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Objective: We aimed to evaluate the prevalence, clinical determinants, and consequences (falls and hospitalization) of frailty in older adults with mental illness.Design: Retrospective clinical cohort study.Setting: We collected the data in a specialized psychogeriatric ward, in Boston, USA, between July 2018 and June 2019.Participants: Two hundred and fourty-four inpatients aged 65 years old and over.Measurements: Psychiatric diagnosis was based on a multi-professional consensus meeting according to DSM-5 criteria. Frailty was assessed according to two common instruments, that is, the FRAIL questionnaire and the deficit accumulation model (aka Frailty Index [FI]). Multiple linear regression analyses were conducted to evaluate the association between frailty and sample demographics (age, female sex, and non-Caucasian ethnicity) and clinical characteristics (dementia, number of clinical diseases, current infection, number of psychotropic, and non-psychotropic medications in use). Multiple regression between frailty assessments and either falls or number of hospital admissions in the last 6 and 12 months, respectively, were analyzed and adjusted for covariates.Results: Prevalence of frailty was high, that is, 83.6% according to the FI and 55.3% according to the FRAIL questionnaire. Age, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty identified by the FRAIL. Dementia, current infection, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty according to the FI. Falls were significantly associated with both frailty instruments. However, we found only a significant association for the number of hospital admissions with the FI.Conclusion: Frailty is highly prevalent among geriatric psychiatry inpatients. The FRAIL questionnaire and the FI may capture different forms of frailty dimensions, being the former probably more associated with the phenotype model and the latter more associated with multimorbidity. [ABSTRACT FROM AUTHOR]

Introduction Patients with severe mental illness die 10-20 younger from general population. In addition to suicide, preventable physical diseases cause most deaths. The mental illness itself and stigma keep the patients from adequate treatment for physical ilnesses. Objectives We aimed to investigate medical consultations for inpatients with severe mental illnes. Methods We retrospectively evaluated medical records of patients diagnosed by schizophrenia, schizoaffective disorders, bipolar disorder, and depression between 1st Februrary 2018 and 30th January 2020. We excluded routine consultations before electroconvulsive treatment. Local ethichs committee approved the study. Results Among total 475 consultations, %41.3 (n=196) was for male, and %58.7 (n=279) was for female patients. Mean age and standart deviation were 48.9 ± 13.9 for male, and 50.1 ± 13.7 for female (p>0.05). Comparing sexes oin terms of primer psychiatric diagnoses, the higher proportion was psychotic disorders for male, and for female it was mood disorders (p

Background: Few studies have examined the concurrent effects of physical disease and systemic inflammation on suicide risk in patients with depression. The authors investigated the independent contributions of chronic physical disease and systemic inflammation as indexed by C-reactive protein (CRP), on risk of suicide attempt. Methods: In this case–control study, 1468 cases of suicide attempters and 14 373 controls, both aged 18–65 years with a diagnosis of depression during 2011–2015, were identified from the hospital-wide database. Regression models were implemented to identify separate effects of physical diseases and systemic inflammation indexed by CRP, on risk of suicide attempt. Results: Compared with having no physical disease, having one, two, and three or more physical diseases was associated with a 3.6-, 6.4-, and 14.9-fold increase in odds of making a suicide attempt, respectively, after adjusting for age, sex, and race/ethnicity. In a sub-sample of cases and controls with available CRP values, patients with high CRP (>3 mg/L) had 1.9 times the odds of suicide attempt compared with patients with low CRP (<1 mg/L). This association was no longer significant when controlling for the effect of physical disease. Conclusions: The presence of physical disease is an important risk factor for suicide attempt among patients with depression. Systemic inflammation is likewise associated with increased risk for suicide attempt, however, this association appears to be accounted for by the presence of physical disease among patients receiving care in a medical center setting. Healthcare providers should consider the risk of suicide attempt in depressed patients burdened with multiple comorbidities. [ABSTRACT FROM AUTHOR]

Multimorbid adults are more likely to have depression. However, existing data are mostly cross-sectional or retrospective with poor control of baseline depressive symptoms and a focus on long-term effects. This prospective study examined the short-term independent predictive association of multimorbidity with depressive symptoms. We collected baseline and three-month follow-up data from a population-based sample of 300 community-dwellers (aged 18-77) in Hong Kong. Multiple regression was used to examine the predictive association of baseline multimorbidity (two or more physical chronic conditions), relative to having one or zero conditions, with depressive symptoms in three months measured by the Center for Epidemiological Studies-Depression (CES-D, out of 60) scale. Multivariable adjustments were made for socio-demographics, baseline CES-D scores, and baseline self-perceived physical health status. A sub-analysis was conducted to compare multimorbid participants with monomorbid (one condition) ones. In our sample, 48 participants (16%) had multimorbidity. Adjusted analysis showed that on average, multimorbid participants had 2.71 (95% CI, 0.36-5.06, Cohen's d = 0.128) more points in the CES-D scale at three-month follow-up than non-multimorbid participants (zero or one condition) did, which was independent of baseline CES-D scores, self-perceived physical health status, and socio-demographics. Compared with monomorbid participants, multimorbidity was associated with a similar difference of 2.92 (95% CI, 0.81-5.66, Cohen's d = 0.220) points. Incremental R-square changes associated with the inclusion of multimorbidity were significant (P < 0.05). In conclusion, the effect of multimorbidity on depressive symptoms may take a shorter period to manifest than previously assumed. The mental health of adults with multimorbidity warrants more attention. [ABSTRACT FROM AUTHOR]

Objective: To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning.Design: Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017).Setting: Home/community.Participants: People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety.Interventions: Non-pharmacological interventions targeted at depression/anxiety.Measurements: We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool.Results: We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n = 5 trials, mean difference in Hamilton Depression Rating Scale score -4.94 [95% CI -7.90 to -1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified.Conclusion: PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population. [ABSTRACT FROM AUTHOR]

Background: The medical burden in mood disorders is high; various factors are thought to drive this pattern. Little research has examined the role of childhood maltreatment and its effects on medical morbidity in adulthood among people with unipolar depression and bipolar disorder.AimsThis is the first study to explore the association between childhood maltreatment and medical morbidity in bipolar disorder and in unipolar depression, and examine whether the impact of abuse and neglect are distinct or combined.Method: The participants consisted of 354 psychiatrically healthy controls, 248 participants with recurrent unipolar depression and 72 with bipolar disorder. Participants completed the Childhood Trauma Questionnaire and received a validated medical history interview.Results: Any type of childhood maltreatment, child abuse and child neglect were significantly associated with the medical burden in bipolar disorder, but not unipolar depression or for controls. These associations worked in a dose-response fashion where participants with bipolar disorder with a history of two or more types of childhood maltreatment had the highest odds of having a medical illness relative to those without such history or those who reported one form. No such significant dose-response patterns were detected for participants with unipolar depression or controls.Conclusions: These findings suggest that childhood maltreatment may play a stronger role in the development of medical illnesses in individuals with bipolar disorder relative to those with unipolar depression. Individuals who had been maltreated with a mood disorder, especially bipolar disorder may benefit most from prevention and intervention efforts surrounding physical health.Declaration of interestNone. [ABSTRACT FROM AUTHOR]

Background Increased physical morbidity in patients with schizophrenia spectrum disorders (SSDs) is well documented. However, much less is known about the association between somatic comorbidities and psychosis treatment outcomes. Subjects and methods This cross-sectional study, nested within the larger frame of a prospective cohort study, was done in 2016 at Psychiatric Hospital Sveti Ivan, Zagreb, Croatia. Data were collected on a consecutive sample of 301 patients diagnosed with schizophrenia spectrum disorders who achieved a stable therapeutic dosage. Key outcome was the number of psychiatric rehospitalizations since diagnosis of the primary psychiatric illness. Predictors were number of physical and psychiatric comorbidities. By robust regression, we controlled different clinical, sociodemographic, and lifestyle confounding factors. Results The number of chronic somatic comorbidities was statistically significantly associated with a larger number of psychiatric rehospitalizations, even after the adjustment for number of psychiatric comorbidities and large number of other clinical, sociodemographic, and lifestyle variables. Conclusions Chronic somatic comorbidities are associated with higher rates of psychiatric rehospitalization independently of psychiatric comorbidities and other clinical, sociodemographic, and lifestyle factors. Therefore, to treat psychosis effectively, it may be necessary to treat chronic somatic comorbidities promptly and adequately. Chronic somatic comorbidities should be considered equally important as the SSD, and should be brought to the forefront of psychiatric treatment and research with the SSD as one entity. The integrative approach should be the imperative in clinical practice. [ABSTRACT FROM AUTHOR]

Background:To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002.Methods:Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use.Results:The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance.Conclusions:These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management. [ABSTRACT FROM PUBLISHER]

Background: Insomnia is a common psychiatric complaint among elderly individuals. This study investigates the prevalence and sociodemographic correlates of insomnia by considering a community sample of elderly individuals in South Korea.Methods: A face-to-face household survey was conducted in five regions of South Korea from June 2008 to August 2008. Among a total of 3,074 individuals aged 65 years and over, 2,002 participants were interviewed. The presence of insomnia was defined as having at least one of four sleep complaints that included difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and non-restorative sleep (NRS) more than three times per week in the last month. The Restless Legs Syndrome (RLS) Questionnaire, a short form of the Geriatric Depression scale (GDS), and a medical review of systems were implemented.Results: Insomnia was found in 29.2% of the participants. DIS, DMS, EMA, and NRS accounted for 19.4%, 21.7%, 19.6%, and 8.0% of the participants respectively. Insomnia accompanied by daytime consequences accounted for 17.1% of the participants. The participants who were females, had no education, lived alone, showed symptoms of RLS or depression, and had a lifetime history of physical illness were significantly more likely to report insomnia. The prevalence of DIS, DMS, EMA, or insomnia increased slightly with age, whereas that of NRS decreased slightly. The lifetime history of head trauma, hyperlipidemia, heart disease, anemia, or depression was significantly related to insomnia.Conclusion: Sleep problems are common among elderly individuals and are closely related to their lifetime history of physical illness. [ABSTRACT FROM PUBLISHER]

Background: Aging societies will be confronted with increased numbers of long-term care (LTC) residents with multimorbidity of physical and mental disorders other than dementia. Knowledge about the prevalence rates, medical and psychosocial characteristics, and care needs of this particular group of residents is mandatory for providing high-quality and evidence-based care. The purpose of this paper was to review the literature regarding these features.Methods: A systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL from January 1, 1988 to August 16, 2011. Two reviewers independently assessed eligibility of studies on pre-established inclusion criteria as well as methodological quality using standardized checklists.Results: Seventeen articles were included. Only one small study describes multimorbidity of a wide range of chronic psychiatric and somatic conditions in LTC residents and suggests that physical–mental multimorbidity is rather rule than exception. All other studies show prevalence rates of comorbid physical and mental illnesses (range, 0.5%–64.7%), roughly in line with reported prevalence rates among community-dwelling older people. LTC residents with mental–physical multimorbidity were younger than other LTC residents and had more cognitive impairment, no dementia, and problem behaviors. Care needs of these residents were not described.Conclusions: Although exact figures are lacking, mental–physical multimorbidity is common in LTC residents. Given the specific characteristics of the pertaining residents, more knowledge of their specific care needs is essential. The first step now should be to perform research on symptoms and behavior, which seem more informative than diagnostic labels as well as care needs of LTC residents with mental–physical multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Anemia and dementia are common diseases among the elderly, but conflicting data are available regarding an association between these two conditions. We analyzed data from the São Paulo Ageing & Health Study to address the relationship between anemia and dementia.Methods: This cross-sectional observational study included participants aged 65 years and older from a deprived area of the borough of Butantan, São Paulo, Brazil. Data about demographics, education, income, and cognitive and daily life function were collected, as well as blood samples. Anemia and dementia were defined according to WHO and DSM-IV criteria, respectively.Results: Of the 2267 subjects meeting the inclusion criteria, 2072 agreed to participate in the study; of whom 1948 had a valid total blood count and were included in the analysis. Anemia was diagnosed in 203 (10.2%) participants and dementia in 99 (5.1%). The frequency of anemia was higher in patients with dementia according to univariate analysis (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17–3.41, p = 0.01), but this association was not present after adjusting for age (OR = 1.33, 95% CI = 0.76–2.33, p = 0.32). Further multivariate adjustment did not change the results.Conclusion: Although anemia and dementia are frequent disorders in older people, we found their relationship to be mediated exclusively by aging in this low-income population from São Paulo. [ABSTRACT FROM AUTHOR]

Introduction: Patients diagnosed with schizophrenia (PDS) have a decreased life expectancy, which has been linked to a higher prevalence of medical comorbidity. Inflammatory, neuroendocrine and immune alterations have been reported in PDS. Current research suggests an intrinsic vulnerability to some physical illnesses in this population. 70% of the risk of developing schizophrenia is genetically determined. Neuroendocrine and immune alterations have been described in relatives of PDS. Therefore, PDS relatives may also have a higher prevalence of physical illnesses. Some studies have reported a high prevalence of diabetes mellitus and autoimmune diseases in this population. However, the literature on this subject is still scarce. Objectives: We intend to study the prevalence of physical illness in relatives of PDS. This research may contribute to expanding knowledge about the etiopathogenesis of schizophrenia. Methods: Cross-sectional observational study. A pilot sample of 30 PDS admitted to the psychiatric hospitalization unit of the Hospital Central de la Defensa Gómez Ulla will be selected. Subjects will be interviewed for a personal and familiar history of psychiatric and medical illness. The data will be contrasted with the information in the patient's medical records. Whenever possible, the data will be confirmed by interviewing the parents or siblings of the patients. Results: The data will be displayed numerically and graphically using a quantitative statistical methodology. Conclusions: Results will be discussed and compared with previous literature on this subject. A larger sample may be needed so that the conclusions can be considered final. [ABSTRACT FROM AUTHOR]

The article presents a study regarding psychiatric morbidity and acute hospitalization in elderly people. The multivariate analysis shows that psychiatric morbidity in old age is associated with increased risk of hospitalization, which necessitates the early treatment of psychiatric illness to reduce the risk of acute hospitalization.

Introduction: Patients with severe mental illness die 10-20 younger from general population. In addition to suicide, preventable physical diseases cause most deaths. The mental illness itself and stigma keep the patients from adequate treatment for physical ilnesses. Objectives: We aimed to investigate medical consultations for inpatients with severe mental illnes. Methods: We retrospectively evaluated medical records of patients diagnosed by schizophrenia, schizoaffective disorders, bipolar disorder, and depression between 1st Februrary 2018 and 30th January 2020. We excluded routine consultations before electroconvulsive treatment. Local ethichs committee approved the study. Results: Among total 475 consultations, %41.3 (n=196) was for male, and %58.7 (n=279) was for female patients. Mean age and standart deviation were 48.9 ± 13.9 for male, and 50.1 ± 13.7 for female (p>0.05). Comparing sexes oin terms of primer psychiatric diagnoses, the higher proportion was psychotic disorders for male, and for female it was mood disorders (p<0.05). The most consulted departments with percentage and number were: internal medicine %44.0 (n=209), neurology and neurosurgery %15.2 (n=72), physical medicine and rehabilitation %8.2 (n=39), dermatology %7.8 (n=37), cardiology %6.7 (n=32). We compared the proportions of consulted department between male and female. Male patients were consulted to dermatology more than female, and female patient were consulted to gynecology or urology more than male (p<0.05). Conclusions: Awareness about physical diseases in paients with severe mental illness between healthcare workers, carries the potential to increase the patients' quality of life and lifespan. For future interventions the focus should involve healthcare worker in internal medicine and neurology, as well as in psychiatry. [ABSTRACT FROM AUTHOR]