RESUMO
Compared to men inmates, women display decreased prevalence of severe mental disorder but increased occurrence of substance use disorders (SUD) and higher rates of previous contacts with mental health services. The group of women in detention is highly heterogeneous according to the status of incarceration (pre-trial detention (PTD), sentence execution (SE) and court ordered treatments (COT)). Studies focusing on the comparison of sociodemographic patterns, detention-related and clinical variables between these groups are still lacking. We explored these parameters in 136 women admitted for acute psychiatric care in the sole Geneva forensic unit during a nine year period (2014-2023). Sociodemographic and detention-related data included age, nationality, marital status, presence of children, education attainment, most frequently speaking language, social support, employment before conviction and type of offenses. Clinical variables included the main ICD-10 diagnosis, presence of concomitant SUD, type of personality disorders, presence of suicidal thoughts and attempts at admission, as well as number and mean duration of stays. PTD and SE women had at least 9 years of formal education in 38.9% and 30.3% of cases. Most women in PTD (77.7%), SE (56.6%) and COT (56.2%) groups were Swiss or European citizens. The level of French knowledge was excellent in most of the cases. 43.8% of COT women had at least one child and this percentage is even higher for PTD and SE cases. The employment rate before conviction was also quite high, mainly for PTD and SE (61.1% and 60.6%) and, in a lesser degree, for COT (43.8%) women. Significant social support was present in the vast majority of women without any significant group difference. The distribution of type of offenses did not differ between the three types of detention with a predominance of physical violence, and drug trafficking. The number of stays during the period of reference was significantly higher in COT compared to both SE and PTD women. History of previous inpatient care was also significantly more frequent in COT that SE and PTD women. Adjustment and affective disorders were more often found in SE and PTD cases, these diagnoses were absent in the COT group. In contrast, a main diagnosis of psychotic disorders was found in 62.5% of COT cases compared to only 21.2% in SE and 24.1% in PTD cases. The number of stays, history of inpatient care and diagnosis of psychosis were independent predictors of COT status. In conclusion, the present data reveal the good social integration and emotional support of women needing acute psychiatric care in prison independently of the type of detention. Clinically, women in PTD and SE display more often emotional distress whereas those in COT suffer from acute psychotic symptoms with previous history of psychiatric care and multiple inpatient stays.
Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Prisioneiros , Transtornos Psicóticos , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Etnicidade , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Prisioneiros/psicologiaRESUMO
Mentally disordered offenders may be convicted to court-ordered psychiatric-psychotherapeutic inpatient care. Based on the concept of a forensic therapeutic community, the treatments of 204 inmates of a medium-security hospital, who presented with psychosis, personality disorders or substance-use disorders, have been assessed. After a median stay of 2.5 years, 56% of the offenders had been transferred to a sheltered educational housing or to an open low-security psychiatric ward. Length of stay was independent of psychiatric diagnosis, yet dependent on the nature of the offense. Having a cluster B personality disorder or a conviction for a sexual offense increased the risk of return to prison. Younger age and offenses without interpersonal violence increased the chances to enter sheltered educational housing.
Les auteurs d'infractions atteints d'un trouble mental sévère peuvent être soumis à un traitement psychiatrique-psychothérapeutique par ordonnance pénale. Basés sur le concept de la communauté thérapeutique forensique, les suivis de 204 détenus-patients atteints d'un trouble psychotique ou de la personnalité ou encore d'une dépendance aux substances ont été évalués. Après un séjour médian de 2,5 ans, 56 % ont été transférés dans un foyer socioéducatif ou une unité psychiatrique hors prison. La durée de séjour est indépendante du diagnostic psychiatrique mais dépend du type de délit. Un diagnostic de trouble de la personnalité cluster B ou une infraction sexuelle augmentent la probabilité de retourner en prison. Un jeune âge et un délit sans violence interpersonnelle favorisent une sortie en foyer.
Assuntos
Pacientes Internados , Transtornos Mentais , Humanos , Tempo de Internação , Suíça , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos da Personalidade/diagnóstico , Resultado do TratamentoRESUMO
Late-life depression has multiple, heterogeneous clinical presentations. The aim of the study was to identify higher-order homogeneous clinical features (symptom complexes), while accounting for their potential causal interactions within the network approach to psychopathology. We analyzed cross-sectional data from community-dwelling adults aged 65-85 years recruited by the European MentDis_ICF65+ study (n = 2623, mean age 74, 49% females). The severity of 33 depressive symptoms was derived from the age-adapted Composite International Diagnostic Interview. Symptom complexes were identified using multiple detection algorithms for symptom networks, and their fit to data was assessed with latent network models (LNMs) in exploratory and confirmatory analyses. Sensitivity analyses included the Partial Correlation Likelihood Test (PCLT) to investigate the data-generating structure. Depressive symptoms were organized by the Walktrap algorithm into eight symptom complexes, namely sadness/hopelessness, anhedonia/lack of energy, anxiety/irritability, self-reproach, disturbed sleep, agitation/increased appetite, concentration/decision making, and thoughts of death. An LNM adequately fit the distribution of individual symptoms' data in the population. The model suggested the presence of reciprocal interactions between the symptom complexes of sadness and anxiety, concentration and self-reproach and between self-reproach and thoughts of death. Results of the PCLT confirmed that symptom complex data were more likely generated by a network, rather than a latent-variable structure. In conclusion, late-life depressive symptoms are organized into eight interacting symptom complexes. Identification of the symptom complexes of late-life depression may streamline clinical assessment, provide targets for personalization of treatment, and aid the search for biomarkers and for predictors of outcomes of late-life depression.
Assuntos
Depressão , Vida Independente , Idoso , Ansiedade , Transtornos de Ansiedade , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , MasculinoRESUMO
Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings.
Assuntos
Transtornos Mentais , Transtornos Psicóticos , Humanos , Tempo de Internação , Psiquiatria Legal/métodos , Transtornos Mentais/psicologia , Hospitalização , Alta do PacienteRESUMO
The coronavirus pandemic and related restrictions impacted the daily lives of children and youth, partly due to the closure of schools and the absence of outdoor activities. The aim of this study was to investigate, quantify, and critically discuss the effect of the pandemic and related restrictions on consultations pertaining to depression and anxiety disorders in children and adolescents. This retrospective cross-sectional study was based on medical record data from the Disease Analyzer database (IQVIA) and included all children and adolescents aged 2-17 years with at least one visit to one of 168 German pediatric practices between April 2019 and December 2019 (n = 454,741) or between April 2020 and December 2020 (n = 417,979). The number of children and adolescents with depression and anxiety disorder diagnoses per practice and the prevalence of these diagnoses were compared for April 2020-December 2020 versus April 2019-December 2019. The number of children and adolescents with depression and anxiety diagnoses per practice increased in April 2020-December 2020 compared to the same period in 2019 (anxiety: + 9%, depression: + 12%). The increase was much greater in girls than in boys (anxiety: + 13% vs. + 5%; depression + 19% vs. + 1%). The prevalence of anxiety disorder increased from 0.31 to 0.59% (p < 0.001), and that of depression from 0.23 to 0.47% (p < 0.001). The biggest increases were observed for girls (anxiety from 0.35 to 0.72% (+ 106%, p < 0.001), depression from 0.28 to 0.72% (+ 132%, p < 0.001). This study shows an increase in the number of pediatric diagnoses of depression and anxiety disorders in the pandemic year 2020 compared to the previous year.
Assuntos
COVID-19 , Masculino , Feminino , Humanos , Adolescente , Criança , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Estudos Retrospectivos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Alemanha/epidemiologiaRESUMO
AIM: The aim of this study was to examine the age distribution and comorbidities of individuals vaccinated in primary care practices in April and May 2021. MATERIALS AND METHODS: The analysis was based on data from the IQVIA Disease Analyzer database and included 245,948 patients who received their first COVID-19 vaccination from one of 820 family medicine practices in April or May 2021. RESULTS: 93.6% of individuals received a vaccination based on general indication, 6.2% based on occupational indication, and 0.2% were nursing home residents. Men were 3.5 years younger on average than women (59.2 vs. 62.7 years). 54% of women and 52% of men younger than 60 years had at least one diagnosis from the priority list. Hypertension was the most common diagnosis (23.6% of men and 20.7% of women). In men, chronic respiratory diseases such as COPD or asthma were the second most common diagnosis (11.0%), while in women, depression (17.0%) was the second most common diagnosis. CONCLUSION: In the first 2 months of vaccination in general practices, most patients vaccinated were either elderly or chronically ill. Further studies comparing the characteristics of vaccinated and unvaccinated individuals would also be of great epidemiological relevance.
Assuntos
COVID-19 , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Demografia , Feminino , Humanos , Masculino , Atenção Primária à Saúde , SARS-CoV-2 , VacinaçãoRESUMO
OBJECTIVE: While incidence rates of depression and anxiety disorders in the elderly have been comprehensively investigated, the incidence rates of other mental disorders have rarely been researched. The incidence rate and predictors of various mental disorders in the elderly were evaluated in different European and associated countries. METHODS: A cross-sectional and longitudinal multi-centre survey of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnoses was conducted in different European and associated countries (Germany, Italy, Spain, Switzerland, the United Kingdom and Israel) to collect data on the prevalence and incidence of mental disorders in the elderly. The sample size of the longitudinal wave was N = 2592 elderly. RESULTS: The overall 1-year incidence rate for any mental disorder in the elderly is 8.65%. At 5.18%, any anxiety disorder had the highest incidence rate across all diagnostic groups. The incidence rate for any affective disorder was 2.97%. The lowest incidence rates were found for agoraphobia (1.37%) and panic disorder (1.30%). Risk factors for the development of any mental disorder were never having been married, no religious affiliation, a higher number of physical illnesses and a lower quality of life. CONCLUSION: In comparison to other studies, lower incidence rates for any affective disorder and middle-range incidence for any anxiety disorder were found. To the authors' knowledge, no prior studies have reported 1-year incidence rates for somatoform disorder, bipolar disorder and substance misuse in community-dwelling elderly. These findings indicate the need to raise awareness of psychosocial problems in the elderly and to ensure adequate availability of mental health services.
Assuntos
Transtornos Mentais , Qualidade de Vida , Idoso , Estudos Transversais , Humanos , Incidência , Transtornos Mentais/diagnóstico , Prevalência , Fatores de RiscoRESUMO
A cohort of occupational dermatology patients will be set up at the University Hospital Heidelberg, Germany. In a 3-year prospective cohort study, the so-called molecular classifier will be applied in 262 patients to better differentiate between eczema and psoriasis. A retrospective cohort of 282 occupational health patients with the same suspected diagnosis but no molecular classifier designation was used as a control group. In 5 follow-up visits during 3 years, data will be obtained on diagnoses, disease course and severity, absence from work, occupation and quality of life. The research questions address whether early diagnoses will help to better identify the efficient treatment, disease course, absence from work and continuance of occupation. The study is sponsored by the public statutory employers' liability insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).
Assuntos
Dermatite Ocupacional , Eczema , Dermatoses da Mão , Psoríase , Estudos de Coortes , Eczema/diagnóstico , Eczema/genética , Seguimentos , Alemanha , Humanos , Estudos Prospectivos , Psoríase/diagnóstico , Psoríase/genética , Qualidade de Vida , Estudos RetrospectivosRESUMO
BACKGROUND: An ageing population worldwide needs to investigate quality of life (QoL) and level of functioning (LoF) in the elderly and its associated variables. We aimed to study the relationship between Quality of Life (QoL) and Level of Functioning (LoF) in an elderly population in Europe. METHOD: As part of the Ment_Dis65+ European Project, 3142 community-dwelling adults aged 65-84 years in six countries were assessed by using the adaptation for the elderly of the Composite International Diagnostic Interview (CIDI65+) to provide psychiatric diagnosis according to the International Classification of Diseases (10th edition) (ICD-10 Classification of Mental and Behavioural Disorders). Socio-demographic and clinical interviews, and two self-report tools, the World Health Organization QoL assessment (WHO QoL BREF), to assess QoL, and the WHO Disability Assessment Schedule -II (WHODAS-II), to assess LoF, were also administered. RESULTS: Most subjects reported good levels of QoL (56.6%) and self-rated health (62%), with no or mild disability (58.8%). There was a linear decrease of the QoL and the LoF by increase of age. Elderly with ICD-10 mental disorder (e.g. somatoform, affective and anxiety disorders) had poorer QoL and lower LoF. There were a number of predictors of lower levels of QoL and disability, including both socio-demographic variables (e.g. male gender, increase in age, poor financial situation, retirement, reduced number of close significant others), ICD-10 psychiatric diagnosis (mainly anxiety, somatoform disorders) and presence of medical disorders (mainly heart and respiratory diseases). CONCLUSIONS: The study indicates that QoL and LoF were quite acceptable in European elderly people. A series of variables, including psychiatric and somatic disorders, as well as socio-demographic factor influenced in a negative way both QoL and LoF. More specific links between mental health, social and health services dedicated to this segment of the population, should be implemented in order to provide better care for elderly people with conditions impacting their QoL and functioning.
Assuntos
Envelhecimento/psicologia , Nível de Saúde , Transtornos Mentais/psicologia , Desempenho Físico Funcional , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologiaRESUMO
BACKGROUND: Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. METHODS: This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. RESULTS: Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. CONCLUSIONS: This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.
Assuntos
Ansiedade/reabilitação , Dor Crônica/reabilitação , Depressão/reabilitação , Dor Lombar/reabilitação , Terapia Ocupacional/métodos , Reabilitação Psiquiátrica/métodos , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Terapia Combinada/métodos , Depressão/diagnóstico , Depressão/etiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/complicações , Dor Lombar/diagnóstico , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Equipe de Assistência ao Paciente , Questionário de Saúde do Paciente , Estudos Prospectivos , Qualidade de Vida , Resultado do TratamentoRESUMO
OBJECTIVES: The aims of this study were to examine the association of Meaning in Life (MiL) with sociodemographic and physical factors, and its association with depression in older people. METHOD: A cross-sectional survey with a sample of N = 2104 older adults from communities of four European countries was conducted, using an age-appropriate interview for the diagnosis of depression and the Schedule for Meaning in Life Evaluation (SMiLE) questionnaire to assess MiL. RESULTS: Overall, MiL was particularly low in old male participants, in older people from Ferrara (Italy), those with a lower religious affiliation, fewer social contacts, and poorer physical health. Furthermore, younger old age (65-69 compared to 80-84 year olds), female gender, being married, living in Geneva and poorer physical health were significantly associated with a higher risk for depression. In addition, lower MiL significantly increased the likelihood to suffer from depression in older people. An interaction effect of study center and MiL also emerged: with decreasing MiL the risk for depression significantly increases in Hamburg compared to the other study centers. CONCLUSION: This study underlines the association of MiL and depression in old age. Integration of meaning-specific aspects in treatment for older adults with depression may be promising.
Assuntos
Depressão/epidemiologia , Depressão/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Nível de Saúde , Humanos , Vida Independente , Entrevista Psicológica , Masculino , Fatores de Risco , Distribuição por Sexo , Inquéritos e QuestionáriosRESUMO
Patients with Parkinson's disease (PD) may benefit from deep brain stimulation (DBS) to improve motor and medication-induced symptoms. Yet mixed evidence regarding the outcome of successful DBS on couple satisfaction has been highlighted in the literature. Thirty patients diagnosed with PD were included in a study investigating couple satisfaction (MSS-14), depression (HAD-D) and anxiety (HAD-A) at four measurement times: before DBS and 6, 12, and 18 months post-surgically. Sixteen spouses/partners were included as well. Couple satisfaction from the patient perspective was never associated with depression or anxiety. However, poor marital adjustment (i.e., difference and absolute difference between patients and spouses/partners MSS-14 scores) predicted patients' pre-operative depressive mood. Longitudinal analyses showed that couple satisfaction (n = 9) worsened at 12 months and 18 months compared to pre-DBS scores, F(2.047, 16.378) = 8.723, p = .003, and despite concomitant motor improvement. Growth curve analyses showed that couple satisfaction worsening occurred between 6 and 12 months post-operatively (b = 2.938, p < .001). Thus, couple satisfaction did not increase along with motor improvement and deteriorated after the adjustment period following DBS.
Assuntos
Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/psicologia , Casamento/psicologia , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Satisfação do Paciente/estatística & dados numéricos , Satisfação Pessoal , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVES: Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life. DESIGN: The study used a cross-sectional multicenter survey. PARTICIPANTS: The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel. MEASUREMENTS: Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+). RESULTS: The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75-84 years compared with those aged 65-74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder. CONCLUSIONS: The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.
Assuntos
Envelhecimento , Transtornos de Ansiedade/epidemiologia , Entrevista Psicológica , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Agorafobia/diagnóstico , Agorafobia/epidemiologia , Transtornos de Ansiedade/diagnóstico , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Israel/epidemiologia , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/epidemiologia , Fobia Social/diagnóstico , Fobia Social/epidemiologia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/epidemiologia , Prevalência , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/diagnósticoRESUMO
ABSTRACTBackground:Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly. METHODS: As part of the MentDis_ICF65+ study, N = 3,142 people aged 65-84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses. RESULTS: Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. "I can deal with my problem on my own" (90%). CONCLUSION: Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.
Assuntos
Cultura , Mau Uso de Serviços de Saúde , Transtornos Mentais , Serviços de Saúde Mental/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Comorbidade , Europa (Continente)/epidemiologia , Feminino , Mau Uso de Serviços de Saúde/prevenção & controle , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Saúde Mental/estatística & dados numéricos , Avaliação das Necessidades , Fatores de Risco , Fatores Sexuais , Fatores SocioeconômicosRESUMO
BACKGROUND: Except for dementia and depression, little is known about common mental disorders in elderly people. AIMS: To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people. METHOD: The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65-84 years) living in selected catchment community areas of participating countries. RESULTS: One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders. CONCLUSIONS: Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.
Assuntos
Transtornos Mentais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , PrevalênciaRESUMO
BACKGROUND: Androgen deprivation (AD) therapy combined to radiotherapy (RT) is a curative therapeutic option for patients with non-metastatic locally advanced or aggressive intermediate prostate cancer (PC), though with a range of nutritional, physical, and psychological side effects. A multidisciplinary care program was created to help frail patients to prevent and manage those side effects. MATERIAL AND METHODS: We conducted a longitudinal interventional study in frail patients, presenting either cardiovascular/pulmonary comorbidities, old age (≥75 years), vulnerability ratings, or balance impairment. Patients were treated by AD and RT and, benefited from nutritional coaching, supervised biweekly 45 minute physical training, and psychological counseling for two years. Treatment outcomes included PC-related quality of life (QoL), body mass index, fat mass index, and fat-free mass index derived from bioelectrical impedance analysis, Six-Minute Walk Test, Timed Up&Go, handgrip strength, Hospital Anxiety and Depression scale, Mini Mental State Examination. Measures were repeated after zero, three, six, nine, 12, 18, 24 months, and 12-months post-study follow-up. A prospective mixed-model design was used to assess longitudinal outcome. RESULTS: Regression analyses revealed no significant change over the two years, including post-study follow-up. Means of QoL, nutritional, physical, as well as psychological variables remained stable over more than two years in the 35 men aged 74 (range 68-76) years. CONCLUSION: The expected side effects of AD and RT were not observed in frail PC patients who followed this multidisciplinary care program.
Assuntos
Quimiorradioterapia/efeitos adversos , Neoplasias da Próstata/reabilitação , Neoplasias da Próstata/terapia , Idoso , Antagonistas de Androgênios/administração & dosagem , Antagonistas de Androgênios/efeitos adversos , Aconselhamento , Idoso Fragilizado , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Neoplasias da Próstata/psicologia , Psicoterapia , Qualidade de VidaRESUMO
BACKGROUND: This study describes the study approach and field procedures of the MentDis_ICF65+ study, which aims to assess the prevalence of mental disorders in older adults. METHODS: An age-appropriate version of the Composite International Diagnostic Interview (CIDI65+) was developed and tested with regard to its feasibility and psychometric properties in a pre-test and pilot phase. In the cross-sectional survey an age-stratified, random sample of older adults (65-84 years) living in selected catchment areas of five European countries and Israel was recruited. RESULTS: N = 3142 participants (mean age 73.7 years, 50.7% female) took part in face-to-face interviews. The mean response rate was 20% and varied significantly between centres, age and gender groups. Sociodemographic differences between the study centres appeared for the place of birth, number of grandchildren, close significants, retirement and self-rated financial situation. The comparison of the MentDis_ICF65+ sample with the catchment area and country population of the study centres revealed significant differences, although most of these were numerically small. CONCLUSIONS: The study will generate new information on the prevalence of common mental disorders among older adults across Europe using an age-appropriate, standardized diagnostic instrument and a harmonized approach to sampling. Generalizability of the findings and a potentially limited representativeness are discussed.
Assuntos
Área Programática de Saúde/estatística & dados numéricos , Projetos de Pesquisa Epidemiológica , Transtornos Mentais/epidemiologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Europa (Continente)/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Israel/epidemiologia , Masculino , Transtornos Mentais/diagnóstico , Projetos Piloto , Prevalência , PsicometriaRESUMO
BACKGROUND: When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques. METHODS: Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min. RESULTS: The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure. CONCLUSION: Surgical airway-naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.
Assuntos
Cartilagem Cricoide/cirurgia , Cartilagem Tireóidea/cirurgia , Traqueotomia/educação , Traqueotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Cateterismo/métodos , Estudos Cross-Over , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pescoço/anatomia & histologia , Estudantes de Medicina , Inquéritos e Questionários , Traqueia , Adulto JovemRESUMO
OBJECTIVE: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement. METHODS: Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory. RESULTS: Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder. CONCLUSION: These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.
Assuntos
Consenso , Depressão/diagnóstico , Comunicação Interdisciplinar , Corpo Clínico Hospitalar , Personalidade , Psiquiatria , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Gerais , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
Burning mouth syndrome (BMS) is a medical condition that is often refractory to conventional diagnostic and therapeutic methods. Patients suffering from BMS can benefit from a biopsychosocial approach in a joint, medical-psychological consultation model. Such a consultation exists at Geneva University Hospitals, involving the collaboration of the maxillo-facial and oral surgery division and the division of liaison psychiatry and crisis intervention, in order to take into account the multiple factors involved in BMS onset and persistence. This article will describe BMS clinical presentation, and present an integrate approach to treat these patients.