Exploration of 27 plasma immune markers: a cross-sectional comparison of 64 old psychiatric inpatients having unipolar major depression and 18 non-depressed old persons.

BACKGROUND: The prevalence of major depression (MD) according to population studies is the same for old (65 years and older) and younger adults. In contrast, an elevated proportion of old MD patients are hospitalized compared to younger adults with MD, indicating a need to expand the characteristics of old inpatients with MD. To illustrate this point, the association between inflammation and MD in old psychiatric inpatients is sparsely investigated even though an association between inflammation and treatment resistance among younger adults with MD has been reported. In this study, we aimed to explore the plasma concentrations of 27 immune markers in old inpatients with MD, and our purpose was to expand the understanding of inflammatory mechanisms in these patients. METHODS: Prior to electroconvulsive treatment of MD, we compared 64 inpatients with unipolar MD (mean age 75.2 years) and 18 non-depressed controls (mean age 78.0 years). Symptoms characterizing MD were assessed by the Hamilton Rating Scale of Depression (HRSD)-17, and the immune markers from peripheral blood plasma were analysed using multiplex assay technology. For statistical analysis of data, we used the independent samples median test, independent samples t-test, χ2-test, receiver operating characteristic curve analyses, stepwise discriminant analysis, and multivariate linear regression. RESULTS: Twenty-two immune markers representing pro- and anti-inflammatory, adaptive and trophic signalling had higher concentrations in the inpatients compared to the controls. Only the four immune markers IL-1ß, IL-5, IL-10 and IL-15 had concentrations below the lower detection limit in a considerable portion (above 20%) of the patient cases. A combination of the concentration in plasma of TNF, vascular endothelial growth factor (VEGF), IL-1ß, IL-7 and monocyte chemotactic protein (MCP)-1, correctly classified 98.4% of the depressed patients and 83.3% of the non-depressed controls. Plasma concentration of TNF and VEGF were associated with the HRSD-17 scores (p = 0.017 and 0.005, respectively). CONCLUSIONS: Our results indicate that several inflammatory mechanisms may be highly activated in old psychiatric inpatients with MD, and indicate that immune markers may contribute to a more comprehensive understanding of MD in old persons. TRIAL REGISTRATION: NCT01559324 ClinicalTrials.gov.

Correlates of major medication side effects interfering with daily performance: results from a cross-sectional cohort study of older psychiatric patients.

BACKGROUND: Polypharmacy is common among older persons who are also vulnerable to side effects. We aimed to characterize patients who on admission to a geriatric psychiatric hospital had major medication side effects interfering with daily performance. METHODS: Cross-sectional cohort study of patients consecutively admitted to a geriatric psychiatric hospital from 2006, 06 December to 2008, 24 October. The UKU side effect rating scale was performed, and patients were divided into those with no/minor side effects versus those with major side effects. Blood levels of 56 psychotropic drugs and 27 safety laboratory tests were measured upon admission. RESULTS: Of 206 patients included in the analysis, 70 (34%) had major side effects related to drug treatment. The most frequent side effects were asthenia (31%), reduced salivation (31%), concentration difficulties (28%), memory impairment (24%), and orthostatic dizziness (18%). The significant characteristics predicting major side effects were female gender (OR = 2.4, 95% confidence interval (CI) = 1.1-5.5), main diagnosis of affective disorder (OR = 4.3, 95% CI = 1.5-12.3), unreported use of psychotropic medications (OR = 2.0, 95% CI = 1.0-4.1), a higher number of reported psychotropic medications (OR = 1.7, 95% CI = 1.2-2.3), a higher number of reported medications for somatic disorders (OR = 1.2, 95% CI = 1.1-1.5), and a higher score on the Charlson comorbidity index (OR = 1.2, 95% CI = 1.0-1.4) (r 2 = 0.238, p < 0.001). CONCLUSIONS: Clinicians should be especially aware of side effects related to drug treatment in geriatric psychiatric female patients with a high use of psychotropic and other medications and somatic comorbidity. Unreported use of psychotropic medications was also related to the risk for side effects, and clinicians should make an effort to ascertain all medications taken by geriatric psychiatric patients.

Psychotropic medication in geriatric psychiatric patients: use and unreported use in relation to serum concentrations.

PURPOSE: The aim of this observational study was to describe the type, number, and serum concentration levels of psychotropic drugs in elderly patients, on admission to a geriatric psychiatric inpatient unit. We further wanted to investigate the use and unreported use of psychotropic drugs by analyzing for a broad spectrum of drugs in the serum samples. METHODS: A total of 236 patients were included. Drug use, patient characteristics, and diagnoses were recorded, and serum analysis was performed for a total of 56 psychotropic drugs in 233 of the patients. RESULTS: Nine out of ten patients (88%) used one or more psychotropic drugs on admission to hospital; the mean use was 2.8 (95% confidence interval (CI) 2.6-2.9) drugs. In 25 patients (11%), drugs reported used were not detected in serum. Unreported use of drugs (serum analysis revealing one or more drugs not reported) was found in 100 patients (43%). This was more common in younger patients. Psychotropic polypharmacy (use of three or more psychotropic drugs) was found in 109 patients (47%). Patients with a main diagnosis of affective disorder used the most psychotropic drugs. CONCLUSIONS: Psychotropic drugs are commonly used among geriatric psychiatric patients on admission to hospital. Psychotropic polypharmacy is a major concern among these patients. There was considerable unreported use of drugs within this population, and a low threshold for a broader serum analysis for psychotropic drugs appears indicated.

Benzodiazepines in geriatric psychiatry: what doctors report and what patients actually use.

OBJECTIVE: Exact information on drug use is important information at admittance to hospital departments. The aim of this study was to validate the information given in the referral regarding benzodiazepine use by analysis of serum samples. METHODS: A total of 241 patients were included at admittance to a geriatric psychiatry department. Information on use of benzodiazepines according to the referral was recorded, and serum samples were analysed for benzodiazepine drugs. The number of patients with incorrect information in the referral was calculated for each benzodiazepine. RESULTS: Information on benzodiazepine use was included in 60 % of patient referrals. However, serum analyses revealed the use of different or additional benzodiazepines compared with the referral information in 24 % of the patients. In 10 % of the patients, a benzodiazepine was detected despite no information on benzodiazepine use at all in the referral. For diazepam, 70 % of users were identified by serum analyses only, while this number was lower for the other benzodiazepines. CONCLUSIONS: This study shows that benzodiazepine use is widespread in geriatric psychiatry, but that information about the use of these drugs is very often incorrect. This may have significant clinical consequences if symptoms caused by use or abrupt cessation of benzodiazepines are misinterpreted.

[Waiting time for hospital patients ready for discharge]. / Ventetid for utskrivningsklare pasienter fra sykehus.

BACKGROUND: Patients expect to be discharged as soon as assessments and necessary treatments are completed and good clinical practice requires hospitals to manage this. To stimulate a good patient flow between hospitals and primary care institutions, the state requires primary health care institutions to pay a daily fee if they do not receive patients within one week after they have been declared ready for discharge from somatic departments. Patients from geropsychiatric departments in Oslo were included in the payment system in the period 1993-2001. The present study compares the waiting time for dischargeable patients from somatic and geropsychiatric departments in Oslo. METHOD: Waiting days from the day the patient was declared ready for discharge from somatic- and geropsychiatric departments until local government authorities were able to place the patient in a primary care institution were recorded for the period 1999-2004. The application procedures were identical and stabile for both groups through the 6-year period. RESULTS: The waiting time for somatic patients decreased from 16.2 to 7.6 days during the 6-yr period, and for geropsychiatric patients it decreased from 52.0 to 32.2 days. After the payment system was stopped for geropsychiatric patients in 2002 the waiting time increased to 59.1 days for this group. In 2004, the waiting time for patients ready for discharge from a somatic department was one week, while patients from a geropsychiatric department waited for more than eight weeks. DISCUSSION: The state induced payment system seems to reduce the waiting time for patients in both somatic- and geropsychiatric departments. After the payment system was stopped for patients in geropsychiatric departments the waiting time has increased for this group.