Objective:The Intensive Initial Support Team for Dementia (IPIST) is a multidisciplinary outreach team that provides intensive initial assessment and support for dementia in Japan, introduced based on the Memory Service in the UK. All municipalities are required to establish at least one team, which consists of at least one physician and two professional staffs such as public health nurses and care workers. IPIST usually complete the work within approximately six months, including consultation with medical specialists and introduction of public supports. IPIST sometimes faces “complex case” that is difficult to manage. Because complex cases often have psychiatric problems, accessibility to psychiatric resources is important for IPIST. This study investigated the percentage of psychiatric professionals among IPIST members and the characteristics of complex cases they face.Methods:Through all 1741 municipalities in Japan, a questionnaire was distributed to each IPIST regarding the complex cases they experienced during April-September 2020. The questionnaire asked for the characteristics of each IPIST (e.g., specialty of the team physician, availability of staff with psychiatric expertise, etc.) and which of the 12 categories each complex case fit into, allowing multiple choice.Results:We could collect responses from 1291 IPISTs. 43.3% of IPISTs had a psychiatrist, 43.1% had an internal medicine physician, 13.4% had a neurologist, and 17.0% had some other physician as their team physician. In addition, 59.4% of the teams had medical staff members with psychiatric experience, including psychiatrists. A total of 7340 cases were reported as complex cases. While the most common category for difficulties in case management was “refusal of services” (19.5%), factors requiring psychiatric intervention such as “behavioral and psychological symptoms of dementia” (16.0%), “co-occurring mental illness” (7.3%), “complaints from neighbors” (7.1%), and “trash-house” (4.3%) were also frequently observed.Conclusion:The survey revealed that many IPISTs already had psychiatrists and other professionals with clinical psychiatric experience, and that they managed a lot of complex cases with issues that would be the target of psychiatric intervention. We believe early psychiatric engagement is important in many complex cases in outreach support for community residents with suspected dementia.
{"title":"P208: The activities of Initial- phase Intensive Support Team for Dementia (IPIST) in Japan","authors":"Yuto Satake, Daiki Taomoto, Maki Suzuki, Kazue Shigenobu, Hideki Kanemoto, Kenji Yoshiyama, Manabu Ikeda","doi":"10.1017/s1041610223002831","DOIUrl":"https://doi.org/10.1017/s1041610223002831","url":null,"abstract":"Objective:The Intensive Initial Support Team for Dementia (IPIST) is a multidisciplinary outreach team that provides intensive initial assessment and support for dementia in Japan, introduced based on the Memory Service in the UK. All municipalities are required to establish at least one team, which consists of at least one physician and two professional staffs such as public health nurses and care workers. IPIST usually complete the work within approximately six months, including consultation with medical specialists and introduction of public supports. IPIST sometimes faces “complex case” that is difficult to manage. Because complex cases often have psychiatric problems, accessibility to psychiatric resources is important for IPIST. This study investigated the percentage of psychiatric professionals among IPIST members and the characteristics of complex cases they face.Methods:Through all 1741 municipalities in Japan, a questionnaire was distributed to each IPIST regarding the complex cases they experienced during April-September 2020. The questionnaire asked for the characteristics of each IPIST (e.g., specialty of the team physician, availability of staff with psychiatric expertise, etc.) and which of the 12 categories each complex case fit into, allowing multiple choice.Results:We could collect responses from 1291 IPISTs. 43.3% of IPISTs had a psychiatrist, 43.1% had an internal medicine physician, 13.4% had a neurologist, and 17.0% had some other physician as their team physician. In addition, 59.4% of the teams had medical staff members with psychiatric experience, including psychiatrists. A total of 7340 cases were reported as complex cases. While the most common category for difficulties in case management was “refusal of services” (19.5%), factors requiring psychiatric intervention such as “behavioral and psychological symptoms of dementia” (16.0%), “co-occurring mental illness” (7.3%), “complaints from neighbors” (7.1%), and “trash-house” (4.3%) were also frequently observed.Conclusion:The survey revealed that many IPISTs already had psychiatrists and other professionals with clinical psychiatric experience, and that they managed a lot of complex cases with issues that would be the target of psychiatric intervention. We believe early psychiatric engagement is important in many complex cases in outreach support for community residents with suspected dementia.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"76 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223001746
Marieke Perry, Eline Verspoor, Rene Melis, Myrra Vernooij-Dassen
Objective:Dementia negatively affects the interaction with the social environment by changes in cognition and behavior. On the other hand, the social network may be an important enabler for persons with dementia to make use of their remaining capacities. Mechanisms driving and explaining these interactions are unknown. We aimed to explore how the social environment impacts the functioning and well-being of a person with dementia.Methods:We performed a qualitative case study, conducting semi-structured interviews. We used the grounded theory approach, as defined by Strauss and Corbin, including alternate data collection and analysis. Per case, the person with dementia, the primary caregiver, significant kin or non-kin network member and the primary healthcare professional were interviewed individually. The interviews were conducted using a topic guide, which was adjusted according to preliminary analyses. Transcripts were coded by two researchers independently, where after axial codes, categories were formulated and a theory including a core phenomenon was identified with the entire research team.Results:Analyses revealed ‘creating a safe environment’ as a core phenomenon. This relates to encouragement and the created anchor points of the environment to compensate for the inevitable feelings of loss of control that persons with dementia experience. The ways safety is created include active acts of involvement and participation, trust, humor, reciprocity, appreciation and shared experiences. Suspicion, loss of initiative by the person with dementia and the inability to act and correcting by the environment were identified as major challenges to creating a safe environment.Conclusions:A safe and supporting environment enables persons with dementia to use their remaining capacities. Active participation, trust, humor and reciprocity are key elements to create such a safe environment. These findings show that basic needs of persons with dementia for daily functioning and well-being are similar to these of all humans.
{"title":"The influence of the social environment on the functioning and well-being of the person with dementia: a qualitative study","authors":"Marieke Perry, Eline Verspoor, Rene Melis, Myrra Vernooij-Dassen","doi":"10.1017/s1041610223001746","DOIUrl":"https://doi.org/10.1017/s1041610223001746","url":null,"abstract":"Objective:Dementia negatively affects the interaction with the social environment by changes in cognition and behavior. On the other hand, the social network may be an important enabler for persons with dementia to make use of their remaining capacities. Mechanisms driving and explaining these interactions are unknown. We aimed to explore how the social environment impacts the functioning and well-being of a person with dementia.Methods:We performed a qualitative case study, conducting semi-structured interviews. We used the grounded theory approach, as defined by Strauss and Corbin, including alternate data collection and analysis. Per case, the person with dementia, the primary caregiver, significant kin or non-kin network member and the primary healthcare professional were interviewed individually. The interviews were conducted using a topic guide, which was adjusted according to preliminary analyses. Transcripts were coded by two researchers independently, where after axial codes, categories were formulated and a theory including a core phenomenon was identified with the entire research team.Results:Analyses revealed ‘creating a safe environment’ as a core phenomenon. This relates to encouragement and the created anchor points of the environment to compensate for the inevitable feelings of loss of control that persons with dementia experience. The ways safety is created include active acts of involvement and participation, trust, humor, reciprocity, appreciation and shared experiences. Suspicion, loss of initiative by the person with dementia and the inability to act and correcting by the environment were identified as major challenges to creating a safe environment.Conclusions:A safe and supporting environment enables persons with dementia to use their remaining capacities. Active participation, trust, humor and reciprocity are key elements to create such a safe environment. These findings show that basic needs of persons with dementia for daily functioning and well-being are similar to these of all humans.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"283 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139666927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223001199
Huizi Li, Huali Wang
Objective:Previous studies have reported that the structure and function of the striatum are important in bvFTD, and the striatum can be divided into more subregions. Changes within brain regions has recently attracted increasing attention, but most studies have explored the relationship between the striatum and other brain regions. Therefore, the aim of this study was to explore the changes in the intra-striatal resting-state functional connectivity (RSFC).Methods:We acquired fMRI data from 26 bvFTD patients and 36 healthy controls. The Human Brainnetome Atlas was used to define the spatial extent of the striatum and delineate its subregions. Intra- and extra-striatal FC values were then calculated for each individual and compared between bvFTD and control groups.Results:Compared to healthy controls, bvFTD showed decreased intra-striatal FC. Both intra-hemispheric and inter-hemispheric functional connectivity were compromised. There was also a gradient reduction in terms of the functional connectivity within striatum: the left dorsolateral putamen showed most decrease and the left ventral caudate exhibited the least (Fig 1). The extra-striatal FC between striatum and the insula was also decreased.Conclusion:The loose intra-striatal functional connectivity may underly the neural substrate of bvFTD.
{"title":"FC21: Loose functional connectivity within the striatum in behavioral variant frontotemporal dementia","authors":"Huizi Li, Huali Wang","doi":"10.1017/s1041610223001199","DOIUrl":"https://doi.org/10.1017/s1041610223001199","url":null,"abstract":"Objective:Previous studies have reported that the structure and function of the striatum are important in bvFTD, and the striatum can be divided into more subregions. Changes within brain regions has recently attracted increasing attention, but most studies have explored the relationship between the striatum and other brain regions. Therefore, the aim of this study was to explore the changes in the intra-striatal resting-state functional connectivity (RSFC).Methods:We acquired fMRI data from 26 bvFTD patients and 36 healthy controls. The Human Brainnetome Atlas was used to define the spatial extent of the striatum and delineate its subregions. Intra- and extra-striatal FC values were then calculated for each individual and compared between bvFTD and control groups.Results:Compared to healthy controls, bvFTD showed decreased intra-striatal FC. Both intra-hemispheric and inter-hemispheric functional connectivity were compromised. There was also a gradient reduction in terms of the functional connectivity within striatum: the left dorsolateral putamen showed most decrease and the left ventral caudate exhibited the least (Fig 1). The extra-striatal FC between striatum and the insula was also decreased.Conclusion:The loose intra-striatal functional connectivity may underly the neural substrate of bvFTD.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"37 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223003241
Romy Engelbrecht
Objective:Historically, older adults in residential aged care facilities (RACF) in Australia had no access to government funded psychology services despite high rates of anxiety and depression. Change Futures is a registered charity that provides funded psychology to more than 220 RACFs in south-east Queensland and northern New South Wales, Australia, and since 2015 has been providing free psychology services to older adults living in aged care, using a predominately provisional psychologist workforce. This presentation will discuss the model of service that is provided, and the findings of a recent outcomes report.Method:Data was collected via clinician entered eHealth records in the 2021/2022 financial year from 01/07/2021 to 30/06/2022. Outcome measures were analysed using six repeated measure t-tests to compare clinical change from first and last assessments.Results:A total of 2865 residents were seen in 17,754 individual sessions and 298 group sessions. Staff education was provided in 94 sessions with 838 participants, who worked in RACFs. The most common presenting issue was difficulties with adjustment (70%), comorbid anxiety and depression (28%), depression (27%), loneliness (18%), and anxiety (17%). Outcomes of the psychology program showed statistically significant improvements on all measures, including the Kessler 5 psychological distress scale, Geriatric anxiety scale, Patient health Questionaire-9, De Jong Gierveld Loneliness Scale, and Brief Adjustment Scale.Conclusion:The described service model resulted in significant improvements to the psychological wellbeing of older adults, and represents an effective and sustainable training approach for provisional psychologists.
{"title":"P163: Closing the gap: Funded psychology in residential aged care in Australia.","authors":"Romy Engelbrecht","doi":"10.1017/s1041610223003241","DOIUrl":"https://doi.org/10.1017/s1041610223003241","url":null,"abstract":"Objective:Historically, older adults in residential aged care facilities (RACF) in Australia had no access to government funded psychology services despite high rates of anxiety and depression. Change Futures is a registered charity that provides funded psychology to more than 220 RACFs in south-east Queensland and northern New South Wales, Australia, and since 2015 has been providing free psychology services to older adults living in aged care, using a predominately provisional psychologist workforce. This presentation will discuss the model of service that is provided, and the findings of a recent outcomes report.Method:Data was collected via clinician entered eHealth records in the 2021/2022 financial year from 01/07/2021 to 30/06/2022. Outcome measures were analysed using six repeated measure t-tests to compare clinical change from first and last assessments.Results:A total of 2865 residents were seen in 17,754 individual sessions and 298 group sessions. Staff education was provided in 94 sessions with 838 participants, who worked in RACFs. The most common presenting issue was difficulties with adjustment (70%), comorbid anxiety and depression (28%), depression (27%), loneliness (18%), and anxiety (17%). Outcomes of the psychology program showed statistically significant improvements on all measures, including the Kessler 5 psychological distress scale, Geriatric anxiety scale, Patient health Questionaire-9, De Jong Gierveld Loneliness Scale, and Brief Adjustment Scale.Conclusion:The described service model resulted in significant improvements to the psychological wellbeing of older adults, and represents an effective and sustainable training approach for provisional psychologists.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"24 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223001072
Mary Ganguli, Yingjin Zhang, Erin Jacobsen, Isabella Wood, Chung-Chou Chang
Objective:Health disparities between communities with greater and lesser advantages are a global concern. In the USA, self-identified race as African American (AA) is consistently associated with mild cognitive impairment (MCI) and dementia, compared to Americans of European descent. In a prospective population-based study, we sought to confirm this association and investigate potential explanatory factors.Methods:The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) and Seniors Project 15104 (SP15104) studies recruited adults aged 65+ years from a group of small towns of lower socioeconomic status in the US. MYHAT recruited by age-stratified random sampling from the voter registration list for all towns; SP15104 recruited by intensive community engagement from three towns with populations that are 60% AA. Based on the Clinical Dementia Rating (CDR), MCI was defined as CDR=0.5 and dementia as CDR > 1. Using Cox proportional hazard models, we modeled time to incident CDR > 0.5 from baseline as a function of race (AA vs. all other), other demographics, and several other covariates at baseline.Results:The sample of 2120 individuals was 8% AA, and 62% female, with median age of 73y, and median educational level of partial college. During follow up of up to 14.5 years, 499 participants developed new-onset MCI/dementia (CDR >0.5). Cox models revealed that being AA was significantly associated with incident CDR > 0.5 (HR=1.45. 95% CI:1.01,2.10). Inclusion of age, sex, and education in the model increased the HR for race to 1.63 (1.1, 2.3). Adding number of regularly taken prescription drugs (reflecting overall morbidity), depression symptoms, preceding year alcohol consumption, and number of visits to emergency or urgent care together reduced the HR to 1.4 (0.96, 2.0), no longer statistically significantConclusions:In this population-based cohort study, self-identified African Americans had an about 40% elevated risk of developing MCI/dementia. Adjusting for demographics, the significant association between race and incident MCI/dementia was attenuated by variables reflecting depression, greater general morbidity, and lesser access to regular health services. These variables possibly reflect downstream effects of historic discrimination, but couldstill be modifiable risk factors for MCI/dementia. Addressing them could potentially mitigate ethno-racial disparities in cognitive impairment.
{"title":"FC9: Ethno-racial identity and cognitive impairment: A population-based study","authors":"Mary Ganguli, Yingjin Zhang, Erin Jacobsen, Isabella Wood, Chung-Chou Chang","doi":"10.1017/s1041610223001072","DOIUrl":"https://doi.org/10.1017/s1041610223001072","url":null,"abstract":"Objective:Health disparities between communities with greater and lesser advantages are a global concern. In the USA, self-identified race as African American (AA) is consistently associated with mild cognitive impairment (MCI) and dementia, compared to Americans of European descent. In a prospective population-based study, we sought to confirm this association and investigate potential explanatory factors.Methods:The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) and Seniors Project 15104 (SP15104) studies recruited adults aged 65+ years from a group of small towns of lower socioeconomic status in the US. MYHAT recruited by age-stratified random sampling from the voter registration list for all towns; SP15104 recruited by intensive community engagement from three towns with populations that are 60% AA. Based on the Clinical Dementia Rating (CDR), MCI was defined as CDR=0.5 and dementia as CDR > 1. Using Cox proportional hazard models, we modeled time to incident CDR > 0.5 from baseline as a function of race (AA vs. all other), other demographics, and several other covariates at baseline.Results:The sample of 2120 individuals was 8% AA, and 62% female, with median age of 73y, and median educational level of partial college. During follow up of up to 14.5 years, 499 participants developed new-onset MCI/dementia (CDR >0.5). Cox models revealed that being AA was significantly associated with incident CDR > 0.5 (HR=1.45. 95% CI:1.01,2.10). Inclusion of age, sex, and education in the model increased the HR for race to 1.63 (1.1, 2.3). Adding number of regularly taken prescription drugs (reflecting overall morbidity), depression symptoms, preceding year alcohol consumption, and number of visits to emergency or urgent care together reduced the HR to 1.4 (0.96, 2.0), no longer statistically significantConclusions:In this population-based cohort study, self-identified African Americans had an about 40% elevated risk of developing MCI/dementia. Adjusting for demographics, the significant association between race and incident MCI/dementia was attenuated by variables reflecting depression, greater general morbidity, and lesser access to regular health services. These variables possibly reflect downstream effects of historic discrimination, but couldstill be modifiable risk factors for MCI/dementia. Addressing them could potentially mitigate ethno-racial disparities in cognitive impairment.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"4 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223001576
Marcia Cristina Nascimento Dourado, Maria Alice Tourinho Baptista, Felipe de Oliveira Silva
Introduction:Awareness is the recognition of changes caused by deficits related to the dementia process. Awareness is related to a given object, like memory functioning or functional status. Objects of awareness can be grouped into a range of domains, including cognition, functional ability, emotional and social functioning, and behavioral difficulties. Preserved awareness in people with young onset dementia (YOD) has been reported; however, there is a lack of research investigating whether there are differences in the domains of awareness impairment according to the age at onset of dementia. This study compared the differences in awareness and its domains and examined associations with cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and quality of life (QoL) among people with YOD and late onset dementia (LOD).Methods:A group of 136 people with dementia and their caregivers (YOD= 50 and LOD= 86) were consecutively selected. We assessed awareness of disease, dementia severity, cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and QoL.Results:People with YOD presented more neuropsychiatric symptoms and worse cognition and functional ability than those with LOD. Compared to people with LOD, there were higher levels of awareness total score, awareness of cognitive functioning and health condition, and awareness of functional activity impairments domains in people with YOD, even in the moderate stage of the disease. There were no significant differences between groups in the emotional state, and social functioning and relationships domains of awareness. Multivariate linear regressions showed that functionality had a broad relationship with awareness in people with YOD. In contrast, neuropsychiatric symptoms and QoL were more significant to the awareness of people with LOD.Conclusion:Different clinical variables are associated with different domains in YOD and LOD groups, reinforcing the heterogeneity of awareness in dementia. Differences in awareness and its domains in YOD and LOD may be particularly relevant to enabling interventions focused on meeting their specific needs and those of their families.
{"title":"Impairment in Awareness and its Domains Vary According to the Age at Onset of Dementia","authors":"Marcia Cristina Nascimento Dourado, Maria Alice Tourinho Baptista, Felipe de Oliveira Silva","doi":"10.1017/s1041610223001576","DOIUrl":"https://doi.org/10.1017/s1041610223001576","url":null,"abstract":"Introduction:Awareness is the recognition of changes caused by deficits related to the dementia process. Awareness is related to a given object, like memory functioning or functional status. Objects of awareness can be grouped into a range of domains, including cognition, functional ability, emotional and social functioning, and behavioral difficulties. Preserved awareness in people with young onset dementia (YOD) has been reported; however, there is a lack of research investigating whether there are differences in the domains of awareness impairment according to the age at onset of dementia. This study compared the differences in awareness and its domains and examined associations with cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and quality of life (QoL) among people with YOD and late onset dementia (LOD).Methods:A group of 136 people with dementia and their caregivers (YOD= 50 and LOD= 86) were consecutively selected. We assessed awareness of disease, dementia severity, cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and QoL.Results:People with YOD presented more neuropsychiatric symptoms and worse cognition and functional ability than those with LOD. Compared to people with LOD, there were higher levels of awareness total score, awareness of cognitive functioning and health condition, and awareness of functional activity impairments domains in people with YOD, even in the moderate stage of the disease. There were no significant differences between groups in the emotional state, and social functioning and relationships domains of awareness. Multivariate linear regressions showed that functionality had a broad relationship with awareness in people with YOD. In contrast, neuropsychiatric symptoms and QoL were more significant to the awareness of people with LOD.Conclusion:Different clinical variables are associated with different domains in YOD and LOD groups, reinforcing the heterogeneity of awareness in dementia. Differences in awareness and its domains in YOD and LOD may be particularly relevant to enabling interventions focused on meeting their specific needs and those of their families.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"21 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223003733
Nora Burca, Miguel Ángel Monferrer, Jordi Valls, Alejandro Tenorio
Objective:We present a case that shows a very favourable response of the antidepressant vortioxetine in the functional and cognitive recovery in a patient with Chronic Fatigue Syndrome and its role as a pain modulator.Methods:This is an observational study using a clinical case. An 80-year-old female patient admitted to the Postacute care unit for recovering her functional baseline following surgical intervention for a hip fracture. On admission, the main symptom was residual pain at the level of the operated lower limb, as well as allodynia and a tingling sensation, which did not subside with conventional analgesia. During admission she also presented, insomnia, daytime hypersomnolence, bradypsychia, and emotional instability in the form of easy crying. It is worth mentioning that prior to admission the patient presented with multiple nonspecific somatic complaints, such as fatigue, headache, myalgia, and arthralgia, adding over time, great difficulty in planning and performing household tasks. The functional progress of the patient during admission was very slow, mainly due to the combination of lack of engagement, together with episodes of irritability, restlessness and suffering from fear of falling syndrome. Given the suspicion of previously undiagnosed Chronic Fatigue Syndrome, exacerbated by the decline in her functional baseline after surgery, treatment was started with vortioxetine in addition to non-pharmacological measures and psychotherapy, obtaining excellent results in approximately 4 weeks.Results:Great effectiveness of vortioxetine in the treatment of Chronic Fatigue Syndrome and in the control of concomitant pain (despite that indication is not included in the molecule's data sheet). The patient followed a very favourable evolution achieving, on discharge, an ad integrum recovery of her functional state.Conclusion:As presented in this case, treatment with multimodal antidepressant treatment (vortioxetine) could have positive impact for patients with Chronic Fatigue Syndrome, achieving improvements in the affective-cognitive aspect and controlling the pain related to this syndrome, avoiding polypharmacy.
{"title":"P149: Chronic fatigue syndrome and its response to the use of a multimodal antidepressant","authors":"Nora Burca, Miguel Ángel Monferrer, Jordi Valls, Alejandro Tenorio","doi":"10.1017/s1041610223003733","DOIUrl":"https://doi.org/10.1017/s1041610223003733","url":null,"abstract":"Objective:We present a case that shows a very favourable response of the antidepressant vortioxetine in the functional and cognitive recovery in a patient with Chronic Fatigue Syndrome and its role as a pain modulator.Methods:This is an observational study using a clinical case. An 80-year-old female patient admitted to the Postacute care unit for recovering her functional baseline following surgical intervention for a hip fracture. On admission, the main symptom was residual pain at the level of the operated lower limb, as well as allodynia and a tingling sensation, which did not subside with conventional analgesia. During admission she also presented, insomnia, daytime hypersomnolence, bradypsychia, and emotional instability in the form of easy crying. It is worth mentioning that prior to admission the patient presented with multiple nonspecific somatic complaints, such as fatigue, headache, myalgia, and arthralgia, adding over time, great difficulty in planning and performing household tasks. The functional progress of the patient during admission was very slow, mainly due to the combination of lack of engagement, together with episodes of irritability, restlessness and suffering from fear of falling syndrome. Given the suspicion of previously undiagnosed Chronic Fatigue Syndrome, exacerbated by the decline in her functional baseline after surgery, treatment was started with vortioxetine in addition to non-pharmacological measures and psychotherapy, obtaining excellent results in approximately 4 weeks.Results:Great effectiveness of vortioxetine in the treatment of Chronic Fatigue Syndrome and in the control of concomitant pain (despite that indication is not included in the molecule's data sheet). The patient followed a very favourable evolution achieving, on discharge, an ad integrum recovery of her functional state.Conclusion:As presented in this case, treatment with multimodal antidepressant treatment (vortioxetine) could have positive impact for patients with Chronic Fatigue Syndrome, achieving improvements in the affective-cognitive aspect and controlling the pain related to this syndrome, avoiding polypharmacy.<jats:fig position=\"float\"><jats:graphic xmlns:xlink=\"http://www.w3.org/1999/xlink\" mime-subtype=\"png\" mimetype=\"image\" position=\"float\" xlink:href=\"S1041610223003733_fig1.png\" /></jats:fig>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"13 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223004210
María Del Sequeros Perdroso-Chaparro, Isabel Cabrera, José A. Fernandes-Pires, Maria Marquez-González, José Ángel Martínez-Huertas, Eva-Marie Kessler, Andrés Losada-Baltar
Objective:Previous research has suggested that negative self-perceptions of aging and lower sense of control were significantly associated with worse physical and mental health, including physical limitations and feelings of guilt for perceiving oneself as a burden. However, no study has analyzed the associations of these variables when jointly considered and assessed the potential differences in the associations between people aged 40 to 59 years and people aged 60 years and older. The objective of this study was to assess the potential differences in the associations mentioned above between people aged 40 to 59 years and people aged 60 years and older.Methods:Participants were 377 people over 40 years (206 aged 40 to 59 years and 171 participants aged 60 years and older) who answered an online survey. The association between negative self-perceptions of aging, perceived control, physical limitations, and guilt for perceiving oneself as a burden was tested through path-analyses, with differences between age groups tested through multigroup analysis.Results:Significant differences between age groups were obtained. The results suggest that the influence of negative self-perceptions of aging on guilt for perceiving oneself as a burden is indirect through lower sense of control in participants aged 40 to 59 years; in participants aged 60 and over, negative self-perceptions of aging had a direct and indirect effect on guilt through greater physical limitations.Conclusion:Negative self-perceptions of aging seem to be a relevant variable to understand feelings of guilt for perceiving oneself as a burden in both middle-aged adults and older adults. However, this study documents potential differences in the correlates of guilt for perceiving oneself as a burden between participants aged 40 to 59 years and individuals aged 60 years and older. Specifically, the results suggest that the associations between negative self-perceptions of aging and guilt for perceiving oneself as a burden are modulated by lower sense of control in middle-aged and by greater physical limitations in older adults. These results support the relevance of social and cognitive processes related with aging for understanding feelings of guilt for perceiving oneself as a burden.
{"title":"P125: Guilt for perceiving oneself as a burden in adults who present physical limitations. Associated factors and age differences","authors":"María Del Sequeros Perdroso-Chaparro, Isabel Cabrera, José A. Fernandes-Pires, Maria Marquez-González, José Ángel Martínez-Huertas, Eva-Marie Kessler, Andrés Losada-Baltar","doi":"10.1017/s1041610223004210","DOIUrl":"https://doi.org/10.1017/s1041610223004210","url":null,"abstract":"Objective:Previous research has suggested that negative self-perceptions of aging and lower sense of control were significantly associated with worse physical and mental health, including physical limitations and feelings of guilt for perceiving oneself as a burden. However, no study has analyzed the associations of these variables when jointly considered and assessed the potential differences in the associations between people aged 40 to 59 years and people aged 60 years and older. The objective of this study was to assess the potential differences in the associations mentioned above between people aged 40 to 59 years and people aged 60 years and older.Methods:Participants were 377 people over 40 years (206 aged 40 to 59 years and 171 participants aged 60 years and older) who answered an online survey. The association between negative self-perceptions of aging, perceived control, physical limitations, and guilt for perceiving oneself as a burden was tested through path-analyses, with differences between age groups tested through multigroup analysis.Results:Significant differences between age groups were obtained. The results suggest that the influence of negative self-perceptions of aging on guilt for perceiving oneself as a burden is indirect through lower sense of control in participants aged 40 to 59 years; in participants aged 60 and over, negative self-perceptions of aging had a direct and indirect effect on guilt through greater physical limitations.Conclusion:Negative self-perceptions of aging seem to be a relevant variable to understand feelings of guilt for perceiving oneself as a burden in both middle-aged adults and older adults. However, this study documents potential differences in the correlates of guilt for perceiving oneself as a burden between participants aged 40 to 59 years and individuals aged 60 years and older. Specifically, the results suggest that the associations between negative self-perceptions of aging and guilt for perceiving oneself as a burden are modulated by lower sense of control in middle-aged and by greater physical limitations in older adults. These results support the relevance of social and cognitive processes related with aging for understanding feelings of guilt for perceiving oneself as a burden.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"36 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139667034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223002259
Manuel Martín-Carrasco, Manuel Gonçalves-Pereira
Euthanasia or assisted suicide are now legal in several European countries. Spain has approved related legislation in 2022, and in Portugal the subject is currently under debate after preliminary ratification. This remains a controversial topic, raising passionate discussions that sometimes hamper the need to consider, in depth, the ethical, clinical, and operational difficulties of processes of this type. Older age people do not necessarily lose their autonomy with age, nor should they lose their right to decide on euthanasia or assisted suicide whenever the jurisdiction allows it. However, there is a growing concern of older people being coerced into decisions about ending their lives, not least due to their own fears of becoming a burden both for their families and the society. Manuel Martín-Carrasco will analyze how ageism can influence or model a wish to die in elderly people, especially those living with greater physical and/or mental disability. The so-called rational suicide focuses on the possibility that a healthy subject eventually decides to end his own life as a reflex of a free decision, and not within the context of a mental illness. Manuel Sánchez-Perez will discuss how difficulties in assessing the rationality of suicidal ideation include its dimensional character, together with the evidence that rationality is not always absent in depression and that the absence of depression does not imply rationality. Next, Lia Fernandes will provide an overview of years of public and parliamentary debates on euthanasia and physician-assisted suicide in Portugal. She will focus on issues regarding the exact role of psychiatrists (old age psychiatrists in particular) in the decision process, as proposed by the recently approved legislation. Finally, Javier Olivera will provide a brief overview of the recent implementation of legal access to euthanasia in Spain. A discussion of several controversial aspects of the operationalization of such a complex process will follow, including those related with conscientious objection.
{"title":"S18: Newcomers to euthanasia and assisted suicide: challenges for Psychogeriatrics with a focus on Spain and Portugal","authors":"Manuel Martín-Carrasco, Manuel Gonçalves-Pereira","doi":"10.1017/s1041610223002259","DOIUrl":"https://doi.org/10.1017/s1041610223002259","url":null,"abstract":"Euthanasia or assisted suicide are now legal in several European countries. Spain has approved related legislation in 2022, and in Portugal the subject is currently under debate after preliminary ratification. This remains a controversial topic, raising passionate discussions that sometimes hamper the need to consider, in depth, the ethical, clinical, and operational difficulties of processes of this type. Older age people do not necessarily lose their autonomy with age, nor should they lose their right to decide on euthanasia or assisted suicide whenever the jurisdiction allows it. However, there is a growing concern of older people being coerced into decisions about ending their lives, not least due to their own fears of becoming a burden both for their families and the society. Manuel Martín-Carrasco will analyze how ageism can influence or model a wish to die in elderly people, especially those living with greater physical and/or mental disability. The so-called rational suicide focuses on the possibility that a healthy subject eventually decides to end his own life as a reflex of a free decision, and not within the context of a mental illness. Manuel Sánchez-Perez will discuss how difficulties in assessing the rationality of suicidal ideation include its dimensional character, together with the evidence that rationality is not always absent in depression and that the absence of depression does not imply rationality. Next, Lia Fernandes will provide an overview of years of public and parliamentary debates on euthanasia and physician-assisted suicide in Portugal. She will focus on issues regarding the exact role of psychiatrists (old age psychiatrists in particular) in the decision process, as proposed by the recently approved legislation. Finally, Javier Olivera will provide a brief overview of the recent implementation of legal access to euthanasia in Spain. A discussion of several controversial aspects of the operationalization of such a complex process will follow, including those related with conscientious objection.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"31 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139667036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective:Older age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. General principles of pharmacotherapy in guidelines for treating OABD are greatly like those for younger adults. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019.Methods:OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilizers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs), and antidepressants, were investigated. Complex polypharmacy was defined as the use of 3 or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test.Results:The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilizers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilizers, lithium, FGAs, and antidepressants plus mood stabilizers significantly decreased.Conclusion:Prescribing patterns changed remarkably for OABD patients over a 14- year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.
{"title":"P31: Prescribing patterns for older age bipolar disorder patients discharged from two public mental hospitals in Taiwan, 2006-2019","authors":"Ching-Hua Lin, Fu-Chiang Wang, Hung-Chi Wu, Li-Shiu Chou","doi":"10.1017/s1041610223003472","DOIUrl":"https://doi.org/10.1017/s1041610223003472","url":null,"abstract":"Objective:Older age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. General principles of pharmacotherapy in guidelines for treating OABD are greatly like those for younger adults. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019.Methods:OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilizers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs), and antidepressants, were investigated. Complex polypharmacy was defined as the use of 3 or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test.Results:The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilizers, and complex polypharmacy significantly increased over time<jats:italic>,</jats:italic> whereas the prescription rates of mood stabilizers, lithium, FGAs, and antidepressants plus mood stabilizers significantly decreased.Conclusion:Prescribing patterns changed remarkably for OABD patients over a 14- year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"112 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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