The effect of social frailty on mental health and quality of life in older people: a cross-sectional study.

PURPOSE: This study aims to evaluate anxiety, depression, loneliness, death anxiety, and quality of life and investigate their relationship with social frailty in the geriatric population. Additionally, it aimed to identify social frailty predictors. METHODS: The study included 136 participants admitted to the geriatric outpatient clinic. The 15-item Geriatric Depression Scale (GDS-15), the Multidimensional Scale of Perceived Social Support (MSPSS), the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Templer Death Anxiety Scale (T-DAS), the Loneliness Scale for the Elderly (LSE), the Quality of Life Scale (CASP-19), the Generalized Anxiety Disorder-7 Test (GAD-7), the Tilburg Frailty Indicator (TFI), the FRAIL Scale, and the Clinical Frailty Scale (CFS) were performed. The TFI was used to collect data about social frailty. RESULTS: There were 61.8% females, and the median age (min-max) was 72.2 (65.3-90.3) years. The prevalence rate of social frailty was 26.7%. The rates of depression, loneliness, anxiety, death anxiety, the burden of chronic disease, and frailty were higher in the social frailty group. Furthermore, logistic regression analysis revealed a strong relationship between social frailty status and widowhood (odds ratio (OR) 6.86; 95% confidence interval (95% CI), 2.42-19.37; p < 0.001), moderate to severe anxiety symptoms (OR 4.37; 95% CI 1.08-17.68; p = 0.038), and a TFI-physical frailty score (OR 1.40; 95% CI 1.12-1.73; p = 0.002). CONCLUSION: In older adults, the social dimension of frailty is associated with quality of life and psychological state. Physical frailty and sociodemographic characteristics may affect the development of social frailty.

Which comorbidity index is more appropriate for geriatric patients from the frailty perspective?

OBJECTIVES: This study examined the relationship between comorbidity indices and physical, psychologic and social frailty and 1-year mortality. METHODS: A cross-sectional analysis was conducted with 136 community-dwelling older adults. The relationship of 4 comorbidity indices (CIRS-G, ACCI, GIC, ICED) with 3 different frailty scales (FRAIL, CFS, TFI) was examined. RESULTS: The participants' median age was 72 years (65-90); 62% of the participants were female. Overall, 15.4% of the participants were living with frailty according to the FRAIL scale, 27.9% of them according to the CFS, 58.8% of them according to the TFI, 47.7% of them living with psychological frailty, and 28.6% of them living with social frailty. There were significant and moderate correlations between CIRS-G and FRAIL, CFS and TFI total scores, TFI-Psychological scores and TFI-Social scores (respectively; p < 0.001, r = 0.530; p < 0.001, r = 0.471; p < 0.001, r = 0.535; p < 0.001, r = 0.402; p = 0.016 r = 0.206). AUC for CIRS-G was calculated as 0.716 among comorbidity indices in predicting the presence of frailty according to the FRAIL scale (p = 0.002, 95%CI [0.60-0.82]), 0.765 according to the CFS (p < 0.001, 95%CI [0.66-0.86]), 0.746 according to the TFI (p < 0.001, 95%CI [0.66-0.82]). CONCLUSION: The CIRS-G index was found to be superior to other indices in predicting the presence of frailty of comorbidity indices, and only GIC scores showed significant results in predicting mortality. However, it would not be the right approach to recommend a single comorbidity index when evaluating older adults.

A Severe Neuroleptic Malignant Syndrome Treated with Daily Electroconvulsive Therapy: A Case Report. / Günlük Elektrokonvülzif Terapi ile Tedavi Edilen Siddetli Nöroleptik Malign Sendrom: Bir Olgu Sunumu.

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition caused by dopamine modulating medications, particularly antipsychotics. First-line treatments of neuroleptic malignant syndrome are supportive care, discontinuation of the offending agent and pharmacotherapy. In drug-resistant and severe situations, electroconvulsive therapy (ECT) is recommended as well. In this paper we present a 23-year old male with bipolar disorder who was treated with multiple injections of zuclopenthixol long acting and depot forms for a recent manic episode and developed NMS. The patient was transferred to an intensive care unit, medical management was initiated including benzodiazepines, bromocriptine and dantrolene. Due to the inadequate response after several days, ECT (bitemporal electrode placement, briefpulse, on a daily basis) was initiated. After 17 sessions, NMS relieved and there was no need for maintenance ECT. The patient is under follow-up care for 3 years with no cognitive and physical sequela. Keywords: Electroconvulsive therapy, neuroleptic malignant syndrome, bipolar disorder.

Effects of Age, Gender and Education on Phonemic and Semantic Verbal Fluency. / Yas, Cinsiyet ve Egitim Düzeyinin Fonemik ve Semantik Sözel Akicilik Testi Puanlari Üzerinde Etkisi.

OBJECTIVE: The aim of this study was to obtain normative data for Verbal Fluency Test and investigate the effects of age, gender, and education on verbal fluency in native Turkish-speaking individuals. METHOD: A pilot study was conducted to determine 3 letters with differing levels of difficulty for completing the phonemic fluency task. First names and animals were chosen for the semantic fluency task, and an alternating semantic task (first name-animal) was also used. In total, 415 participants (208 male and 207 female) were recruited and stratified based on the age and education levels. RESULTS: Level of education had a main effect on all verbal fluency tasks; people with higher education performed better. Age and gender were found to have no effect on phonemic verbal fluency. Only the < name production task was affected by gender, women performed better. Younger age groups produced more words in name generation and semantic alternating fluency tasks. CONCLUSION: The effects of age, gender and education on verbal fluency are in accordance with many previous reports. Analysis of various errors were also conducted. Results for Turkish are presented and discussed in the light of literature.

The Validity and Reliability of the Turkish Version of MacArthur Competence Assessment Tool for Treatment Decision: Correlates of Competence in Schizophrenia Patients.

INTRODUCTION: Informed consent is an indispensable condition of the clinical practice for the provision of health care. The main objective of this study is to translate the MacArthur competence assessment tool for treatment (MacCAT-T) into Turkish and evaluate the validity and reliability of the Turkish version in schizophrenia patients and healthy control subjects. METHODS: In this cross-sectional study, 30 hospitalized schizophrenia patients and 25 healthy subjects were assessed with MacCAT-T, Mental Competence Evaluation Form for Assessment of Competency (MCEF), Positive and Negative Syndrome Scale, Beck Depression Inventory, Mini Mental State Examination, Wechsler Adult Intelligence Scale (WAIS) - Similarities subtest and the Schedule for Assessing the Three Components of Insight. Psychometric properties of MacCAT-T were examined by intra-class correlation coefficients and Cronbach's alpha values. RESULTS: Intra-class correlations ranged between 0.83 and 0.99 for four subscales of the tool. Cronbach alpha value of MacCAT-T was found 0.89. Severity of psychopathology and indices of insight were found to be negatively correlated with the subscales of the tool. WAIS-Similarities subtest scores were found to be positively correlated with understanding and reasoning subscales of MacCAT-T. CONCLUSION: The Turkish version of MacCAT-T is a valid and reliable instrument for Turkish patients. The severity of psychopathology, insight and executive functions were shown to be significantly related to the decision making capacity in patients with schizophrenia.

Factors associated with severe lung disease in an adult population with cystic fibrosis: a single-center experience

Background/Aim: The patients with cystic fibrosis (CF) are living longer compared to the past, but respiratory failure is still the most common cause of mortality. The aim of this study is to investigate factors associated with severe lung disease in a cohort of adult patients with CF. Materials and methods: Demographic data, clinical and laboratory findings of the patients aged 18 years and more were collected and the patients were grouped according to forced expiratory volume in 1 s (FEV1) as severe group: <40% and nonsevere ≥40%. Associations were investigated between groups and clinical outcomes. Results: A total of 76 patients were enrolled in the study. The mean age was 24.5 ± 5.25 years and 36 (47.4%) patients were female. In the severe group; the mean age was higher (27.1 ± 6.0 vs 23.6 ± 4.7, P = 0.013), the median Chrispin-Norman score of severe lung disease group was higher (14 (6­22) vs 5.5 (0­20), P < 0.001), hospitalization at least once in a year for intravenous antibiotic was more common (12/18 (66%) vs 19/58 (32%), P = 0.014). There was a positive correlation between body mass index (BMI) and lung function, indicating that lower nutritional status was related to lower FEV1, r2 = 0.21, P < 0.001. The median FEV1% was lower in patients with CF-related diabetes (38 (14­95) vs 66 (13­121), P = 0.042). Dornase alpha use and physiotherapy rate were higher in severe lung disease group (P = 0.008 and P < 0.001, respectively). Conclusion: Lower BMI, older age, presence of CF-related diabetes, higher radiologic scores, use of dornase alpha and physiotherapy and higher hospitalization rate for intravenous antibiotic therapy are significantly associated with severe lung disease.

Longitudinal Analysis of Female Authorship of Psychiatry Articles in Turkey.

INTRODUCTION: The number of women with careers in medicine and with academic positions at medical schools has increased substantially since the 1980s; however, women remain underrepresented in medical academia, which may be because of the fewer research publications authored by women. This study aimed to determine the gender distribution among Turkish authors of psychiatry articles published in international scientific journals during a 30-year period. METHODS: The ISI Web of Science database was searched for all psychiatry publications between 1980 and 2009 using the search term Turkey. All articles were classified according to publication period (1980-1989, 1990-1999, 2000-2004, and 2005-2009), gender of the first and last authors, first author title, total number of authors, and type of article. RESULTS: In all, 1961 articles meet the study criteria. The first author of 36.5% of the articles and 34.9% of last authors were women. The percentage of female first and last authors did not differ according to publication period (p=0.57). CONCLUSION: To the best of our knowledge this is the first study to examine gender and authorship of psychiatric research in Turkey. In total, 33% of academic positions in Turkish university psychiatry departments were occupied by women, which is comparable to the percentage of female first authors of psychiatric research papers from Turkey. It could be concluded that women academics in psychiatry departments from state universities are as reproductive as their male counterparts, but there is still a "gender gap" in psychiatry field in our country.

Validation of Montreal Cognitive Assessment and Discriminant Power of Montreal Cognitive Assessment Subtests in Patients With Mild Cognitive Impairment and Alzheimer Dementia in Turkish Population.

Montreal Cognitive Assessment (MoCA) is a new cognitive tool developed for screening mild cognitive impairment (MCI). The authors examined validity of MoCA and discriminating power of subtests in a Turkish population comprising of 474 participants (246 healthy controls, 114 subjects with MCI and 114 subjects with dementia). The ANCOVAs showed that age and education had a main effect on MoCA scores. Cut scores were computed according to different education levels. The overall cut-off values for MCI and dementia were found to be lower compared to western studies. MoCA was found to have good internal consistency. The subtests most useful in discriminating MCI from healthy controls were recall, visuospatial and language, while in discriminating dementia from MCI were visuospatial, orientation and attention subtests. The results demonstrated that MoCA is a valid and reliable instrument in screening MCI, and compared with the MMSE, MoCA was proved to have superior sensitivity and specificity in detecting MCI.

The prevalence and recognition rate of delirium in hospitalized elderly patients in Turkey.

OBJECTIVE: Delirium is frequently observed, but generally under recognized in elderly hospitalized patients. The aims of this study were to determine the prevalence of delirium in elderly patients hospitalized at a university hospital, and to determine the recognition rate by hospital staff during hospitalization. METHODS: The study included 108 consecutive patients aged ≥ 65 years that were hospitalized in the medical and surgical inpatient departments at Baskent University Hospital, Ankara, Turkey. All the patients were evaluated using the Mini Mental State Examination (MMSE) upon admission and Confusion Assessment Method (CAM) on a daily basis during hospitalization. Written documents and consultation requests from psychiatry and/or neurology departments were reviewed for recognition of delirium by hospital staff. RESULTS: Among the 108 patients in the study, delirium was noted in 18 (16.7%) during their hospital stay. Consultation from psychiatry or neurology departments was requested for 5 of the 18 patients, only 1 with a delirium diagnosis, indicating that 17 of the cases (94.4%) were not recognized by their primary physicians. CONCLUSIONS: The delirium non-recognition rate in elderly hospitalized patients was very high. We think that hospital staff must be trained to recognize the symptoms of delirium and identify high-risk patients.

Knowledge of and attitudes toward electroconvulsive therapy among medical students, psychology students, and the general public.

OBJECTIVE: Electroconvulsive therapy (ECT) is safe and effective for the treatment of various psychiatric disorders. Despite being a well-known treatment method among health care professionals, lay people generally have a negative opinion of ECT. The present study aimed to examine knowledge of and attitudes toward ECT among medical students, psychology students, and the general public. Psychology students were included because they are among the important groups in mental health care in Turkey. MATERIALS AND METHODS: A Likert-type questionnaire was administered to fifth-year medical students (n = 28), master of science and doctor of philosophy clinical psychology students (n = 35), and a sample of the general public (n = 26). The questionnaire included questions about the general principles of and indications for ECT, and sources of knowledge of and attitudes toward ECT. RESULTS: The medical students were the most knowledgeable about ECT, as expected. The medical students also had a more positive attitude toward ECT than the other 2 groups. More psychology students had negative attitudes on some aspects than general public sample, despite being more knowledgeable. CONCLUSIONS: Medical school theoretical and practical training in ECT played an important role in increasing the level of knowledge of and decreasing the prevalence of negative attitudes toward ECT among the medical students; similar training for psychology students is required to achieve similar results.

The incidence of and risk factors for postpartum depression at an urban maternity clinic in Turkey.

OBJECTIVE: Postpartum depression (PPD) is an important health issue that affects not only mothers, but also entire families. Postpartum follow-up should address emotional and psychological issues, as well as physical issues, especially in those at risk. This study aimed to determine the incidence of PPD and the associated risk factors in a group of new mothers undergoing routine follow-up at an urban maternity clinic. METHODS: This is a cross-sectional study investigating the relationship between PPD and various factors. A total of 187 women that presented to a university hospital for routine postpartum follow-up 4-6 weeks post delivery were recruited consecutively. The mothers were administered a sociodemographic form that included questions about the known risk factors (sociodemographic and sociocultural factors, and mother-related, pregnancy-related, and child-related factors) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The incidence of PPD based on EPDS scores was 28.9% (scores > 12 were defined as PPD). Unplanned/unintended pregnancy, bottle-feeding only, mother's lack of satisfaction with the baby's sleep pattern, lack of family support for baby care, lack of satisfaction with the marital relationship, and family violence were significantly correlated with PPD (P < 0.05). Multiple logistic regression showed that bottle-feeding, lack of family support, lack of satisfaction with the marital relationship, and family violence were the primary factors that significantly increased the risk of PPD. CONCLUSIONS: The findings show that the PPD occurs in almost one-third of women and that, among the risk factors, sociocultural factors were the most strongly associated with PPD.

Reliability and validity of the Geriatric Depression Scale in detection of poststroke minor depression.

OBJECTIVE: The aim of this study was to assess the validity and reliability of the 30-item Geriatric Depression Scale (GDS) as a screening tool for minor depression in poststroke patients. METHOD: Literate patients older than 18 years of age, diagnosed to have stroke, were eligible for the study. Standardized Mini Mental Status Examination (S-MMSE) and GDS were applied to all patients. The GDS was readministered 7 days later for retest reliability. RESULTS: A total of 85 participants--49 nondepressed and 36 with minor depression--were eligible for the study. Cronbach's alpha coefficient was .89 in internal consistency analysis. The GDS scores were significantly higher (p < .001) in the depressed participants reflecting a high discriminant validity. The highest sum of sensitivity and specificity values of 1.44 (sensitivity = .69, specificity = .75) and 1.45 (sensitivity = .66, specificity = .79) were obtained for cutoff scores of 10/11 and 11/12, respectively. The area under receiver operating characteristics curve was .82. The test-retest reliability analysis revealed a high Pearson correlation coefficient (r = .75). CONCLUSION: Our findings suggest that the 30-item GDS has high discriminant validity, internal consistency, and test-retest reliability and reasonably useful cutoff scores; thus it can be used as a screening tool for minor depression in the poststroke population.

A challenging case of syndrome of inappropriate secretion of antidiuretic hormone in an elderly patient secondary to quetiapine.

Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an uncommon complication of treatment with centrally acting drugs including selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications. Antipsychotics are commonly used for the treatment of behavioral and psychiatric symptoms in elderly patients with dementia, and the use of those agents is increasing. Here, we report an elderly man who developed hyponatremia after treatment with medications for depression and agitation.