Measuring suicide risk in the elderly with non-institutionalized depression: an integrative review / Evaluación del riesgo suicida en el anciano con depresión no institucionalizado: revisión integrativa / Mensuração do risco de suicídio no idoso com depressão não institucionalizado: revisão integrativa

ABSTRACT Objective: Analyze the state of the art about instruments, at national and international levels, for assessing the risk of suicide in elderly people with depression assisted in the community. Methods: Integrative review of 38 complete articles, published in journals indexed in the databases: US National Library of Medicine (PubMed Central), Scopus, CINAHL and Web of Science, located using controlled descriptors combined with Boolean operators: elderly OR aged OR older OR elder OR geriatric AND depression AND suicide AND risk assessment. Results: Six instruments were found, all international and published in the English language, in order to identify suicidal behavior and ideation in the elderly. Of these, two are specific scales for assessing the risk of suicide in the elderly in the community: 5-item GDS subscale and Geriatric Suicide Ideation Scale. Final considerations: With the scarcity of national instruments to assess such risk, research is recommended to cross-culturally adapt one of these scales to the Brazilian Portuguese language.

RESUMEN Objetivo: Analizar el estado del arte acerca de los instrumentos, en ámbitos nacional e internacional, de evaluación del riesgo suicida en ancianos con depresión asistidos en la comunidad. Métodos: Revisión integrativa de 38 artículos completos, publicados en periódicos indexados en las bases de datos: US National Library of Medicine (PubMed Central), Scopus, CINAHL y Web of Science, localizados mediante descriptores controlados combinados con operadores booleanos: elderly OR aged OR older OR elder OR geriatric AND depression AND suicide AND risk assessment. Resultados: Se localizaron seis instrumentos, todos internacionales y publicados en lengua inglesa, con objetivo de identificar comportamiento e ideación suicida en ancianos. De estos, dos son escalas específicas para evaluación del riesgo suicida en ancianos en la comunidad: 5-item GDS subscale y Geriatric Suicide Ideation Scale. Consideraciones finales: Con la escasez de instrumentos nacionales para evaluar tal riesgo, se recomienda investigación para adaptar transculturalmente una de esas escalas a la lengua portuguesa brasileña.

RESUMO Objetivo: Analisar o estado da arte acerca dos instrumentos, em âmbitos nacional e internacional, de avaliação do risco de suicídio em idosos com depressão assistidos na comunidade. Métodos: Revisão integrativa de 38 artigos completos, publicados em periódicos indexados nas bases de dados: US National Library of Medicine (PubMed Central), Scopus, CINAHL e Web of Science, localizados mediante descritores controlados combinados com operadores booleanos: elderly OR aged OR older OR elder OR geriatric AND depression AND suicide AND risk assessment. Resultados: Localizaramse seis instrumentos, todos internacionais e publicados na língua inglesa, com objetivo de identificar comportamento e ideação suicida em idosos. Destes, dois são escalas específicas para avaliação do risco de suicídio em idosos na comunidade: 5-item GDS subscale e Geriatric Suicide Ideation Scale. Considerações finais: Com a escassez de instrumentos nacionais para avaliar tal risco, recomenda-se pesquisa para adaptar transculturalmente uma dessas escalas à língua portuguesa brasileira.

Avaliação de delirium com uso do modelo PRE-DELIRIC em uma unidade de terapia intensiva na Argentina / Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

RESUMO Objetivo: Descrever a incidência e os fatores de risco para delirium na unidade de terapia intensiva de um hospital terciário de ensino na Argentina, e conduzir o primeiro estudo não europeu para explorar o desempenho do modelo PREdiction of DELIRium in ICu Patients (PRE-DELIRIC). Métodos: Estudo prospectivo observacional em uma unidade de terapia intensiva com 20 leitos localizada em um hospital terciário de ensino em Buenos Aires, Argentina. O modelo PRE-DELIRIC foi aplicado a 178 pacientes consecutivos dentro de 24 horas após sua admissão à unidade de terapia intensiva. Avaliou-se o delirium com uso da ferramenta Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Resultados: A média de idade foi de 64,3 ± 17,9 anos. O tempo mediano de permanência na unidade de terapia intensiva foi de 6 dias (variação entre 2 e 56 dias). Dentre o total de pacientes, 49/178 (27,5%) desenvolveram delirium, definido como avaliação positiva segundo a CAM-ICU, durante a permanência na unidade de terapia intensiva. Os pacientes no grupo com delirium eram significantemente mais velhos e tinham escore Acute Physiological and Chronic Health Evaluation II (APACHE II) significantemente mais elevado. A taxa de mortalidade na unidade de terapia intensiva foi de 14,6%; não se observou diferença significante entre os dois grupos. Os fatores preditivos para desenvolvimento de delirium foram idade mais avançada, tempo prolongado de permanência na unidade e uso de opioides. A área sob a curva para o modelo PRE-DELIRIC foi de 0,83 (IC95%: 0,77 - 0,90). Conclusões: A incidência observada de delirium salienta a importância deste problema no ambiente da unidade de terapia intensiva. Neste primeiro estudo conduzido fora da Europa, o PRE-DELIRIC previu de forma precisa o desenvolvimento de delirium.

ABSTRACT Objective: To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model. Methods: Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Results: The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90). Conclusions: The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.

Clinical predictors of cognitive impairment and psychiatric complications in Parkinson’s disease / Preditores clínicos de transtorno cognitivo e complicações psiquiátricas na doença de Parkinson

Objective To estimate the clinical and demographics aspects that may contribute to cognitive impairment and psychiatric symptoms in Parkinson’s disease (PD). Method All patients answered a structured standardized clinical questionnaire. Two movement disorders specialists performed the following scale: Unified Parkinson’s disease rating score (UPDRS), the modified Hoehn and Yahr staging, Schwab and England Scale, SCOPA cognition (SCOPA-COG), SCOPA-Psychiatric complications (SCOPA-PC) and Non-Motor Symptoms Scale (NMSS). We built a generalized linear model to assess predictors for the SCOPA-COG and SCOPA-PC scores. Results Almost 37% of our patients were demented as per SCOPA-COG scores. Level of education and the UPDRS-Subscale III were predictors of cognitive impairment. Higher scores in domain 3 of NMSS and male gender were associated with psychiatric complications as assessed per the SCOPA-PC. Conclusion Level of education and disease severity are predictors of dementia in PD. Psychiatric complications are more commonly observed in men. .

Objetivo Estimar aspectos clínicos e demográficos que podem contribuir para o comprometimento cognitivo e sintomas psiquiátricos na doença de Parkinson (DP). Método Todos pacientes responderam questionário clínico padrão. Duas especialistas em distúrbios do movimento aplicaram as seguintes escalas: Unified Parkinson’s disease rating score (UPDRS), Hoehn and Yahr estágios, Schwab and England Scale, SCOPA cognição (SCOPA-COG), SCOPA-Complicações psiquiátricas (SCOPA-CP) e Escala de sintomas não motores (NMSS). Utilizamos análise multivariada, para avaliar os preditores relacionados ao SCOPA-COG e SCOPA CP. Resultados Aproximadamente 37% dos nossos pacientes foram classificados como dementes utilizando-se os valores obtidos no SCOPA-COG. Nível educacional e a parte III do UPDRS foram preditores de comprometimento cognitivo. Escores elevados no domínio 3 do NMSS e sexo masculino associaram-se com complicações psiquiátricas quando acessadas pelo SCOPA-CP. Conclusão Nível educacional e gravidade de doença são preditores de demência na DP. Complicações psiquiátricas são mais comumente observadas em homens. .

Cross-cultural adaptation, validation and reliability of the brazilian version of the Richmond Compulsive Buying Scale

OBJECTIVE: To present the process of transcultural adaptation of the Richmond Compulsive Buying Scale to Brazilian Portuguese. METHODS: For the semantic adaptation step, the scale was translated to Portuguese and then back-translated to English by two professional translators and one psychologist, without any communication between them. The scale was then applied to 20 participants from the general population for language adjustments. For the construct validation step, an exploratory factor analysis was performed, using the scree plot test, principal component analysis for factor extraction, and Varimax rotation. For convergent validity, the correlation matrix was analyzed through Pearson's coefficient. RESULTS: The scale showed easy applicability, satisfactory internal consistency (Cronbach's alpha=.87), and a high correlation with other rating scales for compulsive buying disorder, indicating that it is suitable to be used in the assessment and diagnosis of compulsive buying disorder, as it presents psychometric validity. CONCLUSION: The Brazilian Portuguese version of the Richmond Compulsive Buying Scale has good validity and reliability.

Prevalência de depressão em idosos institucionalizados / Prevalencia de depressión en ancianos institucionalizados / Prevalence of depression in institutionalized older adults

O objetivo deste estudo foi investigar a prevalência de depressão em idosos institucionalizados, utilizando a Escala de Depressão Geriátrica Yesavage. Trata-se de um estudo descritivo-exploratório, de abordagem quantitativa, realizado com 60 idosos residentes em uma instituição asilar, no município de Maringá-PR, no período de outubro de 2008 a março de 2009, através de visitas semanais ao asilo, para aplicação do instrumento aos participantes. De acordo com os resultados, a maioria dos idosos (61,6%) apresenta quadro depressivo; 33,3% eram mulheres; 51,7% tinham entre 60 a 79 anos; a grande maioria era analfabeta; com predomínio dos estados civis de solteiros e viúvos; 36,6% estavam institucionalizados há menos de um ano; 31,6% faziam uso de medicamentos antidepressivos. Os dados apontam a importância dos profissionais de saúde estarem aptos para estabelecer um diagnóstico precoce e o planejamento de uma intervenção no tratamento da depressão a essa população.

This study used the Yesavage Geriatric Depression Scale to investigate the prevalence of depression among institutionalized older adults. This exploratory, quantitative, descriptive study of 60 elderly residents in a nursing home in the town of Maringa, Paraná, was carried out from October 2008 to March 2009. During weekly visits to the nursing home a questionnaire was applied to the participants. According to the results, most (61.6%) suffered from depression; 33.3% were women; 51.7% were between 60 to 79 years old; most were illiterate; single and widowed people predominated; 36.6% had been admitted to the nursing home less than one year earlier; and 31.6% used antidepressants. The findings show the importance of health personnel's being able to establish an early diagnosis and to plan intervention to treat depression in this population.

Este estudio investigó la prevalencia de la depresión en ancianos institucionalizados, mediante la Escala de Depresión Geriátrica de Yesavage. Es un estudio exploratorio-descriptivo, con enfoque cuantitativo, realizado con 60 ancianos residentes en una institución geriátrica en la ciudad de Maringá, PR - Brasil. El estudio fue realizado de octubre de 2008 a marzo de 2009, a través de visitas semanales a los participantes, cuando ellos han respondido al cuestionario. Los resultados muestran que la mayoría de los ancianos (61,6%) manifestaron cuadro depresivo; 33,3% eran mujeres; 51,7% tenían entre 60 y 79 años; la mayoría era analfabeta, con prevalencia de solteros y viudos; 36.6% estaban institucionalizados hacia menos de un año; 31,6% estaban usando antidepresivos. Estos resultados demuestran la importancia de los profesionales de la salud en establecer un diagnóstico precoz y en planificar una intervención en el tratamiento de la depresión de esa población.

Adult oncology and chronically ill patients: comparison of depression, anxiety and caregiver's quality of life

A diagnosis of cancer can be devastating for patients and their loved ones. We compared the intensity of anxiety and depression for 30 terminally ill cancer patients and 30 chronically ill patients and the quality of life of their most attendant caregivers. Hamilton depression and anxiety scales were used with the patients and the quality of life scale [family] was used with the caregivers. Cancer patients and their caregivers had significantly higher scores on these scales and suffered more from depression and anxiety than chronically ill patients and caregivers. Cancer patient caregivers also had poorer quality of life than did caregivers of the chronically ill

Psychosocial assessment of geriatric subjects in Abha City, Saudi Arabia

Psychosocial assessment of geriatric subjects was carried out through a home-based survey of people aged 65 years and over [n = 810] in the catchment areas of 3 primary health care centres. All the participants had a structured interview and were given a short version of the geriatric depression scale. Depression was found in 17.5% of the subjects, more commonly in women [27.7% versus 12.7%]. The combined effect of impaired perceived health status [52.4%] and functional capacity [26.6%], loneliness [4.5%], single status [24.3%], and lack of education [80.5%] explained 23.7% of the variance in depression score by multiple regression analysis. Depression is a problem among the geriatric population in the region, especially women. Periodic home psychosocial screening of geriatrics is recommended

Psychiatric morbidity in primary care

The prevalence of hidden psychiatric morbidity was assessed using the General Health Questionnaire [GHQ] and Hospital Anxiety Depression Scale [HAD]. A total of 149 Bahraini patients aged > or = 16 years were selected randomly from those attending primary health care centres for problems other than psychiatric illness. The prevalence of psychiatric morbidity using GHQ was 45.1% [cut-off > or = 5] and 27.1% [cut-off > or = 9]. Using the HAD scale, the prevalence was 44.4% [cut-off > or = 8] and 23.6% [cut-off > or = 11]. Psychiatric morbidity was more common in women aged 50-55 years, in divorcees or widows and in lesser educated patients. Either instrument could be used to diagnose psychiatric illness