Dementia (BPSD) 241 Prognosis of Dementia 308
R. McShane and N. Gormley B. Reisberg, A. Kluger and E. Franssen
Eating Disorders in Alzheimer’s Disease 245
P. E. Cullen and C. Ballard
EVIII Treatment and Management of Dementias
EIV Vascular Dementia 57 Acute Management of Dementia 313
47 Pathology of Vascular Dementia 247 B. Pitt
J. M. MacKenzie 58a Present and Future Treatments of Alzheimer’s
International Criteria for Vascular Dementia and Disease 317
Their Problems: ICD-10, DSM-IV, ADDTC L. J. Whalley and J. M. Starr
and NINDS–AIREN 249 58b Possible Future Treatments and Preventative
J. V. Bowler and V. Hachinski Strategies for Alzheimer’s Disease 325
48 Vascular Dementia 251 S. Lovestone
P. Humphrey 59a Psychological and Psychosocial Interventions 327
Vascular Dementia Subgroups: Multi-infarct E. Miller
DementiaandSubcorticalWhiteMatterDementia 255 59b Informal Carers and Their Support 331
I. Skoog D. Buck
The Role of Blood Pressure in Dementia 256 TheRoleandInfluenceoftheAlzheimer’sSociety 334
I. Skoog N. Graham
viii CONTENTS
EIX Conditions Associated with, or Sometimes 73 Neuro-imaging
Mistaken for, Primary Psychiatric Conditions Neuro-imaging Studies of Depression 403
60 The Psychiatric Manifestations of M. T. Abou-Saleh
CNS Malignancies 335 Is Imaging Justified in the Investigation
M. Glantz and E. W. Massey of Older People? 404
61 Peripheral Neuropathy and Peripheral Nerve D. McWilliam
Lesions 341 74 Clinical Features of Depression and Dysthymia 407
J. M. Massey and E. W. Massey D. G. Folks and C. V. Ford
Outcome of Depressive Disorders: Findings of
EX Investigations of Organic States and Dementia
a Longitudinal Study in the UK 413
62 Electroencephalography (EEG) 345
V. K. Sharma
The Late G. W. Fenton
Longitudinal Studies of Mood Disorders
63 Computed Tomography (CT) 351
in the USA 415
A. Burns and G. Pearlson
D. G. Blazer
64 Magnetic Resonance Imaging (MRI) 355
Outcome of Depression in Finland 416
K. R. R. Krishnan
S.-L. Kivela¨
65 Functional Magnetic Resonance Imaging (MRI) 357
75a Physical Illness and Depression 417
K. R. R. Krishnan
M. E. Evans
66 Positron Emission Tomography (PET) 359
Physical Illness and Depression:
P. F. Liddle and C. L. Grady
A Number of Conundrums 423
67 Single-photon Emission Computed
M. R. Eastwood
Tomography (SPECT) 363
75b Depression after Stroke 425
M. T. Abou-Saleh
P. Knapp and A. House
Treatment of Depression in Older People
with Physical Disability 427
PART F AFFECTIVE DISORDERS 369
S. Banerjee and F. Ruths
76 Acute Management of Late-life Depression 429
FI Nosology and Classification
V. Gardner and D. C. Steffens
68 Nosology and Classification of Mood Disorders 371
77 Electroconvulsive Therapy (ECT) 433
D. G. Blazer
D. G. Wilkinson
FII Depression, Dysthymia, Bereavement and 78 Pharmacological Treatment of Depression 439
Suicidal Behaviour M. T. Abou-Saleh
69 Genetics of Affective Disorders 375 Treatment-resistant Depression 442
J. L. Beyer and D. C. Steffens A. J. Flint
70aEnvironmental Factors, Life Events and 79 Psychotherapy of Depression and Dysthymia 445
Coping Abilities 379 T. R. Lynch and C. M. Vitt
T. C. Antonucci and J. S. Jackson 80 Long-term Management of Affective Disorders 453
70bThe Aetiology of Late-life Depression 381 M. T. Abou-Saleh
M. Prince and A. Beekman 81 Laboratory Diagnosis: Dexamethasone
Risk Factors and the Incidence of Post-stroke Suppression Test 461
Depression 386 M. T. Abou-Saleh
P. W. Burvill 82 Bereavement 465
71 Epidemiology of Depression: Prevalence R. Kastenbaum
and Incidence 389 83 Suicidal Behaviour 469
D. G. Blazer H. Cattell
Epidemiological Catchment Area Studies of
Mood Disorders 392 FIII Mania
D. G. Blazer 84 Genetics and Aetiology 473
EURODEP—PrevalenceofDepressioninEurope 393 T. Thompson and W. McDonald
J. R. M. Copeland 85 Epidemiology and Risk Factors 477
Depression in Older Primary Care Patients: S. Lehmann and P. Rabins
Diagnosis and Course 393 86 Mania: Clinical Features and Management 479
J. M. Lyness and E. D. Caine S. Lehmann and P. Rabins
72 Neurochemistry 397 87 Prognosis 481
L. S. Schneider, updated by M. T. Abou-Saleh M. M. Husain
CONTENTS ix
88 The Management of Acute Mania 483 PART I PERSONALITY DISORDERS 585
J. L. Beyer and K. R. R. Krishnan
107 Personality Disorders: Aetiology and Genetics 587
V. Molinari, T. Siebert and M. Swartz
PART G SCHIZOPHRENIC DISORDERS AND 108 Theoretical and Management Issues 593
MOOD-INCONGRUENT PARANOID STATES 491 R. C. Abrams
89 Late-life Psychotic Disorders:
PART J MENTAL AND BEHAVIOURAL
Nosology and Classification 493
DISORDERS DUE TO PSYCHOACTIVE
L. T. Eyler Zorrilla and D. Jeste
SUBSTANCES 599
90 Clinical Assessment and Differential Diagnosis 497
D. N. Anderson
109 Alcohol Abuse in the Elderly 601
91 Aetiology, Genetics and Risk Factors 503
H. Kyomen and B. Liptzin
D. J. Castle and R. M. Murray
110 Epidemiology of Alcohol Problems and
Brain Imaging in Schizophrenia-like and
Drinking Patterns 607
Paranoid Disorders in Late Life 508
C. F. Hybels and D. G. Blazer
R. Howard
111 Drug Misuse in the Elderly 613
92 Schizophrenic Disorder and Mood-incongruent
P. Bown, A. H. Ghodse and M. T. Abou-Saleh
Paranoid States: Epidemiology, Prevalence,
Benzodiazepam Use and Abuse in the
Incidence and Course 511
Community: Liverpool Studies 619
R. Howard
K. Wilson and P. Mottram
93 The Fate of Schizophrenia with Advancing
Age: Research Findings and Implications for
Clinical Care 513 PART K LEARNING AND BEHAVIOURAL
R. Howard DISORDERS 621
94 Rehabilitation and Long-term Management 517
R. Pugh 112 Old Age and Learning Disability 623
95 Treatment of Late-onset Psychotic Disorders 521 O. Raji and S. Hollins
E. M. Zayas and G. T. Grossberg 113a Elderly Offenders 627
96 Risk Factors for Dyskinesia in the Elderly 527 J. M. Parrott
T. R. E. Barnes 113b Sleep and Ageing: Disorders and Management 631
H. Chiu
Rating Scale for Aggressive Behaviour
PART H NEUROSES 535
in the Elderly 633
L. C. W. Lam
97 Nosology and Classification of
114 Sexual Disorders 635
Neurotic Disorders 537
J. M. Kellett
D. Bienenfeld
115 Phenomenology of Wandering 637
98 Epidemiology of Neurotic Disorders 541
A. Habib and G. T. Grossberg
D. G. Blazer
99 Stress, Coping and Social Support 545
L. R. Landerman and D. Hughes PART L THE PRESENTATION OF MENTAL
100 Clinical Features of Anxiety Disorders 551 ILLNESS IN ELDERLY PERSONS IN
E. L. Cassidy, P. J. Swales and J. I. Sheikh DIFFERENT CULTURES 639
101 Prognosis of Anxiety Disorders 555
P. J. Swales, E. L. Cassidy and J. I. Sheikh 116a Problems of Assessing Psychiatric Symptoms
102 Acute Management of Anxiety and Phobias 559 and Illness in Different Cultures 641
J. I. Sheikh, E. L. Cassidy and P. J. Swales M. Abas
103 Psychopharmacological Treatment of Anxiety 563 116b Depression in the Indian Subcontinent 645
J. L. Beyer and K. R. R. Krishnan V. Patel
104 Obsessive–Compulsive Disorder 571 116c Dementia in the Indian Subcontinent 647
J. Lindesay S. Rajkumar, M. Ganguli and D. Jeste
105 Hypochondriacal Disorder 575 117 Dementia and Depression in Africa 649
A. Allen and E. W. Busse O. Baiyewu
106 Other Neurotic Disorders 579 118 Mental Illness in South America 651
J. J. Schulte and D. Bienenfeld S. L. Blay
x CONTENTS
PART M THE PRACTICE OF MIII Liaison with Medical and Surgical Teams
PSYCHOGERIATRIC MEDICINE 653 134 Liaison with Medical and Surgical Teams 731
S. A. Mann
119 Psychiatry of the Elderly—the WPA/WHO
135 Education and the Liaison Psychogeriatrician 737
Consensus Statements 655
D. N. Anderson
C. Katona
MI The British Model of the Organization of Services MIV Rehabilitation and General Care
120 Development of Health and Social Services in
136 Rehabilitation 739
the UK in the Twentieth Century 657
R. Jones
J. P. Wattis
137 Anaesthetics and Mental State 743
121 The Pattern of Psychogeriatric Services 661
D. G. Seymour
J. P. Wattis
138a Nutritional State 749
Organization of Services for the Elderly
D. N. Anderson and M. T. Abou-Saleh
with Mental Disorders 664
Mental Illness in Nursing Homes and
E. Chiu
Hostels in Australia 752
122 The Multidisciplinary Team 667
D. Ames
H. Rosenvinge
138b Caregivers and Their Support 755
123 Community Care: The Background 671
K. C. Buckwalter, L. Garand and M. Maas
C. Godber
The Sydney Dementia Carers’
Health Care of the Elderly:
Training Program 762
The Nottingham Model 673
H. Brodaty
Tom Arie
138c Elder Abuse—Epidemiology, Recognition
124 The Development of Day Hospitals and
and Management 771
Day Care 677
M. J. Vernon
R. Jenkins and D. J. Jolley
125 Day Care 681 138d The Care of the Dying Patient 775
J. M. Eagles and J. Warrington R. E. Nelson and K. G. Meador
126 New Technology and the Care of
Cognitively Impaired Older People 685 MV Prevention of the Mental Disorders of Old Age
A. Sixsmith 139a Prevention in Mental Disorders of Late Life 779
B. D. Lebowitz and J. L. Pearson
MII The North American Model of the
139b A Damning Analysis of the Law and the
Organization of Services
Elderly Incompetent Patient—
127 The United States System of Care 689
Rights, What Rights? 783
C. C. Colenda, S. J. Bartels and G. L. Gottlieb
P. Edwards
128 Community-based Psychiatric Ambulatory Care:
139c Older People, Clinicians and Mental
The Private Practice Model in the USA 697
Health Regulation 789
E. M. Stein and G. S. Moak
E. Murphy
129a The Psychiatrist’s Role in Linking
Community Services 705
MVI Education
D. Johnston, K. A. Sherrill and B. V. Reifler
140 Training Requirements for Old Age
129b The Medical Psychiatry Inpatient Unit 709
Psychiatrists in the UK 791
D. G. Folks and F. C. Kinney
S. M. Benbow
130 The Psychiatrist in the Nursing Home 713
W. E. Reichman Old Age Psychiatrists and Stress 793
Patient Autonomy vs. Duty of Care— S. M. Benbow
the Old Age Psychiatrist’s Dilemma 715 141 Developing and Maintaining Links between
A. Treloar Service Disciplines: The Program for
131 Psychiatric Services in Long-term Care 717 Organizing Interdisciplinary
I. R. Katz, K. S. Van Haitsma and J. E. Streim Self-education (POISE) 795
132 Care in Private Psychiatric Hospitals 723 J. A. Toner
K. G. Meador, M. M. Harkleroad 142 Appendix: International Psychogeriatric
and W. M. Petrie Association 799
133 Quality of Care and Quality of Life in B. Reisberg and F. F. Finkel
Institutions for the Aged 727
M. Powell Lawton Index 801
PrinciplesandPracticeofGeriatricPsychiatry.
Editors:ProfessorJohnR.M.Copeland,DrMohammedT.Abou-SalehandProfessorDanG.Blazer
Copyright&2002 JohnWiley&SonsLtd
PrintISBN0-471-98197-4 OnlineISBN0-470-84641-0
Contributors
M. Abas Department of Psychiatry and Behavioural S. J. Bartels Department of Psychiatry, Dartmouth
Science, University of Auckland, Private Bag 92019, Medical School, Hanover, NH, USA
Auckland, New Zealand
A. Beekman Institute of Psychiatry, De Crespigny Park,
M.T.Abou-Saleh DepartmentofAddictiveBehaviourand London SE5 8AF, UK
Psychological Medicine, St George’s Hospital Medical
S. M. Benbow Wolverhampton Health Care NHS Trust,
School, Cranmer Terrace, London SW17 0RE, UK
PennHospital,PennRoad,WolverhamptonWV45HA,
R. C. Abrams Department of Psychiatry, New York
UK
PresbyterianHospital,Box140,525East68Street,New
York, NY 10021, USA G. E. Berrios Department of Psychiatry, Addenbrooke’s
Hospital, Box 189, Hills Road, Cambridge CB2 2QQ,
W.A.Achenbaum InstituteofGerontology,Universityof
UK
Michigan, 300 North Ingalls, Ann Arbor, MI 48109-
2007, USA J. L. Beyer Department of Psychiatry, Duke University
Medical Center, Box 3519, Durham, NC 27710, USA
A. Allen Dorothea Dix Hospital, Raleigh, NC, USA
D. Bienenfeld Department of Psychiatry, Wright State
D. Ames Associate Professor of the Psychiatry of Old
University School of Medicine, PO Box 927, Dayton,
Age, Department of Psychiatry, 7th Floor, Charles
OH 45401-0927, USA
Connibere Building, Royal Melbourne Hospital, Park-
ville, Victoria 3050, Australia D.H.R.Blackwood RoyalEdinburghHospital,Edinburgh,
UK
D. N. Anderson North Mersey Community NHS Trust,
EMI Directorate, Sir Douglas Crawford Unit, Mossley S.L.Blay Servic¸oPu´blicoFederal,UniversidadeFederal
Hill Hospital, Park Avenue, Liverpool L18 8BU, UK de Sa˜o Paulo, Escola Paulista de Medicina, Rua
Botucatu 740, CEP 04023-900 Sa˜o Paulo, Brazil
T. C. Antonucci Institute for Social Research, University
of Michigan, Ann Arbor, MI 48106-1248, USA
D. G. Blazer Department of Psychiatry and Behavioral
T. Arie Ageing and Disability Research Unit, The Sciences, Box 3003, Duke University Medical Center,
Medical School, Queen’s Medical Centre, Nottingham Durham, NC 27710, USA
NG7 2UH, UK
M. Bogren Department of Clinical Neuroscience, Divi-
K. Hulter-Asberg University of Uppsala, Gotgatan 3, sionofPsychiatry,TheLundby Study,Lund University
S-753 15 Uppsala, Sweden Hospital, St Lars, SE-221 85 Lund, Sweden
O. Baiyewu Department of Psychiatry, University of J. V. Bowler Department of Neurology, Royal Free
Ibadan,CollegeofMedicine,PMB5116,Ibadan,OyoState Hospital, Pond Street, London NW3 2QG, UK
C. Ballard MRC Neurochemical Pathology Unit, New- P. Bown Department of Addictive Behaviour and Psy-
castle General Hospital, Westgate Road, Newcastle chological Medicine, St George’s Hospital Medical
upon Tyne NE4 6BE, UK School, Cranmer Terrace, London SW17 0RE, UK
S.Banerjee SectionofMentalHealthandAgeing,Health C. Brayne Department of Public Health and Primary
Services Research Department, Institute of Psychiatry, Care, University of Cambridge, Forvie Site, Robinson
De Crespigny Park, London SE5 8AF, UK Way, Cambridge CB2 2SR, UK
T.R.E.Barnes ProfessorofClinicalPsychiatry,Imperial J. C. S. Breitner Professor and Chair, Johns Hopkins
College School of Medicine, Academic Centre, St University, School of Hygiene and Public Health,
Bernard’s Site, Ealing Hospital, Uxbridge Road, Ealing Department of Mental Hygiene, 624 Broadway, Balti-
UB1 3EU, UK more, MD 21205-1999, USA