The needs of older people with mental health problems in a Portuguese psychiatric setting.

BACKGROUND: This study aims to identify met and unmet needs, according to the patient, the carer and the staff, and their relationship with socio-demographic and clinical characteristics in elderly people with mental health problems. METHODS: A sample of 306 elderly patients ≥65 years, of both sexes, diagnosed with mental illness (ICD-10 criteria), was recruited from inpatient/outpatient settings in a Department of Psychiatry and Mental Health, in northern Portugal. Patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE. RESULTS: The majority of diagnoses were depression (33.7%), dementia (24.5%), and schizophrenia (12.7%). The patients' main unmet needs found were psychological distress (15.0%), daytime activities (10.5%), and benefits (6.5%). Patients reported significantly lower unmet and global needs than carers and staff (Z = -8.58, p < 0.001; Z = -11.07, p < 0.001, respectively). A larger number of global needs (met and unmet) were associated with the diagnosis of dementia, followed by schizophrenia, bipolar, and depressive disorder (p < 0.001), with inpatients reporting more needs than outpatients. CONCLUSIONS: Mental disorders were associated with a greater number of needs in elderly patients, which makes this assessment important as it includes the patients' perspective, when they are the focus of intervention, in order to decrease distress and make more beneficial use of services, especially in inpatient settings. These different perspectives are crucial when assessing and planning psychiatric and mental health services.

The needs of older people with mental health problems: a particular focus on dementia patients and their carers.

The problems and needs of older people are often associated with mental illness, characterized by a set of clinical manifestations, which constitute important domains for investigation and clinical practice. This paper presents the results of a pilot study whose main purpose was to identify met and unmet needs and to analyze the relationship between those needs, psychopathology and functionality in older people with mental health problems. A sample of 75 patients aged 65 or over, of both sexes, diagnosed with mental illness using ICD-9. The main diagnoses were depression (36%) and dementia (29.3%). Most patients had cognitive impairment (MMSE, 52%; CDT, 66.7%), depression (GDS, 61.3%), anxiety (ZAS, 81.3%), and moderate dependence (BI, 49.3% and LI, 77.3%). The main unmet needs found were daytime activities (40%), social benefits (13.3%), company (10.7%), psychological distress (9.3%), and continence (8%). The majority of these unmet needs occur with dementia patients. The majority of the carers of these patients had global needs (met and unmet) in terms of psychological distress. Findings also reveal that a low level of functionality is associated with dementia diagnoses. The association analyses suggest that dementia is an important determinant of the functional status and needs.

Anestesia geral para colecistectomia laparoscópia: efeito de óxido nitroso sobre a ventilaçåo pulmonar / Anesthesia for laparoscopic cholecystectomy: importance of nitrous oxide to the pulmonary ventilation

Twenty-four patients of both sexes, physical status ASA I and II, were submitted to laparoscopic cholecystectomy. Patients were premedicated with 10 mg of diazepam and the anesthesia was induced with droperidol (0,03 mg.kg(-1)), alfentanil (40 mg.kg(-1)), propofol (2 mg.kg(-1) ) and atracurium (0,5 mg.kg(-1)). After tracheal intubation, pulmonary ventilation was maintained with a Takaoka 676 ventilator with a tidal volume of 7 ml.kg(-1), FiO2 of 0.33-0.35, intracheal pressure of 10-12 cmH2 O and respiratory rate adjusted to maintain ETCO2 36-38 mmHg and Sp)2 97-98 por cent. The patients were allocated into two groups. Group air: ventilated eith room air enriched with oxygen to a FiO2 of 0.35 and group N20: ventilated with 67 por cent N2O in O2. Maintenance of anesthesia was done with 10 mg.kg(-1).h(-1) of propofol in the first 20 min and with 5 mg.kg(-1).h(-1) afterwards until the end of the surgical procedure, plus intermittent doses of alfentanil. Changes in pulmonary ventilation rate and in the intratracheal pressures were record at nine moments. Carbon dioxide was administered until intrabdominal pressure reached 12-14 mm Hg; the initial and final volumes administered were recorded. The intracavitary concentration of N2O was evoluated by an Ohmeda 5250 Gas Multianalyser at the end of the procedure. Systolic and dystolic blood pressure and heart rate were evaluated every 5 min, at the same moments as the pulmonary ventilation parameters. There was no difference in the minute volumes at moment 1, but they were significantly higher at the subsequent moments (p major then 0,05), in the group which was ventilated with air. There were significant differences in intratracheal pressures before and the after the insuflation of CO2 and after the deflation within each group, but not between the groups. Nitrous oxide was detected in the abdominal cavity in remarkable concentrations. There were significant differences between the groups regarding systolic arterial pressure after insuflation and deflation of CO2, during maintenance and after extubation. The authors conclued that N2O diffuses to the abdominal cavity in significant concentrations and that it is able to minimize the respiratory changes associated with high intrabdominal pressure and with CO2 absorption. There were no differences in CO2 volumes required during the laparoscopic procedure