Support practices by an interdisciplinary team in a palliative-care unit for relatives of patients in agonal phase.

BACKGROUND: In the absence of extant recommendations, the aim of this study was to formalise support practices used by an interdisciplinary team in a palliative-care unit (PCU) for the relatives of patients in the agonal phase preceding death. The secondary objective was to understand the expectations of relatives during this phase in terms of the support provided by professionals and volunteers. METHODS: Thirty-two people took part in this study; all were interviewed through focus groups (FGs). Each FG comprised one category of individuals working in the PCU: nurses, care- assistants, doctors, psychologists, other professionals, palliative-care volunteers, and relatives. Groups were surveyed using an interview guide, and the interviews were recorded and transcribed to enable identification and characterization of all practices. Care practices were classified into four categories: current consensual practices (i.e. performed by all team members), occasional consensual practices, non-consensual practices (performed by one or a few participants), and practices to be developed. RESULTS: In total, 215 practices were mentioned by professionals and palliative-care volunteers: 150 current consensual practices, 48 occasional consensual practices, 1 non-consensual practice, 16 practices yet to be developed, and 29 practices for relatives. Many practices were mentioned by different categories of participants; thus, after cross-checking, the number of practices decreased from 215 to 52. A list of practices deemed desirable by all was drawn up and then validated by the entire interprofessional team. These practices were organised around four themes: providing care and ensuring comfort; communicating, informing, and explaining; interacting; and mobilising interdisciplinary skills. CONCLUSIONS: These results underline the importance of the quality of care provided to patients, the attention given to the relatives themselves, and they highlight the importance of the helping relationship. Following this study, which established a list of varied practices aimed at supporting the relatives of patients in agonal phase, it will be important to set up a broader study seeking to establish a consensus on these practices with an interprofessional group of experts from other PCUs using broad surveys and an adapted methodology. Such studies will make it possible to develop training modules for teams working with relatives.

The impact of chronic psychiatric disorders on cognitive decline.

OBJECTIVES: Based on seemingly contradictory results in the existing literature, the objective of our study was to investigate whether older individuals suffering from chronic psychiatric disorders show a more rapid decline in cognitive performances than their non-psychiatric counterparts, or if the pattern of decline through older age is similar in both groups. METHOD: A total of 820 older adults were selected from the Ageing Multidisciplinary Investigation (AMI) cohort study, which studies health-related issues of people over 65 years old living in rural areas. Among them, 30 suffer from chronic psychiatric disorders. Cognition was assessed with four neuropsychological tests: the Mini-Mental State Examination, the Digit Symbol Substitution Test, the Free and Cued Selective Reminding test and the Isaacs Set Test. Linear mixed models were used to compare the evolution of cognitive performances in the two groups between baseline and the four-year follow-up. RESULTS: Despite lower performances at baseline, the pattern of cognitive decline of the psychiatric group is similar to that of the control group. CONCLUSION: As suggested by this study conducted in rural communities, community-dwelling people suffering from chronic psychiatric disorders should not be considered at greater risk of age-related accelerated cognitive decline than the non-psychiatric older population.

Older People Facing the Crisis of COVID-19: Between Fragility and Resilience.

The health crisis we are facing is challenging seniors' resources and capacities for adaptation and resilience. The PACOVID survey, set up a few days after containment, investigates their psychological and social experiences with regard to the COVID-19 crisis and to what extent these characteristics, representations and attitudes have an impact on health and mortality. A telephone survey is being carried out on 935 people already followed up in the framework of ongoing epidemiological studies. As we are writing this article, the interviews conducted during the containment have just ended. Even though we will have to wait for the analysis of the results to draw conclusions, words collected by the psychologists during the interviews already illustrate a great heterogeneity in the way older adults lived this experience: social isolation, anxiety, the importance of family and the difficulty of being deprived of it, but also remarkable coping skills and resilience capacities.

[Semantic and letter fluency tasks: normative data in an elderly population of 70 years old and over from the PAQUID cohort]. / Fluences verbales sémantiques et littérales: normes en population générale chez des sujets âgés de 70 ans et plus issus de la cohorte PAQUID.

INTRODUCTION: Verbal fluency tasks are frequently used in neuropsychological examinations. The aim of this study was to produce norms for a normal elderly population in semantic (colors, animals, fruits, city names) and letter fluency (letters "L" and "P") tasks performed in 60 seconds. METHODS: These data were collected as part of the PAQUID cohort, a French population-based study on aging conducted in Gironde and Dordogne. RESULTS: The sub-sample analyzed included 1730 non-institutionalized and non-demented subjects. Norms were calculated according to age (70-74 years, 75-79 years, >or=80 years), sex and educational level (no diploma, primary degree, secondary degree and higher). For each task, the number of correct words produced and repetition errors were analyzed. CONCLUSION: The contribution of this work is to provide clinicians with normative scores for semantic and letter fluency tasks helpful for interpreting the performances of elderly patients consulting for cognitive disorders.

Ultrastructural aspects of the liver perisinusoidal space in diabetic patients with and without microangiopathy.

To determine whether abnormalities of the perisinusoidal space of Disse are present in the liver of diabetic patients with microangiopathy, an ultrastructural stereologic study of the space of Disse was performed in six insulin-treated diabetics with severe performed in six insulin-treated diabetics with severe proliferative retinopathy and six insulin-treated diabetics with normal fluorescein angiography, six patients with familial unconjugated hyperbilirubinemia were studied as controls. No patient had clinical and/or biochemical hepatic abnormalities and none suffered from any of the pathologic conditions known to be associated with collagenization of the perisinusoidal space. In control patients, the space of Disse of liver sinusoids contained occasional small deposits of collagen fibers. The relative volume of these fibers per unit of sinusoid represented 2.63 +/- 0.82%. In all diabetic patients with retinopathy, marked deposition of collagen fibers within the perisinusoidal space was constantly observed, a finding confirmed by ultrastructural stereologic analysis which showed that the relative volume of collagen fibers per unit of sinusoid represented 7.33 +/- 1.44% and differed significantly from control patient values (P less than 0.001). On the contrary, the relative volume of collagen fibers within the space of Disse in diabetic patients without retinopathy (3.95 +/- 2.96%) did not differ significantly from control patient values. These findings demonstrate that collagenization of the space of Disse is positively correlated with the presence of diabetic microangiopathy. Ultrastructural examination of the liver sinusoids might constitute a sensitive and useful approach for detecting the early changes of the microcirculation in diabetic patients.

Impaired transport of iron-dextran complex in myelinated central fibers.

The labeling of retinal ganglion cells by axonal transport of an iron-dextran complex (injected into the superior colliculus and the lateral geniculate nucleus) was compared to the previously described labeling of the dopaminergic neurons of the substantia nigra (after striatal injection), to test the validity of the method in myelinated and unmyelinated CNS pathways. It was shown that the retrograde labeling in the visual pathway was impaired, consecutive to the penetration of iron-dextran into the myelin sheaths and a subsequent myelin alteration along the optic nerve.

Morphology, density and distribution of tyrosine hydroxylase-like immunoreactive cells in the retina of mice.

The immunohistochemical detection of tyrosine-hydroxylase (TH) was used to visualize dopaminergic neurons on flat mounted retinas in two strains of mice (pigmented and non-pigmented). The morphology of the TH-positive neurons was similar to that of dopaminergic cells described in other vertebrates. Interplexiform dopaminergic neurons were observed. No differences were noticed between the morphology, density and distribution of dopaminergic neurons either in the various portions of the retina or in the whole retina of the two strains of mice.

Tyrosine hydroxylase immunohistochemistry fails to demonstrate dopaminergic interplexiform cells in the turtle retina.

A number of catecholaminergic, presumably dopaminergic, cells could be observed in the turtle retina, because of their tyrosine hydroxylase immunoreactivity. They were amacrine cells with a pear-shaped soma and dendrites distributed in 3 sublayers within the inner plexiform layer. Neither sclerally directed TH-positive processes nor terminals in the outer plexiform layer were observed, suggesting that dopaminergic interplexiform cells do not exist in the turtle retina.

Circadian pattern of motor activity in major depressed patients undergoing antidepressant therapy: relationship between actigraphic measures and clinical course.

The 24-hour motor activity pattern was evaluated in 26 inpatients with major depression at treatment onset and after 4 weeks of antidepressant therapy. Clinical state, depression, and psychomotor retardation, as well as motor activity level and circadian rhythm, were simultaneously assessed. Treatment responders and nonresponders were also considered. Diurnal hypoactivity and reduced 24-hour rhythm amplitude were found at treatment onset. Activity level increased significantly on discharge. The rest-activity cycle for each depressed patient fit a cosine function of 24-hour periodicity. Data tended to show no phase shift but a large intragroup phase variability. Preliminary findings of a negative correlation between basic activity level and clinical improvement, and a trend toward responders having a lower activity level than nonresponders, suggest that activity could be used to predict therapeutic response.

Executive functioning and verbal memory in young patients with unipolar depression and schizophrenia.

Although neuropsychological studies have consistently reported executive deficits in schizophrenia, studies of executive functions in depression have produced equivocal results. The aim of this study was to examine the profile and the specificity of the executive impairment and its association with memory performance in young patients with unipolar depression. We compared patients with depression to normal control subjects and schizophrenics. Twenty young inpatients with unipolar depression, 14 schizophrenics and 20 age-, education- and IQ-matched control subjects were assessed with a neuropsychological battery including: (1) verbal memory task; (2) frontal tasks (WCST, Cognitive Estimate, Verbal fluency, verbal and visuo-spatial span) and a new complex sorting test (Delis test). Depressed patients and schizophrenics exhibited executive deficits. Unlike schizophrenics, depressed patients did not show memory impairment. Deficits in several 'higher-level' functions combined to produce executive impairments in patients with depression including complex integration for concept formation, spontaneous cognitive flexibility and initiation ability. Impaired functions in schizophrenia and in depressed patients were similar but were differently related to clinical variables. The pattern of memory failure in our schizophrenics is believed to reflect retrieval and encoding deficits. Our findings highlight the heterogeneity of skills grouped under the term 'executive functions' that are vulnerable in depression or schizophrenia.

[Deficits in memory retrieval: an argument in favor of frontal subcortical dysfunction in depression]. / Les troubles de la récupération mnésique: un argument en faveur d'un dysfonctionnement des structures sous-cortico-frontales dans la dépression.

UNLABELLED: While numerous studies have objective quantitative and qualitative deficits of memory in depressed patients, the mechanisms of these impairments are not well established. The study reported here was designed to assess encoding and retrieval processes in depression and to define the specific nature of memory failure associated with this disorder. METHODS: Ten inpatients with major depression responding to DSM III-R criteria and ten normal controls were included in this study. All subjects were assessed with a neuropsychological battery including: a) subtests of Weschsler memory scale (digit span, logical memory); b) verbal fluency (letter); c) two tasks assessing executive functions (cognitive estimate, Nelson's test); d) two explicit tasks of verbal learning (California Verbal Learning Test and Grober & Buschke's procedure) which measure memory performance in various conditions of encoding (incidental vs controlled) and of recollection (free recall, cued recall and recognition). Severity of depression was assessed with the MADRS and the Retardation Rating Scale for Depression. RESULTS: Although there was no difference between patients and controls on digit span and logical memory tasks, depressed patients exhibited a deficit in verbal learning with CVLT and Grober & Buschke's procedure. On California Verbal Learning Test, depressive subjects performed poorly in free recall and demonstrated poor consistency. Patients show free recall improvement across trials 1 or 5 and this learning effect didn't differ from controls. Score of patients and controls on cued recall and recognition were at the same level. Grober & Buschke's procedure confirmed these results. Despite a control of encoding processes during the initial presentation of the words, free recall measure revealed significant difference between groups. Like controls, patients recalled almost all items when semantic cues was provided and their recognition results showed a ceiling effect. Consistency indexes of free recall and cued recall differed significantly between groups. Verbal fluency and frontal tasks didn't allow to distinguish the depressive patients from controls. DISCUSSION: Depressive subjects exhibited a deficit in free recall and poor consistency while cued recall and recognition were normal. Patient's results in free recall are characterized by difficulties in planning and in maintaining retrieval strategies. These findings suggest that memory failure in depression could reflect an impairment in retrieval processes depending on executive functions controlled by the subcortical structures.

[Deficit in selective attention and its evolution in depression]. / Le déficit de l'attention sélective et son évolution au cours de la dépression.

Selective attention was measured in 34 depressed patients and 34 controls using a computerized version of the Stroop test, that included a manipulation of the stimulus onset asynchrony (SCA) in order to explore the efficacy of cognitive inhibition as a function of depression and of clinical amelioration of degression after therapy. Clinical tests included a measure of psychomotor slowing [Echelle de Ralentissement de Widlöcher (ERD), the Hamilton (Psychiatric Rating Scale for Depression (HAMD), and the Brief Psychiatric Rating Scale (BPRS)]. Selective attention was measured with the Stroop test, which includes four measures: Word, Color, Color-Word, and Color-Word minus Color, or interference. All of these measures were deficient in the depressed patients, particularly Stroop interference. Even when additional time was given to inhibit the Stroop distractor in the SOA condition, depressed subjects still showed significantly inferior performance. After four weeks of anti-depressive treatment, fifteen of the patients were retested, and showed significant improvement on all the Stroop measures, particularly on Stroop interference. The improvement in performance on the attentional measures was comparable in magnitude to that seen on the clinical scales, and suggests that the interference measure can be a sensitive indicator of clinical status in depressed patients.

[Significance of studies of motor activity in depression]. / Intérêt des études actométriques dans la dépression.

Actometry is a technique that enables continuous monitoring of spontaneous motor activity. This technique can be applied to the study of depression either by studying qualitative motor activity patterns or by measuring quantitative motor parameters. We present here the results of a quantitative actometric analysis. 13 depressive in-patients were evaluated both clinically by depression scales and by actometry before and after trimipramine treatment. Correlation analysis was made between actometric and clinical rating scores at different moments of the treatment. Some actometric parameters appear to be specific indices of depression and psychomotor retardation. Future prospects for the use of actometric techniques in depression are discussed.

Over-reporting of maladjustment by depressed subjects. Findings from retesting after recovery.

The extent to which patients' reports of maladjustment is influenced by depressive symptoms was estimated in 25 acute depressed patients responding to pharmacotherapy. Their social adjustment over the same four-month period immediately prior to hospitalization was assessed on two separate occasions: firstly when they were acutely depressed, and again a mean of 20 days later when clinically recovered. Significant differences between the two reports were found in mean score of maladjustment in four out of five fields of social adjustment (work, social/leisure life, family of origin, marriage, and sex). The reduction in depressive symptoms scores (of pessimism considered separately), correlated significantly with changes in the total maladjustment score. The reduction in pessimism scores correlated with changes in the scores for both work and social/leisure fields, and also accounted for 40% of the total variance in maladjustment score. These results indicate that impaired social adjustment as assessed during the height of the depressive illness arises in part from a symptom--related overreporting bias leading patients to make a harsh appraisal of themselves.

Subjective bias in reports of poor work adjustment in depressed patients.

Twenty-five depressed inpatients were asked to report their adjustment at work during the 4-month period preceding their hospitalization. Two separate reports were given: the first during the acute illness phase and the second one 10-28 days later, after symptomatic remission following standardized pharmacotherapy. Thirty-two percent more patient ratings showed absence of adjustment problems on the second report compared with the first. Significant differences between the 2 reports were found in 7 of the 9 items on the Structured and Scaled Interview to Assess Maladjustment, which is designed to assess specific aspects of maladjustment at work. The changes in the scores of maladjustment correlated with the changes in the scores of depressive symptoms, and 40% of the variation in maladjustment scores was accounted for by the pessimism item of the Montgomery-Asberg Depression Rating Scale. Much of the poor work adjustment reported by the acutely depressed patients thus seems to be caused by symptom-related subjective bias.