Elderly Psychiatric Outpatients Research Articles

Prevalence of Dementia among Elderly Patients attending Psychiatry OPD of Tertiary Care Hospital and its Association with Socio Demographic Variables

Introduction: World is graying. With the rise in life expectancy, the elderly population is increasing. At the same time, prevalence of dementia is also increasing as ageing is the main risk factor for dementia. This study aims to find out the prevalence of dementia among old age patients and associated variables among the elderly psychiatric outpatients in a tertiary care hospital.Material and Method: A total of 210 consecutive elderly (60 or more years) outpatients in psychiatric OPD were enrolled in a period of one year, after taking informed consent with caretakers. Mini Mental State Examination (MMSE) was done as screening tool for cognitive impairment. Diagnoses were made according to ICD-10 guidelines. Data was analysed using SPSS.Results: Out of 210 subjects, 50.95% were female, 43.8% were of age group 60-64 years. Prevalence of dementia was 11.4% among which Alzheimer's dementia constituted 70.8% of total cases of dementia followed by vascular dementia (25%). Significant association of dementia was seen with age, occupation and Mini Mental State Examination (MMSE) score. Among other psychiatric comorbidities, depression (36.7%) was found to be the commonest mental illness followed by Neurotic, stress related and somatoform disorders (13.8%) and Alcohol dependence syndrome (12.9%).Conclusion: This study concludes that significant number of elderly patients attending OPD of tertiary care hospital suffers from dementia and MMSE is a reliable tool to screen dementia in the elderly patients.J Psychiatrists’ Association of Nepal Vol .6(1), 2017, p.12-17

Suicide risk assessment in the elderly

ObjectivesTo assess suicide risk in elderly psychiatric outpatients and to identify potential suicide risk factors in this population.MethodsThis was a cross-sectional, descriptive and analytical study, including 50 psychiatric outpatients, aged 65 years or more and attending the Hédi Chaker University Hospital, in Sfax (Tunisia), between November and December 2015. We used a hetero questionnaire including epidemiological and clinical data and three scales: the Suicidal Risk Assessment Scale of Ducher (RSD), the Hospital Anxiety and Depression Scale (HADS) and the Mini Mental State Examination (MMSE).ResultsThe sex ratio (M/F) was 1. The average age of patients was 68.62 years. The majority of them were married (68%), unemployed (98%), living in urban area (58%) and within their family (88%); they had at most a primary degree (80%) and a low socioeconomic level (74%).The prevalence of patients at risk of suicide (RSD ≥ 3) was 26%. This risk was high (RSD ≥ 7) in 18% of cases.The presence of suicidal ideation (RSD ≥ 3) was correlated with: a family history of suicide attempt (58.3% vs. 15.8%; P = 0.003), a personal history of suicide attempt (80% vs. 12.5%; P < 0.001), depressive symptoms (HAD-D ≥ 11) (36.7% vs. 10%; P = 0.05) and anxiety (HAD-A ≥ 11) (52.4% vs. 6.9%; P = 0.001).ConclusionOur study showed that among older psychiatric outpatients, one in four had suicidal thoughts. This high rate encourages us to search systematically these suicidal thoughts in this population, especially in patients with risk factors such as a family history of suicide attempt, depressive or anxious symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Diabetes mellitus onset in geriatric patients: does long-term atypical antipsychotic exposure increase risk?

Diabetes mellitus (DM) in common in adults using psychotropic medications. However, it remains largely unknown whether there is an additional risk of diabetes mellitus (DM) in elderly psychiatric outpatients, particularly those with long-term exposure to atypical antipsychotics (AP). In this retrospective longitudinal study, 61 atypical AP-exposed and 64 atypical AP-unexposed geriatric psychiatric patients were compared to a group of 200 psychotropic-naïve controls. Our main composite outcome was diabetes incidence over a 4-year period, defined by fasting blood glucose ≥ 7.0 mmol/L or a new-onset oral hypoglycaemic or insulin prescription during the 4-year period. The 4-year incidence of DM did not differ significantly between groups: 12.3%, 6.7%, and 11.9% in the atypical AP-exposed, atypical AP-unexposed, and control groups, respectively (χ(2) = 1.40, P = 0.50). Depression and antidepressant, cholinesterase inhibitor, and valproate use were independently associated with increases in fasting glucose. However, hyperglycaemia and hypoglycaemic prescriptions were not more common in geriatric psychiatric patients. DM does not appear to be more common in geriatric psychiatric patients than similarly aged controls and is not more common in atypical AP users. However, depression and antidepressant, cholinesterase inhibitor, and valproate use may increase fasting glucose levels, and the clinical significance of this warrants further investigation. Nonetheless, given the rates of untreated and undertreated fasting hyperglycaemia in both our geriatric psychiatric and control samples (>10% of all patients), we recommend regular screening for DM in these populations.

Psychiatric morbidities of elderly psychiatry out-patients in a tertiary-care hospital

With the rise in life expectancy, the elder population is increasing. Morbidity profiles of elderly people may indicate different needs and priorities. This study aims to sort out referral pattern, attitude about psychiatric referral and morbidity profile among elderly psychiatric outpatients in a general hospital. A total of 100 consecutive elderly (>55 years) out-patients in psychiatry OPD coming into contact of the investigator and giving informed consent were enrolled. Diagnoses were made according the ICD-10. More (54%) were female, mainly of age, 55-70 years (79%). Main ethnicity groups seeking care were Mongol (32%), Brahmin (25%), indigenous Terai tribes (14%) and Newar (11%). People from cities and semi-urban settings predominated the study. Referrals made most commonly by the departments were medicine, family medicine, surgery and ENT. More than a fourth (28%) were dissatisfied and questioned about the referral to psychiatric service. Greater proportions (71%) were comfortable and happy about psychiatry referral. Mood related and physical complaints each were presenting complaints in about half of subjects. Major psychiatric diagnoses were mood affective, anxiety, substance use and organic psychiatric disorders. Great majority had physical co-morbidity. Common mental disorders among elderly psychiatry out-patients were mood affective, anxiety and substance use disorders. A significant number of elderly psychiatry out patients had physical comorbidity. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 1-8 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6735

Risk factors for vascular dementia in elderly psychiatric outpatients with preserved cognitive functions

The aim of the study was to assess risk factors for vascular dementia (VaD) in elderly psychiatric outpatients without dementia, and to determine to what extent clinical interventions targeted such risk factors. Out of 250 clinical charts, 78 were selected of patients over 60 years old, who showed no signs of dementia. Information was obtained regarding demographics, clinical conditions (diagnosis according to ICD-10), complementary investigation, cognitive functions (via CAMCOG), neuroimaging, and the presence of risk factors for VaD. Depression was the most prevalent psychiatric disorder (74%). A great majority of the patients (86%) had at least one risk factor for VaD. One-third of the sample showed three or more risk factors for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), tryglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (19.2%), alcohol abuse (16.7%), and sedentarism (14.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD.

Aging and visual hallucinations in elderly psychiatric outpatients

Estimates of the reported prevalence of visual hallucinations in the elderly vary from study to study. The aim of the present investigation was to re-evaluate the prevalence of visual hallucinations in elderly psychiatric outpatients and to examine pertinent risk factors. One hundred and twenty-two elderly (≧60 years old) consecutive outpatients at our university hospital were investigated with a questionnaire regarding visual hallucinations and the Mini-Mental State Examination. Twelve of 122 (10%) patients suffered from visual hallucinations. Although advanced age, lower MMSE scores and dementia were significantly associated with the presence of visual hallucinations, logistic regression analysis revealed that only advanced age showed a tendency to predict the presence of visual hallucinations. In 53 patients with dementia examined separately, only advanced age was significantly associated with visual hallucinations. The present findings suggest that the prevalence of visual hallucinations in the elderly is about 10% and that aging is an important risk factor in the development of visual hallucinations in dementia. Further studies are required in order to investigate the contribution of age-related factors such as lowering visual acuity, bereavement and loneliness to the presence of visual hallucinations.

Personality Disorders and Self-Perceived Quality of Life in an Elderly Psychiatric Outpatient Population

The aim of this work was to assess the impact of personality disorder and traits on the subjective assessment of quality of life by a sample of elderly psychiatric outpatients (60 years or more). Sixty of the total number of subjects interviewed were included in the test sample since they met the Vragenlijst Klinishe Persoonlijkheid (VKP) criteria for personality disorder. A control sample was also formed, composed of 50 subjects without personality disorders or traits. Quality of life was assessed using the LEIPAD questionnaire. Personality disorder diagnoses were prevalently distributed in cluster C (25%) and in cluster A (20%). A total of 48.3% of patients (n = 29) had more than 1 personality disorder. Sixty percent of the sample (n = 36) presented with comorbid Axis I psychiatric disorders, in most cases depressive pathologies. Comparing the case and control groups, worse LEIPAD scores were achieved by subjects with personality disorders. Between clusters of personality disorders, the worst scores were observed in subjects with more than 1 personality disorder diagnosis. Elderly people who presented with a personality disorder were more vulnerable to late-life distress, especially those with more than one diagnosis. In keeping with linear regression analysis, widowhood, divorcehood and living with others appear to be variables able to negatively influence quality of life in this population. While the VKP needs to be adapted to the application in the elderly, it does seem to be a particularly useful screening instrument.

RELATIONSHIP BETWEEN PSYCHOPATHOLOGY AND COGNITIVE FUNCTIONING IN ELDERLY PERSONS

There has been much controversy over the common belief that elderly people incur declining cognitive function with increasing age. Such decline has been attributed to cross-sectional cohort effects, the effects of stress and intercurrent medical illness, as well as age per se (Botwinick, 1977; Eisdorfer & Wilkie, 1977). We studied the relationship between psychopathology and cognitive functioning in two groups of elderly people, 115 elderly psychiatric outpatients (M age and SD, 71.48 yr. and 6.05 yr.) and 213 symptomatic volunteers (M 3ge and SD, 70.08 yr. and 5.25 yr.). The symptomatic volunteers mere senior citizen club members living in the community who were not psychiauic patients but who complained of substantial memory problems. Both groups lived in the same geographical area; and ages and sex were comparably distributed. The Conceprual Level Analogy Test, a multiple-choice analogy rest which assesses

The effectiveness of assertive training with elderly psychiatric outpatients.

The usefulness of assertive training for elderly psychiatric outpatients was assessed through a quasi-experimental evaluation of a program at a community geriatric facility. Elderly clients are frequently labeled as "untreatable" and are therefore often denied therapeutic treatment. This study is an example of the potential effectiveness of applying treatment techniques which have been developed with younger populations to a geriatric population. Nineteen clients, aged 50-75, participated in the study, either as participants in the assertion training or as members of a no-treatment control group. The assertion training consisted of 14 semi-weekly sessions, with coaching and feedback provided by the therapists. Assertive behaviors were assessed through self-report, role play and staff ratings of adaptive behaviors of clients. Pre-intervention comparisons between the groups along these dimensions were nonsignificant. However, post-test assessment indicated a significant between group difference in self-reported assertiveness-(t(17) = 2.69; p less than .05). Dependent t-tests indicated that the experimental group became more assertive (t(9) = 2.59; p less than .05), but the control group did not. Changes as assessed by role play and staff rating did not reach statistical significance. Results which indicate the potential effectiveness of assertive training with this population are discussed in terms of a specificity conceptualization of assertiveness and implications for assertive training with this population.

Dizziness and falling in elderly psychiatric outpatients

The authors examined 100 psychiatric patients who were 60 years old and older for orthostatic hypotension and symptoms of dizziness and falling. Almost 40% of the patients complained of dizziness and falling, although only 27% had systolic orthostatic hypotension. Drug treatment, particularly the combination of tricyclics with other orthostatic hypotension-inducing drugs, was the most important factor accounting for the dizziness and falling. Underlying medical illness, particularly heart disease, also correlated significantly with the patients' symptoms.

Clinical utility of a rapid diagnostic test series for elderly psychiatric outpatients.

Psychiatric evaluation of the elderly is especially difficult for several reasons, e.g., the presence of organic impairment, the effects of multiple drug therapy, and the tendency to confuse the normal concomitants of aging with neurotic symptoms. The authors have developed and evaluated a brief series of self-report assessment tests (GRDB) designed to assist the psychiatrist in the process of diagnosis. Coefficients of the internal consistency of the seven scales are presented. A comparison was make between 28 psychiatric patients attending a geriatric clinic and 48 well-functioning elderly persons matched for age and sex, and living in the same community. Results showed that the geriatric outpatients functioned at a lower level of adaptation than did the control group, on all seven scales - depression, daily living skills, social interaction, cognitive skills, number of illnesses, number of life problems, and the use of drugs and alcohol. These findings provide a measure of discriminant validity. The advantages of this brief assessment instrument are discussed.