title: Reasons for psychiatric consultation referrals in Dutch nursing home patients with dementia: a comparison with normative data on prevalence of neuropsychiatric symptoms.
abstract: OBJECTIVE
  To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms.
  
  
  METHODS
  This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the Netherlands. Nursing home physicians (NHP) noted the primary reasons for psychiatric consultation according to the Neuropsychiatric Inventory items and two extra domains. Patients were subsequently assessed by an old-age psychiatrist. Eligible patients were those that had dementia. Reasons for referral were compared with independent data on prevalence of neuropsychiatric symptoms in nursing home patients with dementia.
  
  
  RESULTS
  A total of 325/787 (41.3%) patients had dementia. Agitation, disinhibition and aberrant motor behaviour were frequent reasons for referral (>25%). Psychotic symptoms, apathy and eating behaviour changes were infrequent reasons (<10%) for seeking consultation. Agitation and disinhibition were more often primary reasons for consultation than would have been expected based on normative prevalence estimates of these symptoms. In contrast, delusions, euphoria, apathy, irritability and eating behaviour changes were less often reasons for referral compared with prevalence estimates.
  
  
  CONCLUSIONS
  This study is the first to examine psychiatric consultation for dementia patients in Dutch nursing home. Large differences exist between referral reasons and normative data on symptom prevalence. Specialized mental health service was provided for the agitated and disinhibited patient in particular. Chances are that this is at the expense of the apathetic, retarded and quietly 'not causing any trouble' patient.
authors.affiliation: Medical Center Alkmaar, Department of Geriatric Medicine, Alkmaar, The Netherlands. psykat@hetnet.nl
authors.forename: Martin G
authors.initials: MG
authors.lastname: Kat
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van der Ploeg
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Kalisvaart
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.forename: Jos F M
authors.initials: JF
authors.lastname: de Jonghe
mesh_terms: D000368:Aged; D000374:Aggression; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D005852:Geriatric Psychiatry; D006707:Homes for the Aged; D006801:Humans; D007508:Irritable Mood; D008297:Male; D009735:Nursing Homes; D018579:Patient Selection; D015995:Prevalence; D011595:Psychomotor Agitation; D012017:Referral and Consultation