DatSCAN In Differential Diagnostics of Lewy Body Disease.

Differential diagnosis between Lewy body disease and Alzheimer´s disease might be difficult because of similarities of clinical symptoms in both neurodegenerative diseases. DatSCAN is a modern functional neuroimmaging method which differentiates between this similar diseases and helps in correct treatment strategy. We report our positive experience with DatSCAN in differentiating Lewy body disease from Alzheimer´s disease. This is a case report of a woman with Lewy body disease, initially diagnosed as Alzheimer´s disease. DatSCAN neuroimmaging method was used in differential diagnosis of dementia. Memory impairment, impaired activities of daily living, sleep and behavioral disturbances were present in our case. Donepezil was well tolerated, but haloperidol administration was followed by development of severe dystonia. DatSCAN showed deficient dopaminergic presynaptic transport in substantia nigra and striatum. This finding is typical for Lewy body disease not for Alzheimer´s disease. DatSCAN neuroimmaging is a suitable method for differentiating Lewy body disease from Alzheimer´s disease. Deficient dopaminergic presynaptic transport in substantia nigra and striatum is typical for Lewy body disease.

Non-adherence in seniors with dementia - a serious problem of routine clinical practice.

BACKGROUND: Non-adherence to treatment in seniors with dementia is a frequent and potentially dangerous phenomenon in routine clinical practice which might lead to the inappropriate treatment of a patient, including the risk of intoxication. There might be different causes of non-adherence in patients with dementia: memory impairment, sensory disturbances, limitations in mobility, economical reasons limiting access to health care and medication. Non-adherence leads to serious clinical consequences as well as being a challenge for public health. AIM: to estimate prevalence of non-adherence in seniors with dementia and to study correlation between cognitive decline and non-adherence. SUBJECTS AND METHODS: Prospective study, analyzing medical records of seniors with dementia admitted to the inpatient psychogeriatric ward in the Kromeriz mental hospital from January 2010 to January 2011. Cognitive decline measured by MMSE, prevalence of Non-adherence to treatment and reasons for patient Non-adherence were studied. RESULTS: Non-adherence to any treatment was detected in 31.3% of seniors; memory impairment was the most common cause of non-adherence to treatment. CONCLUSION: In conclusion, non-adherence to treatment in the studied group of seniors with dementia correlates with the severity of cognitive impairment - a higher cognitive decline correlates with a higher risk of non-adherence to treatment.

Dementia Still Diagnosed Too Late - Data from the Czech Republic.

BACKGROUND: The goal of the study is to evaluate the sensitivity of Czech physicians to the early diagnosis of dementia in patients with memory impairment. METHODS: A retrospective observational study was designed. We have reviewed the electronic medical records of patients who have been hospitalized for the first time due to dementia of any type at the Kromeriz Mental hospital from January 1, 2012 to December 31, 2013 (24-month period). Pluralistic methods combining the qualitative and quantitative approach were used in this study. RESULTS: Dementia of any type was diagnosed in 125 patients in the monitored period. The mean time between patient memory complaints and his / her admission to our facility for their first hospitalization due to dementia was 7.1 years (+- 3.7 years). Most patients with dementia had no prior outpatient treatment of their memory impairment (56.2%); a minority of patients (43.8%) had treatment of their memory impairment by an outpatient physician. CONCLUSION: The sensitivity of Czech physicians to the early diagnosis of dementia is very low. Any delay in starting the treatment of dementia means a worsened effectiveness of this treatment, a worsened quality of life of patients with dementia and their caregivers. Our recommendations for both the early diagnosis and treatment of dementia should be involved in guidelines and should become a part of the pregraduate and postgraduate education of all physicians.

Prevalence of elder abuse and neglect in seniors with psychiatric morbidity - example from central moravia, czech republic.

BACKGROUND: Elder abuse and neglect (EAN) comprises emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. Elder abuse and neglect in seniors with psychiatric morbidity was not monitored in the Czech Republic at all, despite the literature shows mental morbidity as one of the important risk factor for developing elder abuse and neglect. METHODS: We designed comparative cross sectional study comprising 305 seniors hospitalized in Mental Hospital Kromeriz in June 2011 - group of 202 seniors hospitalized due to mental disorder in psychogeriatric ward and group of 103 seniors hospitalized due to somatic disorder in internal ward. Content analysis of medical records was done in both groups of seniors, with regards to symptoms of elder abuse. Then, we discussed the topic of elder abuse with 30 nurses of psychogeriatric ward in focus group interview. RESULTS: Between two compared groups of seniors we detected statistically higher prevalence of elder abuse in seniors with psychiatric morbidity (48 cases, 23.8% prevalence of EAN), compared to somatically ill seniors (3 cases, 2.9%). As for nursing staff, 5 from 30 nurses (16.7%) have never heard about symptoms of elder abuse and neglect, 10 from 30 nurses (33.3%) had just a partial knowledge about elder abuse and neglect and its symptoms, the rest of nurses (15 from 30 nurses, 50.0%) had good knowledge about elder abuse and neglect and its symptoms. CONCLUSION: Elder abuse and neglect seems to be a relevant problem in senior population with mental disorders. Development of educational programs for nursing and medical staff about Elder abuse and neglect (symptoms of EAN, early detection of EAN, knowledge how to report cases of EAN) could improve the situation and help mentally ill seniors to better quality of life.

Agomelatine in elderly--finally a patient friendly antidepressant in psychogeriatry?

BACKGROUND: Geriatric depression is a serious psychiatric conditions with prevalence from 10­40% in community living seniors. Polymorbidity and potential vulnerability of seniors towards medication is a challenge for seeking newer, well tolerated antidepressant with good clinical efficiency and safety. Agomelatine is new promising antidepressant which could fulfill these criteria. OBJECTIVE: Evaluation of effectiveness, safety and side effects of agomelatine used for treatment senior patients with major depression hospitalized in inpatient psychogeriatric ward in Mental hospital in Kromeriz (2010-2011). METHODS: Psychiatric scales Montgomery-Asberg Depression Scale (MADRS) and Clinical Global Impression (CGI) were used initially before starting with agomelatine treatment, then after 4 and 8 weeks and finally after 12 weeks of using agomelatine. Potential side effects caused by agomelatine (side effects according AISL databasis--Automatized Information system of Registered Drugs in the Czech republic) were monitored after 12 weeks of treatment with agomelatine. RESULTS: While treating major depression in seniors with agomelatine, decrease in Montgomery-Asberg Depression Scale (MADRS), Clinical Global Impression scale (CGI) was evident after 4 weeks of treatment and continued constantly after 8 and 12 weeks of treatment. Clinical remission was achieved in all studied patients. CONCLUSION: Agomelatine proved excellent efficiency in treating severe major depression in seniors with no serious averse effects.

Ileus states - conditions connecting psychiatrists and surgeons?

BACKGROUND: Ileus states are serious conditions that may lead to pathophysiological changes which in turn can result in perforation of bowel, peritonitis, sepsis or death. Our paper discusses paralytic ileus states, which can be caused by psychopharmaceutics with anticholinergic side effects. METHODS AND RESULTS: Retrospective analysis of cases of paralytic ileus in mentally ill patients admitted to Mental Hospital Kromeriz. CONCLUSION: Although some old psychopharmacs have a much higher potential for anticholinergic side effects than the new ones, there are still some of the new modern antipsychotics which also have anticholinergic side effects which could cause paralytic ileus. Both psychiatrists and surgeons should pay attention to atypical or changed signs of ileus states in mentally ill patients and should be aware of the confounding factors which could make the diagnosis of ileus difficult in mentally ill patients.

Does gerontopsychiatry belong to medicine? Cross-sectional study monitoring polymorbidity in hospitalized gerontopsychiatric patients.

BACKGROUND: A cross-sectional study has been designed and the study observes the prevalence of polymorbidity in senior inpatients suffering from psychiatric morbidity hospitalized in gerontopsychiatric ward in one of the biggest psychiatric hospitals in the Czech Republic. The aim of the study is to prove that gerontopsychiatry is a comprehensive specialization for both doctors and nurses and should not be viewed as a low-status medical specialization. METHODS AND RESULTS: A cross-sectional study comprising of 304 patients was designed and a simple descriptive analysis of the patients' medical records was carried out. Polymorbidity and serious somatic conditions were present in senior patients hospitalized in gerontopsychiatric ward. Polypharmacy is a widespread phenomenon and has hazardous side effects for the treatment of patients. Last but not the least it also makes the treatment more expensive. CONCLUSION: Both doctors and nurses working in gerontopsychiatry should have a comprehensive interdisciplinary knowledge that would help in both early detection of many serious somatic conditions and in the improvement of the reputation of gerontopsychiatry.

Quality of life in hospitalized seniors with psychiatric disorders (a cross-sectional study from the Kromeriz District, Czech Republic).

BACKGROUND: The quality of life is one of tools used for a comprehensive evaluation of provided health care services. Unlike medical specialties such as oncology or transplantation medicine where maintaining or improving the quality of life has been a traditional challenge, these issues are relatively new to gerontopsychiatric practice. The article is a contribution to research into the quality of life in hospitalized seniors with psychiatric disorders. METHODS AND RESULTS: We designed a cross-sectional study involving 297 patients in two study groups from two main health care institutions in the Kromeriz District, the Psychiatric Hospital Kromeriz and St. Vincent de Paul Hospital. The WHOQOL-BREF questionnaire, MMSE, GDS, patient medical records, interviews and psychiatric assessment were used in the study. Generally, low ability to complete the questionnaires was observed in both studied groups and a low quality of life in hospitalized seniors was revealed, together with a high prevalence of underdiagnosed depression and dementia. Poor social contacts are also common in hospitalized seniors with psychiatric disorders. CONCLUSION: Continuous evaluation of the quality of life in hospitalized seniors with psychiatric disorders and attempts at its improvement should become an integral part of health care provided to older people suffering from any psychiatric condition.