[Geriatric Psychiatry at the Hôpital en santé mentale Albert-Prévost: Fostering Patient Resilience Through Positive Psychiatry]. / La gérontopsychiatrie à l'Hôpital en santé mentale Albert-Prévost : favoriser la résilience des patients âgés grâce à la psychiatrie positive.

Quebec's population is aging, a situation that will only increase over the next decades. While in 2017 approximately 1 in 5 people belonged to the 65 and over the age group, this will be the case for a quarter of Quebecers in 2031, and almost a third of them by 2061. The trajectories of aging are unique and depend on various factors, such as the vulnerabilities and strengths of the individual and his interaction with his loved ones and society. Old age is often accompanied by a series of losses. This creates constraints that hamper autonomy. Disease can be very confronting for the aging individual with reduced capacities and become a reminder of an inevitable death approaching. It can sometimes become a certain form of trauma. This process challenges caregivers to think about a therapeutic projects promoting resilience, a concept that goes beyond adjustment, and that suggests potential for development and psychological rebound. At Albert-Prévost Mental Health Hospital, geriatric psychiatry patients often have a triple vulnerability: cognitive impairment, physical disability and chronic or de novo psychiatric illness. Their needs are therefore multiple and complex. This is how, in 2017, we developed a positive psychiatry approach in our geriatric psychiatry service. Our goal is to promote the well-being and resilience of our patients through different levels of positive intervention. The strategies can then range from simple positive orientation during the psychiatric interview to positive psychotherapy, including psychoeducation, bibliotherapy and the prescription of certain positive psychology intervention.

Does age worsen EEG slowing and attention deficits in obstructive sleep apnea syndrome?

OBJECTIVE: The aim of this study was to determine whether EEG slowing is more pronounced in older than younger OSAS patients and to verify whether this cortical slowing is correlated to daytime performance, respiratory perturbation and sleep fragmentation. METHODS: Twelve young OSAS patients (mean age 38.2+/-2.0 y) and 13 older OSAS patients (mean age 62.2+/-1.9 y) along with 13 young controls (mean age 35.8+/-2.0 y) and 14 older controls (mean age 60.2+/-2.0 y) underwent a polysomnographic evaluation followed by a waking EEG recording. As a global index of cortical slowing, a ratio of slow-to-fast frequencies was calculated in all cortical regions. Daytime performance was assessed using the four choice reaction time test. RESULTS: Differences in waking EEG and in daytime performance were analyzed by ANOVAs with Group and Age as factors. Waking EEG did not yield a Group by Age interaction. OSAS patients had higher ratios across all regions than controls. Similarly, daytime performance revealed no Group by Age interaction. However, OSAS patients showed more lapses than controls and older subjects were slower than younger subjects. CONCLUSIONS: Our results indicate that age does not interact with OSAS to worsen the severity of cortical slowing, but age can add to the OSAS effect to worsen daytime performance deficits in OSAS patients. SIGNIFICANCE: The daytime performance deficits observed particularly in elderly OSAS patients warrant a careful clinical assessment of these patients to prevent accidents and injuries.

Deficits in involuntary attention switching in obstructive sleep apnea syndrome.

Cognitive functions are altered in patients with obstructive sleep apnea syndrome (OSAS) and it has been proposed that vigilance and attentional deficits play a pivotal role in all aspects of these deficits. One way to assess attentional system integrity is the study of event-related-potentials (ERP), but only a few ERP studies have been conducted in patients with OSAS. The aim of the study was to use ERP to further assess attentional impairments in these patients. Thirteen OSAS patients and 13 age-matched controls underwent a night of polysomnographic recording. Each subject was also tested with an ERP paradigm where standard (95%, 1000Hz), high deviant (2.5%, 1250Hz) and low deviant (2.5%, 1050Hz) tones were presented. Subjects were asked to ignore the stimuli and read during the task. Mismatch negativity (MMN) and P3a amplitudes and latencies were measured. No between-group difference was observed for sleep stages, except a lower percentage of rapid eye movement (REM) sleep in patients with OSAS (p<0.01). Moreover, the OSAS group showed a higher micro-arousal index and more sleep transitions than the control group (p<0.05). A significant group effect was found for the amplitude of the P3a component (p<0.05) that was lower in patients with OSAS for both high and low deviant tones. No between-group difference was found for the MMN and the P3a latencies. In conclusion, patients with OSAS have specific alterations of the P3a component that reflects involuntary attention switching, but automatic auditory processing assessed by MMN appears to be preserved.

Slow-wave sleep and delta power in rapid eye movement sleep behavior disorder.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by the loss of normal muscle atonia during REM sleep, leading to an increase of phasic muscle activity and complex motor behaviors during the night. There is some evidence that RBD patients have more of slow-wave sleep (SWS) than healthy elderly subjects. No study has looked at quantitative electroencephalogram analysis during non-REM sleep in either primary or secondary RBD. The aim of this study was to assess the increase of SWS and to analyze different electroencephalographic frequency ranges during non-REM sleep in 28 idiopathic RBD patients compared with 28 age- and sex-matched healthy volunteers. Idiopathic RBD patients spent more time in SWS (men: 1.4%; women: 5.9%) than control subjects (men: 0.4%; women: 0.6%; p = 0.004). Spectral analyses demonstrated that idiopathic RBD patients had increased all-night delta power in comparison with control subjects (p = 002). This study shows an increase of SWS and power in the delta band during non-REM sleep in idiopathic RBD patients compared with control subjects. Results are discussed about the possible nigrostriatal dopaminergic impairment in RBD patients and the association between RBD and neurodegenerative disorders.

Slowing of electroencephalogram in rapid eye movement sleep behavior disorder.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by a loss of atonia and an increase in phasic muscle activity during REM sleep, leading to complex nocturnal motor behaviors. Brainstem structures responsible for the pathogenesis of RBD are also implicated in cortical activation. To verify the hypothesis that electroencephalogram (EEG) activation will be impaired in RBD, we performed quantitative analyses of waking and REM sleep EEG in 15 idiopathic RBD patients and 15 age- and gender-matched healthy subjects. During wakefulness, RBD patients showed a considerably higher theta power in frontal, temporal, and occipital regions with a lower beta power in the occipital region. The dominant occipital frequency was significantly lower in RBD. During REM sleep, beta power in the occipital region was lower in RBD. This study shows for the first time an impaired cortical activation during both wakefulness and REM sleep in idiopathic RBD, despite an absence of changes on sleep architecture compared with controls. EEG slowing in these patients may represent an early sign of central nervous system dysfunction, perhaps paralleled by subclinical cognitive deficits. The topographical distribution of EEG slowing and possible pathophysiological mechanisms are discussed in light of the known association between RBD and neurodegenerative disorders.

Procedural skill learning in obstructive sleep apnea syndrome.

STUDY OBJECTIVES: To better characterize the cognitive deficits observed in obstructive sleep apnea syndrome (OSAS) by examining procedural skill learning abilities. DESIGN: Procedural skill learning was assessed using Mirror Tracing and Rotary Pursuit skill learning tasks. Subjects also completed a comprehensive neuropsychological test battery. SETTING: Cognitive testing was performed during the day following the second of two consecutive nights during which sleep and respiratory variables were recorded. PARTICIPANTS: Two groups (28 OSAS patients and 18 normal controls) with equivalent mean age and education levels. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: No significant differences in learning rates were observed between the groups on the Rotary Pursuit Task. On the Mirror Tracing Task, overall learning of the skill and transfer to a new figure or to the reverse tracing direction was similar in the OSAS and NC groups. However, there was a subgroup of OSAS subjects (n=11) who showed marked difficulties in the initial acquisition of the Mirror Tracing Task. This subgroup's performance was no longer significantly different from that of controls and OSAS subjects without initial adaptation difficulty in the subsequent trials. Performance of subjects who had difficulty with initial adaptation on the Mirror Tracing was also significantly lower on tests of frontal executive function, but not on episodic memory tests. Sleep and respiratory variables did not distinguish between the two subgroups of OSAS patients. However, none of the young OSAS subjects (<40 years) presented this deficit. CONCLUSION: Results indicate that contrary to this study's hypothesis, OSAS patients did not show procedural skill learning deficits. A subgroup of OSAS patients, however, did show deficits in initial skill adaptation and difficulties on other neuropsychological tests. Frontal dysfunction and decrement in psychomotor efficiency and vigilance appeared to be the most consistent explanation for characterizing the profile of neuropsychological test results among the OSAS patients.