What diseases affect elderly Mexican population? Clinical and socialdemographic characteristics of patients of the psychogeriatric clinic of the National Institute of Psychiatry / ¿De qué se enferman nuestros adultos mayores? Características clínicas y sociodemográficas de los pacientes de la clínica de psicogeriatría del Instituto Nacional de Psiquiatría

Abstract Introduction The demographic and epidemiological transition, as well as the aging population has changed how older adults are treated in our healthcare system. Objective To establish the sociodemographic and clinical characteristics of the patients from the Psychogeriatric Clinic (PC) of the Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM) seen between January 1, 2011, and December 31, 2020. Method Descriptive, observational, cross-sectional, retrospective study. A database was created with the information from digital clinical records. No additional scales were used. Statistical analysis performed in SPSS 20.0. Results 2056 records were found, 1247 met the inclusion criteria. The mean age was 74.28 years, women 73.46% (n = 916), primary school 46.62% (n = 427), married 35.70% (n = 327), urban area 93.99% (n = 1172), home-based 78.28% (n = 717), low socioeconomic level 59.99% (n = 522). The most common psychiatric pathology was depressive disorders 62.07% (n = 774) and neurocognitive disorders 37.52% (n = 468) due to Alzheimer's disease 17.08% (n = 213), with Mini-Mental State Examination of 18.88 points (± 6.68). They had comorbidities such as arterial hypertension 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) and had a geriatric syndrome in 64.42% (n = 218). Discussion and conclusion Aging in Mexico affects the female population the most. The analysis report from the prevalence for psychogeriatric pathologies of the PC it's for of its kind. The main goal is promoting research on dementias and highlighting the magnitude of the problem for Latin American governments. The results are not intended to be extrapolated to the general population.

Resumen Introducción La transición demográfica y epidemiológica, el subsecuente envejecimiento poblacional, produjeron cambios en los sistemas de salud y cómo se atiende a los adultos mayores. Objetivo Establecer las características sociodemográficas y clínicas de los pacientes de la Clínica de Psicogeriatría (CP) del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM) que acudieron entre el 1 enero de 2011 y 31 diciembre de 2020. Método Estudio descriptivo, observacional, corte transversal, retrospectivo. Se creó una base de datos con la información de los expedientes clínicos digitales. No se utilizó ninguna escala adicional. Análisis estadístico realizado en SPSS 20.0. Resultados Se encontraron 2056 registros, 1247 cumplieron los criterios de inclusión. Edad media 74.28 años, mujeres 73.46% (n = 916), primaria 46.62% (n = 427), casadas 35.70% (n = 327), área urbana 93.99% (n = 1172), ocupación hogar 78.28% (n = 717), nivel socioeconómico bajo 59.99% (n = 522). La patología psiquiátrica más común fueron los trastornos depresivos 62.07% (n = 774) y trastorno neurocognitivo 37.52% (n = 468), por enfermedad de Alzheimer 17.08% (n = 213), con MMSE de 18.88 puntos (± 6.68). Con comorbilidades como hipertensión arterial 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) y tenían síndromes geriátricos en 64.42% (n = 218). Discusión y conclusión El envejecimiento se observa principalmente en las mujeres mexicanas. Reporte del análisis de las prevalencias puntuales de las patologías psicogeriátricas de la CP. Primero en su tipo. Se intenta fomentar la investigación en las demencias y resaltar la magnitud del problema en los países latinoamericanos para sus gobiernos. Los resultados no pretenden ser extrapolados a la población general.

The frequency of psychotic symptoms in types of dementia: a systematic review / A frequência de sintomas psicóticos em tipos de demência: uma revisão sistemática

ABSTRACT The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives: This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods: A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results: A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions: We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.

RESUMO A frequência de sintomas psicóticos em idosos é alta, principalmente em cognições neurocognitivas das mais variadas etiologias. Objetivos: Revisar os estudos que analisam a frequência dos tipos de delírios, alucinações e erros de identificação em quadros demenciais de diferentes etiologias. Métodos: Foi realizada uma revisão sistemática em 9 de agosto de 2021, nas bases de dados PubMed, PsycInfo, Embase, Web of Science e Scopus, com os seguintes descritores: (demência OR doença de alzheimer OR demência com corpos de Lewy OR demência frontotemporal OR demência mista OR vascular demência OU transtorno neurocognitivo maior OU demência da doença de Parkinson) E (sintomas psicóticos OU psicose OU alucinações OU delírios OU psicopatologia OU identificação errônea) E (prevalência OU epidemiologia). Resultados: Foram encontrados 5.077 artigos, com inclusão final de 35. A frequência geral de sintomas psicóticos foi de 34 a 63% em quadros demenciais das mais variadas etiologias. A doença de Alzheimer (DA) apresenta mais delírios, alucinações e maior frequência quanto à presença de erros de identificação. Por outro lado, a demência com corpos de Lewy (DCL) parece apresentar mais alucinações, inclusive auditivas, quando comparada às demais demências, concomitantemente aos delírios. As demências vascular e frontotemporal apresentam menos sintomas psicóticos do que a DCL e a DA. Conclusões: Identificamos lacuna na literatura quanto à descrição dos sintomas psicóticos das demências, principalmente naquelas de etiologia não DA. Estudos que aprofundem os sintomas neuropsiquiátricos das demências podem contribuir de forma mais definitiva para o diagnóstico causal da demência.

Analysis of psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in Medicare Part D in the United States

Abstract Introduction The opioid epidemic is a severe problem in the world, especially in the United States, where prescription opioid overdose accounts for a quarter of drug overdose deaths. Objective To describe psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in the United States. Methods We conducted a retrospective cross-sectional study of the 2016 Medicare Part D claims data and analyzed psychiatrists' prescriptions of: 1) opioids; 2) benzodiazepines, whose concurrent prescription with opioids can cause overdose death; 3) buprenorphine, a partial opioid agonist for treating opioid addiction; 4) and naltrexone microsphere, a once-monthly injectable opioid antagonist to prevent relapse to opioid dependence. Prescribers with 11 or more claims were included in the analysis. Results In Medicare Part D in 2016, there were a total of 1,131,550 prescribers accounting for 1,480,972,766 total prescriptions and 78,145,305 opioid prescriptions, including 25,528 psychiatrists (2.6% of all prescribers) accounting for 44,684,504 total prescriptions (3.0% of all prescriptions) and 131,115 opioid prescriptions (0.2% of all opioid prescriptions). Psychiatrists accounted for 17.3% of benzodiazepine, 16.3% of buprenorphine, and 33.4% of naltrexone microsphere prescriptions. The opioid prescription rate of psychiatrists was much lower than that of all prescribers (0.3 vs 5.3%). The buprenorphine prescription rate of psychiatrists was much higher than that of all prescribers (2.3 vs. 0.1%). There was a substantial geographical variation across the United States. Conclusions The results show that, proportionally, psychiatrists have lower rates of opioid prescription and higher rates of benzodiazepine and buprenorphine prescription.

A percepção dos profissionais de saúde sobre o cuidado ao idoso com transtorno mental / The perception of health professionals regarding the care for the elderly with mental disorders / La percepción de los profesionales de la salud sobre el cuidado al anciano con el trastorno mental

OBJETIVO: compreender as percepções da equipe de um Centro de Atenção Psicossocial sobre o cuidado ao idoso com transtorno mental. MÉTODO: estudo qualitativo com referencial teórico-metodológico: Teoria das Representações Sociais. O campo de estudo foi um Centro de Atenção Psicossocial no interior do estado de São Paulo. Amostra composta por conveniência, fechada por exaustão, constituída por 12 profissionais. A coleta de dados foi realizada por meio da entrevista semiestruturada e estes foram analisados pela análise temática de conteúdo. RESULTADOS: emergiram três categorias que evidenciam contradições sobre a percepção dos profissionais acerca do papel do CAPS. Essas contradições podem estar ancoradas nas representações sobre as dificuldades relatadas na assistência ao idoso, que se sobrepõem às dificuldades no cuidado ao indivíduo com transtorno mental. A ausência de estratégias para o atendimento cotidiano é abordada e a educação profissional é apontada como importante, porém ausente. O desgaste do profissional em saúde mental emerge e a percepção sobre a falta de recursos humanos é revelada nos discursos. Essas problemáticas trazem uma representação de práticas insuficientes que refletirão no cuidado ao idoso com transtorno mental. CONCLUSÃO: o estudo contribui com esclarecimentos a serem abordados em estudos de intervenção para potencializar a transformação do cuidado.

OBJECTIVE: to understand the perceptions of the staff of a Psychosocial Care Center regarding the care for the elderly with mental disorders. METHOD: qualitative study with a theoretical and methodological framework: Theory of Social Representations. The field of study was a Psychosocial Care Center in the state of São Paulo. Convenience sampling was used, and the sample consisting of 12 professionals was determined by saturation. Data were collected by semi-structured interviews and analyzed by thematic content analysis. RESULTS: three categories emerged, and they showed contradictions regarding the professionals' perceptions of the CAPS' role. Such contradictions may be supported on the representations concerning the difficulties reported in the care for the elderly, which overlap with those in the care for individuals with mental disorders. The lack of strategies for routine care is discussed, and professional education is mentioned as important although it is non-existent. The burnout of mental health professionals emerges, and the perception of the lack of human resources is revealed in the discourses. These problems bring about a representation of insufficient practices that will reflect on the care for the elderly with mental disorders. CONCLUSION: the study contributes with clarifications to be addressed in intervention studies in order to strengthen heath care change.

OBJETIVO: comprender las percepciones del equipo de un Centro de Atención Psicosocial sobre el cuidado al anciano con trastorno mental. MÉTODO: estudio cualitativo con referencial teórico-metodológico: Teoría de las Representaciones Sociales. El campo de estudio fue un Centro de Atención Psicosocial en el interior del estado de São Paulo. Una muestra compuesta por conveniencia, cerrada por agotamiento, constituida por 12 profesionales. La recolección de datos fue realizada, a través de la entrevista semiestructurada y el análisis de los datos del análisis temático de contenido. RESULTADOS: surgieron tres categorías que evidencian contradicciones sobre la percepción de los profesionales acerca del papel del CAPS. Estas contradicciones pueden estar ancladas en las representaciones acerca de las dificultades relatadas en la asistencia al anciano que se superpone con dificultades en el cuidado al individuo con trastorno mental. La ausencia de estrategias para la atención cotidiana es abordada y la educación profesional es señalada como importante, pero ausente. El desgaste del profesional en salud mental emerge y la percepción sobre la falta de recursos humanos es revelada en los discursos. Estas problemáticas traen una representación de prácticas insuficientes que reflejará en el cuidado al anciano con trastorno mental. CONCLUSIÓN: el estudio contribuye con aclaraciones para ser abordados en estudios de intervención para potenciar la transformación del cuidado.

Multi-ethnic validation of 15-item Geriatric Depression Scale in Chile

Abstract Background: There has been scant research published regarding the assessment of depression in ethnic groups, and few studies have addressed the validation of scales for standardized assessment of depressive symptoms among indigenous minorities. Objective: The aim of this study was to analyze the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15) for a multi-ethnic sample of older Chilean adults.Methods: Cross-sectional study with a sample of 800 older people, 71% of whom were self-declared indigenous (Aymara/Mapuche).Results: The non-indigenous group had a higher total GDS-15 score and lower quality of life and wellbeing scores than the indigenous groups (p< 0.001). The GDS-15 had a KR-20 coefficient of 0.90 for the non-indigenous group, 0.80 for Aymara, and 0.85 for Mapuche. The homogeneity index was 0.38 for non-indigenous, 0.24 for Aymara, and 0.29 for Mapuche.Discussion: The GDS-15 showed satisfactory psychometric characteristics for the samples studied. However, the better results observed for the non-indigenous group suggest that some characteristics and content of the rating scale are not fully appropriate for the indigenous older population. Conclusions:There is a need to develop the transcultural validation of scales such as GDS-15, which are applied in a standardized manner in geriatric evaluations as part of primary healthcare.

Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer's disease in Brazil

Objective: To perform a cost-effectiveness analysis of donepezil and rivastigmine therapy for mild and moderate Alzheimer's disease (AD) from the perspective of the Brazilian Unified Health System. Method: A hypothetical cohort of 1,000 individuals of both sexes, aged >65 years, and diagnosed with AD was simulated using a Markov model. The time horizon was 10 years, with 1-year cycles. A deterministic and probabilistic sensitivity analysis was performed. Results: For mild AD, the study showed an increase in quality-adjusted life years (QALYs) of 0.61 QALY/21,907.38 Brazilian reais (BRL) for patients treated with donepezil and 0.58 QALY/BRL 24,683.33 for patients treated with rivastigmine. In the moderate AD group, QALY increases of 0.05/BRL 27,414.96 were observed for patients treated with donepezil and 0.06/BRL 34,222.96 for patients treated with rivastigmine. Conclusions: The findings of this study contradict the standard of care for mild and moderate AD in Brazil, which is based on rivastigmine. A pharmacological treatment option based on current Brazilian clinical practice guidelines for AD suggests that rivastigmine is less cost-effective (0.39 QALY/BRL 32,685.77) than donepezil. Probabilistic analysis indicates that donepezil is the most cost-effective treatment for mild and moderate AD.

Depressive symptoms in older adults in basic health care / Sintomas depressivos em idosos na atenção básica à saúde

ABSTRACT OBJECTIVE: To identify depressive symptoms in older adults treated in primary care. METHOD: A descriptive-exploratory cross-sectional quantitative study was conducted with 260 older adults registered with Family Health Units in João Pessoa, Paraíba, Brazil. A sociodemographic instrument and the Geriatric Abridged Depression Scale (GDS-15) were applied. Descriptive analysis summarized the variables through percentages and number of participants. RESULTS: There was a prevalence of older adults aged 60-70 years (n=154; 59.2%), who were female (n=186; 71.5%) and had a low educational level (n=89; 34.2%). The GDS-15 revealed that 195 (75.0%) of the older adults had no depressive symptoms. It was observed that 219 (84.2%) older adults were satisfied with their lives, 198 (76.1%) felt happy most of the time, 194 (74.6%) were in a good mood most of the time, 236 (90.8%) reported feeling hope in their lives and 248 (95.4%) mentioned feeling that it was wonderful to be alive. In addition, 135 (51.9%) older adults preferred to go out rather than stay at home, 180 (69.2%) felt full of energy, and 226 (86.9%) considered themselves useful people, although 112 older adults (43.0%) had interrupted many of their activities and 141 (54.2%) feared that something bad would happen. CONCLUSÃO: Primary Health Care is responsible for the screening of depressive symptoms in older adults to implement actions to protect and promote the health of this population. It is a guiding strategy of the care process, aimed at stimulating active aging and autonomy, as well as the prevention of health problems. This study contributes to reflections on the importance of public policies and good practices in the care of older adults.

OBJETIVO: Identificar sintomas depressivos em idosos atendidos na atenção básica. MÉTODO: Pesquisa descritivo-exploratória, delineamento transversal, quantitativa, realizada com 260 idosos cadastrados nas Unidades de Saúde da Família de João Pessoa, Paraíba, Brasil. Aplicou-se instrumento sociodemográfico e Escala de Depressão Geriátrica Abreviada (EDG-15). A análise descritiva resumiu as variáveis em percentagens e número de participantes. RESULTADO: Predomínio de idosos com 60-70 anos de idade (n=154; 59,2%), sexo feminino (n=186; 71,5%) e baixa escolaridade (n=89; 34,2%). A EDG-15 mostrou que 195 (75,0%) idosos não apresentaram sintomas depressivos. Foi observado que 219 (84,2%) idosos estavam satisfeitos com a própria vida, 198 (76,1%) sentiam-se felizes a maior parte do tempo, 194 (74,6%) sentiam-se de bom humor a maior parte do tempo, 236 (90,8%) referiram sentir esperança na vida e 248 (95,4%) mencionaram achar maravilhoso estarem vivos. Ademais, 135 (51,9%) idosos preferiam sair a ficar em casa, 180 (69,2%) sentiam-se cheios de energia, 226 (86,9%) consideravam-se pessoas úteis, mas 112 (43,0%) idosos interromperam muitas de suas atividades e 141 (54,2%) temiam que algo de ruim acontecesse. CONCLUSÃO: A atenção básica à saúde é corresponsável pelo rastreio de sintomas depressivos em idosos para implementar ações de proteção e promoção da saúde dessa clientela. Constitui estratégia norteadora do processo de cuidado, adequado para o estímulo ao envelhecimento ativo e autonomia, bem como para prevenção de agravos à saúde. Esta pesquisa contribui para reflexão sobre a importância de políticas públicas e boas práticas no cuidado ao idoso.

Cognitive screening test in primary care: cut points for low education

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

Validation of the Munich ChronoType Questionnaire in Korean Older Adults

OBJECTIVE: This study aimed to evaluate psychometric properties of the Munich ChronoType Questionnaire (MCTQ) in a sample of Korean older adults. METHODS: One-hundred ninety two participants aged 65 and over completed interview-based questionnaires about chronotype, insomnia, depression, and anxiety. Additionally, a small subset of subjects completed a 7-day sleep diary and actigraphy measurements. RESULTS: Morningness-Eveningness Questionnaire (MEQ) scores were significantly negatively correlated with Midpoint of sleep on free days corrected for sleep debt accumulated through weekdays (MSFsc) (r=-0.45, p < 0.01) assessed by the MCTQ. MSFsc using the MCTQ was significantly positively correlated with MSFsc assessed by both the sleep diary (r=0.74, p < 0.05) and actigraphy (r=0.76, p < 0.05). Additionally, MSFsc assessed by the MCTQ was significantly positively correlated with insomnia (r=0.26, p < 0.01), depression (r=0.25, p < 0.01), and anxiety (r=0.18, p < 0.05). Finally, based on MEQ scores, we derived a cut-off score for the MCTQ that distinguishes morning type and other types (intermediate/evening types) in older adults. CONCLUSION: The results of these studies supported the validity of the MCTQ in Korean older adults. Additionally, while sleep rhythms in elder adults may be more advanced, eveningness tendency may be still important and indicative of sleep and psychological disturbance.

Depression and Memory Decline in the Elderly / Depressão e Declínio de Memória em Idosos / La Depresión y el Deterioro de la Memoria en Personas Mayores

Abstract Objective: To analyze the memory performance of participants aged 60 years and older with and without depressive symptoms. Methods: 199 participants were assessed using the Beck Depressio. In ventory (BDI) with a cut-off point of 20 for depression. Of these, 22 met the criteria for depression group; the remaining participants were allocated to the non-depression group. The Rey Auditory-Verbal Learning Test (RAVLT) was used to assess verbal learning, figures I and II of the Visual Reproduction subtest of the Wechsler Memory Scale Revised (WMS-R) was used to evaluate immediate and delayed visual memory, and the Logical Memory subtests I and II of WMS-R were used to test verbal memory. Results: The average scores for verbal learning in the depression group were significantly lower than those in the non-depression group (p = .001). There were no group differences on visual and logical memory I and II scales. Conclusion: Depressive symptoms affect information retention and verbal learning in the elderly. However, they had no effect on visual and logical memory processing in this sample. The results suggest that, in addition to age-related cognitive decline, depression impairs memory performance considerably.

Resumo Objetivo: analisar o desempenho de memória de participantes com 60 anos ou mais de idade, apresentando ou não sintomas de depressão. Métodos: 199 participantes foram examinados através d. In ventário de Depressão de Beck (BDI) com ponto de corte em 20 pontos para depressão. 22 participantes atingiram o critério para inclusão no grupo de depressão e o restante foi alocado no grupo sem depressão. Os testes utilizados foram: Rey Auditory-Verbal Learning Test (RAVLT) para avaliar aprendizagem verbal, teste de reprodução de figuras I e II da Escala Wechsler Revisada (WMS-R) para memória visual imediata e duradoura e teste de memória lógica I e II da WMS-R para memória verbal. Resultados: os escores médios para aprendizagem verbal no grupo com depressão foram significativamente mais baixos do que no grupo sem depressão (p= 0,001). Não ocorreram diferenças significativas entre os grupos nas escalas para memória visual ou lógica I e II. Conclusões: sintomas de depressão afetam a retenção de informação e a aprendizagem verbal em idosos. Entretanto, não parecem afetar o processamento das memórias visual e lógica. Os resultados sugerem que, além do declínio cognitivo devido ao envelhecimento, a presença de depressão afeta e empobrece o desempenho de memória.

Resumen Objectivo: Analizar el rendimiento de la memoria de participantes con mas de 60 anos con sintomas de depresion. Metodos: 199 participantes fueron examinados a traves de. In ventario de Depresion de Beck (BDI), tomando en consideracion acima de 20 puntos para la depresion. 22 participantes alcanzaron el criterio de inclusion en el grupo de depresion y lo restante fue colocado en el grupo sin depresion. Las pruebas utilizadas fueron: Rey Auditory-Verbal Learning Test para evaluar el aprendizaje verbal; Prueba de Reproduccion de Figuras I y II de Wechsler Memory Scale (WMS-R) para memoria inmediata y duradera, memoria visual y logica de ensayo I y II de la WMS-R para memoria verbal. Resultados: La aprendizaje verbal en el grupo con depresion fue abajo que en el grupo sin depresion (p = .001). No hubo diferencias significativas entre los grupos en las escalas para memoria I y II visual y logica. Conclusiones: La depresion afecta la retencion de informacion y aprendizaje verbal en los ancianos pero no parece afectar el procesamiento de los recuerdos visuales y logicos. Los resultados sugieren que, ademas de deterioro cognitivo debido al envejecimiento, afecta a la presencia de depresion y el rendimiento de la memoria se vuelve pobre.

Accuracy of the 15-item Geriatric Depression Scale (GDS-15) in a community-dwelling oldest-old sample: the Pietà Study / Acurácia da versão de 15 itens da Escala de Depressão Geriátrica (GDS-15) em uma amostra de idosos muito-idosos residentes na comunidade: Estudo Pietà

Abstract Introduction Late-life depression (LLD) is common, but remains underdiagnosed. Validated screening tools for use with the oldest-old in clinical practice are still lacking, particularly in developing countries. Objectives To evaluate the accuracy of a screening tool for LLD in a community-dwelling oldest-old sample. Methods We evaluated 457 community-dwelling elderly subjects, aged ≥75 years and without dementia, with the Geriatric Depression Scale (GDS-15). Depression diagnosis was established according to DSM-IV criteria following a structured psychiatric interview with the Mini International Neuropsychiatric Interview (MINI). Results Fifty-two individuals (11.4%) were diagnosed with major depression. The area under the receiver operating characteristic (ROC) curve was 0.908 (p<0.001). Using a cut-off score of 5/6 (not depressed/depressed), 84 (18.4%) subjects were considered depressed by the GDS-15 (kappa coefficient = 53.8%, p<0.001). The 4/5 cut-off point achieved the best combination of sensitivity (86.5%) and specificity (82.7%) (Youden's index = 0.692), with robust negative (0.9802) and reasonable positive predictive values (0.3819). Conclusion GDS-15 showed good accuracy as a screening tool for major depression in this community-based sample of low-educated oldest-old individuals. Our findings support the use of the 4/5 cut-off score, which showed the best diagnostic capacity.

Resumo Introdução A depressão geriátrica (DG) é um transtorno prevalente que permanece sendo subdiagnosticado. Ferramentas validadas para rastreio de DG em idosos muito idosos na prática clínica são necessárias, especialmente em países em desenvolvimento. Objetivos Avaliar a acurácia diagnóstica da Escala de Depressão Geriátrica (Geriatric Depression Scale, GDS-15) em uma população de idosos muito idosos residentes na comunidade. Métodos Foram avaliados, com a GDS-15, 457 indivíduos nãodemenciados, residentes na comunidade, com idade ≥75 anos. O diagnóstico definitivo de depressão maior foi realizado através da entrevista semiestruturada Mini International Neuropsychiatric Interview (MINI), de acordo com os critérios do DSM-IV. Resultados Cinquenta e dois indivíduos (11,4%) foram diagnosticados com episódio depressivo maior. A área sob a curva receiver operating characteristic (ROC) foi de 0,908 (p<0,001). Utilizando-se o ponto de corte 5/6 (não-deprimido/deprimido), 84 (18,4%) indivíduos foram considerados deprimidos pela GDS-15 (coeficiente de kappa = 53,8%, p<0,001). O ponto de corte 4/5 atingiu a melhor combinação entre sensibilidade (86,5%) e especificidade (82,7%) (índice de Youden = 0,692), com valor preditivo negativo robusto (0,9802) e razoável valor preditivo positivo (0,3819). Conclusão A GDS-15 demonstrou boa acurácia para o rastreio de depressão maior nesta amostra de base populacional de idosos muito idosos com baixa escolaridade. Os resultados do presente estudo indicam que o ponto de corte 4/5 mostrou-se mais adequado para utilização nesta população.

Family of older adults with mental disorder: perception of mental health professionals / El sufrimiento psíquico en la familia del anciano: una percepción de los profesionales de salud mental / Família do idoso em sofrimento psíquico: percepção dos profissionais de saúde mental

ABSTRACT Objective: to understand the perceptions of healthcare professionals of the Psychosocial Care Centers regarding the family of older adults with mental disorders. Method: study of a Qualitative Case conducted with 12 healthcare professionals from a Psychosocial Care Center, with a convenient and exhaustive sample. Conducting semi-structured interviews to collect data, which were analyzed with the Content Analysis technique. Results: the following categories stood out: "Family exhaustion and deterioration in the perception of the healthcare professional" and "The abandonment of older adults by family members and their distancing in the perception of the healthcare professional." Final considerations: culpability of older adults and penalization of the family were verified by healthcare professionals. To bring awareness about the difficulties faced in the attempt to bring the family closer to the healthcare service, it is necessary to analyze the care given to the older adult and to overcome challenges in the effective construction of the bond between family, healthcare user and mental health service.

RESUMEN Objetivo: conocer las percepciones de los profesionales del Centro de Atención Psicosocial sobre el sufrimiento psíquico en la familia del anciano. Método: estudio de caso cualitativo no aleatorizado con agotamiento de la muestra, del cual participaron doce profesionales del Centro de Atención Psicosocial. Para la recolección de datos se hizo entrevistas semiestructuradas, y después se los evaluaron desde el Análisis de Contenido. Resultados: las siguientes categorías fueron las más subrayadas: "El cansancio y el desgaste familiar desde la percepción del profesional" y "El abandono y el alejamiento del anciano por la familia desde la percepción del profesional". Consideraciones finales: se verificó la culpabilidad al anciano y la penalización de la familia desde la perspectiva de los profesionales. Con el propósito de concientizar las dificultades de acercarlo a la familia, es necesario crear espacios que discutan el cuidado a esta población, así como superar los retos para la efectiva construcción del vínculo entre familia, usuario y servicio de salud mental.

RESUMO Objetivo: compreender as percepções dos profissionais do Centro de Atenção Psicossocial acerca da família do idoso em sofrimento psíquico. Método: estudo de Caso Qualitativo conduzido com 12 profissionais de um Centro de Atenção Psicossocial com amostra composta por intencionalidade e fechada por exaustão. Realização de entrevistas semiestruturadas para coleta de dados, analisados por meio da técnica de Análise de Conteúdo. Resultados: destacaram-se as categorias "O cansaço e o desgaste familiar na percepção do profissional" e "O abandono e o afastamento do idoso pela família na percepção do profissional". Considerações finais: verificou-se a culpabilização do idoso e a penalização da família pelos profissionais. Visando à conscientização das dificuldades em aproximar a família, é necessária a criação de espaços reflexivos sobre o cuidado a essa população, bem como a superação dos desafios na construção efetiva do vínculo entre família, usuário e serviço de saúde mental.

Prevalence of Suicidal Ideation and Associated Factors among Community-Dwelling Korean Elderly

OBJECTIVE: This study aimed to evaluate the relationship between suicidal ideation and its associated clinical factors among community-dwelling elderly in Korea. METHODS: A cross-sectional survey was conducted using the data obtained from the face to face interviews of 1,500 (mean age : 74.41±6.44, male : 41.0%) elderly people aged 65 or above living in the community. The questionnaire used in this study was composed of detailed questions about the clinical characteristics including sociodemographic, life style, physical status, and psychiatric factors. In order to assess the suicidal ideation, the subjects were asked questions about the suicidal idea in the past year. RESULTS: A total of 156 (10.4%) elderly reported the suicidal ideation over the last year. Multiple logistic regression analysis revealed significant correlation with dissatisfaction with life [odds ratio (OR) 4.41, 95% confidence interval (CI) 1.55-12.60], depression (OR 2.87, 95% CI 1.62-5.07), cognitive decline (OR 2.38, 95% CI 1.38-4.10), poor perception of health (OR 2.34, 95% CI 1.04-5.24), and insomnia (OR 2.24, 95% CI 1.31-3.84). CONCLUSION: These results showed the several clinical factors associated with suicidal ideation among community-dwelling elderly living in Korea. The present study suggested the necessity for the various aspects of approach.

Kraepelin's description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype / A descrição de Kraepelin de mania crônica: um quadro clínico que corresponde ao fenótipo da variante comportamental da demência fronto-temporal

ABSTRACT Chronic mania is an under-investigated condition and few reports have associated this disorder with an organic background. The present work examines Kraepelin’s reliable description of chronic mania from a current behavioral neurology viewpoint. Kraepelin had described a cluster of symptoms that are now recognized as core manifestations of the behavioral variant frontotemporal dementia (bvFTD) clinical phenotype. We also carried out additional reviews of original manuscripts from Kraepelin’s peers, in order to find any case reports that might fulfill the current diagnostic proposal for bvFTD. Even though we failed to find an ideal case, we found some scholars who seemed to agree that chronic mania should be considered a special form of dementia. The present work highlights, through historical data, the possible overlapping features between primary psychiatric disorders and neuropsychiatric symptoms secondary to neurodegenerative conditions.

RESUMO A mania crônica constitui uma condição subinvestigada e alguns trabalhos têm associado esta desordem a um substrato orgânico. O presente manuscrito analisa a descrição fidedigna de Kraepelin de mania crônica a partir de um ponto de vista atual da neurologia comportamental. Concebemos que ele havia descrito um conjunto de sintomas que atualmente é reconhecido como manifestações centrais do fenótipo clínico da variante comportamental da demência frontotemporal (bvFTD). Também realizamos uma revisão adicional de manuscritos originais de pares contemporâneos de Kraepelin, a fim de procurar por um único relato de caso que poderia preencher critério diagnóstico atual de bvFTD. Mesmo que não tenhamos conseguido encontrar um caso perfeitamente exemplar, identificamos que alguns estudiosos da época pareciam concordar que a mania crônica devesse ser considerada uma forma especial de demência. O presente trabalho destaca por meio de dados históricos a sobreposição entre transtornos psiquiátricos primários e sintomas neuropsiquiátricos secundários a doenças neurodegenerativas.

The Distribution of Depressive Symptoms among the Community-Dwelling Elderly

OBJECTIVES: This study was to understand the characteristics of depressive symptoms among the community-dwelling elderly. METHODS: Through a community mental health mass screening program in senior society, 197 elderly were evaluated for depressive symptoms with Korean version of Short form Geriatric Depression Scale (SGDS-K). The subjects were grouped into normal or caution groups with a cut-off score of 6. The response rate and odds ratio were calculated and compared within each question. RESULTS: Although they had low total score, many subjects in normal group have the symptoms of the question 2, 13, 5, 10, 7, 4 (in order). Question 12, 6, 8, 4, 14, 3 (in order) showed higher odds ratio in caution group than normal group. Questions belonged to a factor 'general depressive mood' scored much higher odds ratio than the other. CONCLUSION: Even the elderly with low score in SGDS-K might complain of symptoms such as decreased level of energy, activities, interests, and memory. However the subjects with high score tend to report feeling more worthless, afraid, helpless, bored, hopeless, and empty. It can be helpful to know the distribution of depressive symptoms for providing careful mental health service to the elderly dwelling in the communities.

Research of cognitive function and influencing factors in first-degree relatives of elderly schizophrenia / 重庆医学

Objective To investigate the cognitive function and its influencing factors in first-degree relatives of elderly schiz-ophrenia.Methods Totally 30 cases of healthy children with elderly patients with schizophrenia(a family group ),50 cases of pa-tients with schizophrenia(patient group),52 healthy elderly subjects (health group)all accepeted mini-mental state examination (MMSE),clinical memory scale(CMS),wisconsin card sorting test(WCST),trail making test(TMT-A),number sign(DSy)and digit span(DSp)tests.The influencing factors were analyzed by stepwise multiple regression analysis method.Results The MMSE score,MQ,connection time,DSy points,and DSp scores of kinship group were significantly higher in patients group(P 0.05),and its completed categories,connec-tion time was significantly lower than the normal group (P < 0.05 ).Years of education and BEAM were incorporated into the MMSE,the number of sustained response were the dependent variable regression equation,the coefficient of determination R 2 was 0.276 and 0.422,Life events,BEAM,personality,parent-child relationship,previous occupation MQ were the dependent variable in-to the regression equation,R 2 was 0.475.Years of education and MMSE score,MQ were significant positive correlation(P <0.05), and sustained response were significantly negatively correlated(P <0.01);BEAM and sustained response were significantly correla-ted(P <0.01);age and completed categories were significantly negatively correlated and the connection time is significant positive correlation(P <0.05);life events,parent-child relationship were significant negative correlation with MQ(P <0.05).Conclusion First-degree relatives of elderly schizophrenia have obvious executive dysfunction,the impact of factors including years of education, BEAM and age.

Somatisation of symptoms in the geriatric population of mangalore city (a cross sectional study).

Aim & Objectives: This cross sectional study was conducted to bring out a better understanding of the link between somatic symptoms and underlying psychiatric conditions in geriatric population of Mangalore city. Material and methods: 200 subjects with the age above 50 years in the outpatient department of hospitals, except the psychiatry wards, and consist of a face to face interview using the standard HADS scale. Result: A total of 105 males and 95 females were interviewed during the study period. The HAD scores of the patients were noted. It was found that in the anxiety sub-scale of the HADS scale 79(39.50%) patients scored less than 8 ('normal') 29(14.50%) scored between 8 and 11 ('borderline abnormal') and 92(46%) patients scored more than 11 ( 'abnormal'). In the depression sub-scale of the HADS scale 79(39.50%) scored less than 8('normal') and 34(17%) scored between 8 and 11('borderline abnormal') and 87(43.50%) scored more than 11('abnormal').In the combined score,71(35.5%) scored less than 8('normal') 54(27%) scored between 16 to 22('borderline abnormal') 75(37.50%) scored more than 22('abnormal'). Among those who were borderline abnormal and abnormal on the HADS scale, it was found that somatic manifestations of underlying depression was found in 64.21% women and 63.81% men. The chief complaints of these patients mostly included dizziness(10.85%), GI symptoms (10.85%), headache(18.60%), menopausal symptoms(17.05%), sleep disturbances (18.60%), general malaise(14.73%) others(9.30%). Conclusion: The present study suggested that somatic symptoms could be due to an underlying psychiatric condition(depression). The patients might present with complain of dizziness, GI symptoms, headache, menopausal symptoms, sleep disturbances, general malaise. While examining a patient, the psychological well-being of the patient should be assessed too. Ageing is another important aspect, and aging patients are more prone to somatisation. This should be kept in consideration while examining a patient.

Depressive morbidity among elderly individuals who are hospitalized, reside at long-term care facilities, and are under outpatient care in Brazil: a meta-analysis

Objectives: i) To investigate studies published between 1991 and 2010 on the prevalence of depressive morbidity (major depressive disorder [MDD], dysthymia and clinically significant depressive symptoms [CSDS]) among elderly Brazilians assisted at healthcare facilities; ii) to establish the prevalence of depression and identify its related factors; and iii) to conduct a meta-analysis to assess the prevalence of depressive syndrome among elderly individuals assisted or hospitalized at healthcare facilities. Methods: Studies were selected from articles dated between January 1991 and June 2010 and extracted from the MEDLINE, LILACS, and SciELO databases. Results: The final analysis consisted of 15 studies, distributed as follows: i) four sampled hospitalized patients, totaling 299 individuals, and found a prevalence of CSDS varying between 20 and 56%; ii) four sampled outpatients, totaling 1,454 individuals; the prevalence of CSDS varied between 11 and 65%, and the prevalence of MDD varied between 23 and 42%; and iii) seven sampled elderly individuals residing in long-term care facilities (LTCF), totaling 839 individuals, and the prevalence of CSDS varied between 11 and 65%. Conclusion: The present review indicated a higher prevalence of both MDD and CSDS among elderly Brazilians assisted at healthcare facilities. .

Delírium en pacientes mayores de 60 años en un hospital público de tercer nivel en la ciudad de Pereira (Colombia ): subdiagnóstico y subregistro / Delirium in Patients Over 60 Years of Age in a Tertiary Level Public Hospital in the City of Pereira (Colombia ): Under-Diagnosed and Under-Recorded

Introducción: El delírium es un trastorno común entre la población geriátrica hospitalizada y es de gran importancia por sus repercusiones en la evolución clínica de los pacientes, pero a menudo su diagnóstico no se realiza. Objetivo: Clarificar el estado del registro y el diagnóstico del delírium en un hospital público de tercer nivel en la ciudad de Pereira. Métodos: Se realizó un estudio descriptivo de corte transversal, en el cual se consultaron las bases de datos de pacientes hospitalizados entre 2010 y 2011 mayores de 60 años, utilizando como filtro la clasificación CIE-10 y verificando los criterios diagnósticos del DSM-IV en las historias clínicas. Resultados: En los años 2010 y 2011, estuvieron hospitalizados 5.325 pacientes mayores de 60 años (19,3 %); según registros de estadística oficiales, el 0,08 % de ellos con diagnóstico de delírium no especificado (F059 ). En la consulta por historias clínicas, se encontró que 455 pacientes tenían esos mismos criterios (40,2 %); el 90,1 % de ellos sufrían delírium y se clasificó con el código F059 sólo al 29,5 %. Conclusiones: Se produce subregistro y subdiagnóstico de delírium de los pacientes mayores de 60 años, lo que se evidencia por la incongruencia en la información oficialmente reportada y la información real obtenida de las historias clínicas respectivas; este hecho incrementa el riesgo y la vulnerabilidad de los pacientes con delírium no diagnosticado o diagnosticado y no reportado en las fuentes estadísticas hospitalarias. La psiquiatría de enlace es una necesidad en las instituciones de tercer nivel, al igual que la formación continua del personal de salud sobre los criterios de prevención, diagnóstico y manejo del delírium.

Introduction: Delirium is a common disorder in the hospitalized geriatric population and it has a great importance on the clinical outcome of inpatients; however, delirium is not diagnosed properly. Objective: To clarify the state of delirium diagnosis and records in a tertiary level public hospital in the city of Pereira. Methods: A cross-sectional descriptive study was performed by searching the clinical records of hospitalized patients older than 60 years 2010 and 2011, using the ICD-10 classification as a filter, and verifying the diagnostic criteria of DSM-IV in the clinical records. Results: In the years 2010 and 2011, 5325 patients older than 60 years were hospitalized (19.3 %). According to the official statistical records; 0.08 % of them were reported with an unspecified diagnosis of delirium (F059 ). In the clinical records search 455 additional delirium patients were found using the same criteria (40.2 %), of which 90.1 % had delirium, and only 29.5 % were classified with the code F059. Conclusions: The diagnoses and recording of delirium patients over 60 years old patients are underestimated, which is demonstrated by the incongruence of the data obtained from the official records and those obtained from the clinical records. This fact increases the risk and vulnerability of patients with undetected delirium or diagnosed but not reported delirium in hospital statistical sources. Liaison psychiatry is a necessity in third level health institutions, as well as a program of continued education for the health staff about prevention, diagnosis criteria and treatment of delirium.

Hippocampal volume and CDR-SB can predict conversion to dementia in MCI patients / O volume do hipocampo e a soma dos subitens da escala CDR podem predizer a conversão para a demência nos pacientes com comprometimento cognitivo leve

OBJECTIVE: To evaluate the combination of two factors: clinical dementia rating sum of boxes scores (CDR-SB) and hippocampal volume (HV) as predictors of conversion from mild cognitive impairment (MCI) to dementia. METHODS: Twenty-eight individuals (9 normal and 19 with MCI) were classified according to their CDR sum of boxes scores into 3 groups. RESULTS: The hippocampal volume was significantly lower in the high-risk group and in those who developed dementia after two years. The rate of conversion was crescent among the three groups. CONCLUSION: We were proposed an additional measurement of the hippocampal volume which may be helpful in the prognosis. However, we noted that the CDR-SB is a method as efficient as neuroimaging to predict dementia with the advantage of being a procedure for low cost and easy implementation, more consistent with public policy.

OBJETIVO: Avaliar a combinação de dois fatores: clinical dementia rating sum of boxes scores (CDR-SB) e volume hipocampal (VH) como preditores de conversão de ditúrbio cognitivo leve (DCL) em demência. MÉTODO: Vinte e oito indivíduos (9 normais e 19 com DCL) foram classificados de acordo com a soma dos escores CDR-SB em 3 grupos. RESULTADOS: O volume do hipocampo foi significativamente menor no grupo de alto risco e naqueles que desenvolveram demência depois de dois anos. A taxa de conversão foi crescente entre os três grupos. CONCLUSÃO: Propusemos uma medição adicional do volume do hipocampo que pode ser útil no prognóstico. No entanto, notou-se que a CDR-SB é um método tão eficiente quanto neuroimagem para prever demência com a vantagem de ser um processo de baixo custo e de fácil implementação, mais consistente com a política pública.