Psychiatric symptoms are not an independent mortality risk factor in community-living elderly people.

BACKGROUND: Mortality risk factors have attracted great research interest in recent years. Physical illness is strongly associated with mortality risk in elderly people. Furthermore, a relationship between mortality risk and psychiatric disease in the elderly has gained research interest. METHODS: This is a prospective longitudinal multicenter study. A sample of 324 participants was selected as a representative sample of community members aged 65 years and older and living in Huesca (Spain). The following information was collected: affiliation data, severity of physical illness, psychosocial, and psychiatric factors. Statistical analyses were completed with a multivariate analysis in order to control possible confounding variables related to mortality. RESULTS: Of the initially selected sample, 293 participants were assessed. Sixty-four participants died (21.8%, 95% CI [16.9%, 26.7%]), 5.3% annual rate, and 46.1% showed symptomatology of mental disorders. Older people have eight times greater risk of mortality. The risk increased 53 times in patients affected by several physical illness. No relationship between cognitive dysfunction and depressive symptomatology was observed. In fact, physical condition was associated with depression, and the percentage of participants with depressive symptoms increased according to the severity of physical illness. CONCLUSIONS: Severity of physical illness and age are independently and directly associated with mortality in the elderly people. Therefore, severity of physical illness seems to be a crucial factor in the bi-directional association between mortality and depression, acting as a risk factor independently for both. So the relationship between depression and mortality can be affected by the severity of physical illness.

Prevalence of psychiatric symptoms and mental disorders detected in primary care in an elderly Spanish population. The PSICOTARD Study: preliminary findings.

OBJECTIVES: To investigate the prevalence of mental health problems among the elderly attending Primary Care centres in the Province of Huesca (Spain). To detect factors associated with the psychopathology of the elderly, and to demonstrate that specific training for GPs (General Practitioners) in the use of psychogeriatric screening instruments significantly increases detection. METHODS: Sample selection was made by means of systematic random sampling, stratified by the participants' health centres. Two hundred and ninety-three patients over 65 were assessed with the Spanish version of the Mini-Mental State Examination, Clock Drawing Test, Verbal Fluency, Informant Questionnaire (detection of cognitive impairment), Yesavage Geriatric Depression Scale, Goldberg Anxiety and Depression Scale, and Geriatric Mental State Schedule (items for delusions, hallucinations, obsessive ideas and hypochondriacal ideas). RESULTS: Almost half the patients (46.1%) presented some type of psychiatric symptom at the time of assessment. The most prevalent disorders were: cognitive impairment (16.4%), anxiety (15.7%), depression (14.3%), psychosis (6.1%), obsessive symptoms (4.4%) and hypochondriacal ideas (7.2%). Women presented more psychopathological disorders than men (58.7% vs 34.0%). Age, severity of physical illness, poor social support and previous psychiatric comorbidity were associated with psychiatric disorders in the elderly. CONCLUSIONS: Only 29% of the elderly population studied had a previous psychiatric diagnosis, so the detection of mental problems in old age is low in Primary Care. When Family Doctors are trained in psychogeriatric screening instruments, detection and sensitivity in the recognition of these important health problems increases. Greater training in psychogeriatric assessment is required in Primary Care.

Assessment of sexual functioning in depressed patients treated with mirtazapine: a naturalistic 6-month study.

UNLABELLED: Antidepressant-induced sexual dysfunction is a frequent side effect which may greatly contribute to treatment non compliance. Mirtazapine has a pharmacological profile expected to result in a lack of sexual dysfunction. The main purpose of this 6-month open-label study was to evaluate the effects of mirtazapine on sexual function of a sample of depressed patients. METHODS: Seventy-eight patients meeting DSM-IV criteria for major depression or adjustment disorder with depressed mood or with mixed anxiety and depressed mood, sexually active prior to the episode, were treated with mirtazapine (15-60 mg/day). Effectiveness was assessed using the 17-item Hamilton rating scale for depression (HAM-D-17), the Hamilton rating scale for anxiety (HAM-A) and the clinical global impression (severity and improvement) scales (CGI). Sexual function was evaluated with the psychotropic-related sexual dysfunction questionnaire (PRSexDQ) which detects clinical changes in sexual dysfunction. RESULTS: Forty-eight patients (61.5%) were experiencing sexual dysfunction at baseline. A return to normal sexual functioning was observed in 27 of 38 (71.1%) patients completing the study. Significant reductions in mean total PRSexDQ scores were detected at day 90 and endpoint and only four patients withdrew or required dose reduction due to mirtazapine-induced sexual dysfunction. A total of 37 patients (47.4%) achieved complete remission of depression (HAM-D-17 score