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Objective In an era of rising geriatric mental health care needs worldwide, technological advances can help address care needs in a cost-effective fashion. Our objective in this review was to assess whether mobile health technology, such as tablets and smartphones, are feasible to use in patients with late-life mental and cognitive disorders, as well as whether they were generally reliable modes of mental health/cognitive assessment. Methods We performed a focused literature review of MEDLINE, PsychInfo, and Embase databases, including papers specifically assessing the implementation of mobile health technologies: electronic tablets (e.g., iPad), smartphones, and other mobile computerized equipment in older adults (age ≥65 years) diagnosed with or at risk of a mental and/or cognitive disorder. Results A total of 2,079 records were assessed, of which 7 papers were of direct relevance. Studies investigated a broad variety of mobile health technologies. Almost all examined samples with dementia/cognitive dysfunction or at risk for those disorders. All studies exclusively examined the use of mobile health technologies for the assessment of cognitive and or mental illness symptoms or disorders. None of the studies reported participants having any difficulties using the mobile health technology assessments and overall reliability was similar to paper-and-pencil modes of assessment. Conclusion Overall, mobile health technologies were found to be feasible by patients and had promising reliability for the assessment of cognitive and mental illness domains in older adults. Future clinical trials will be necessary to assess whether portable communication interventions (e.g., symptom tracking) can improve geriatric mental health outcomes.

Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who are theoretically at high risk of QTc prolongation. The main objective of our study is to examine the effect of the Health Canada warning on citalopram/escitalopram prescribing patterns in the consultation-liaison (C-L) psychiatry setting.We performed a retrospective cohort study including 275 randomly selected inpatients with medical illness assessed by the psychiatric C-L team of a large Canadian academic hospital between 2008 and 2014. We grouped patients based on whether they were assessed by the C-L team before or after the citalopram Health Canada warning. Our primary outcome was change in citalopram/escitalopram prescribing patterns.We found that of patients seen before the Health Canada warning, a significantly higher number were prescribed citalopram/escitalopram (44.1% vs. 22.3%, χ(2) = 14.835, p0.001), even after controlling for confounders. However, the percentage of patients using a citalopram/escitalopram dose exceeding those recommended by the Health Canada warning was similar in both groups (8.9% vs. 12.1%, χ(2) = 0.233, p = 0.63).Overall, C-L psychiatrists were less likely to prescribe citalopram/escitalopram following the Health Canada warning, which did not translate into safer dosing. Clinicians should not avoid prescribing citalopram/escitalopram appropriately in medically vulnerable inpatients when benefits outweigh disadvantages.

Se ha demostrado que el oxido nitrico (ON) previene la hiperplasia neointimal y disminuye la aterosclerosis en diversos modelos animales. Es un importante modulador de la homeostasia y produce efectos vasoprotectores frente a la aterosclerosis. Sin embargo, en el ambito clinico no se ha utilizado ON con esta finalidad terapeutica. El objetivo del presente estudio consistio en combinar un elastomero de uso medico y un donante de ON, el aducto de ON dietilenotriamina (DETA/ON), para determinar si su administracion perivascular podia atenuar la aterosclerosis y la lesion vascular. En 22 conejos machos sanos, New Zealand White, alimentados con una dieta rica en colesterol durante las 4 semanas previas, se produjo una lesion intimal aortica usando un cateter pediatrico de valvuloplastia pulmonar. Localmente se aplico una combinacion del elastomero Silastic y DETA/ON para cubrir las aortas en el grupo experimental. Despues de 6 semanas adicionales de alimentacion con la dieta rica en colesterol, se obtuvieron las aortas y muestras sanguineas para efectuar un analisis anatomopatologico y una comparacion con el grupo de control. En el grupo experimental el area superficial media de aterosclerosis y de lesion vascular fue de 6,68 x 105 μm2 comparado con 3,44 x 10 μ2 en el grupo de control. Sin embargo, no se detectaron diferencias estadisticamente significativas en el area superficial aterosclerotica entre ambos grupos. A la concentracion utilizada, la aplicacion perivascular del donante de ON DETA/ON no previno la aterosclerosis en conejos alimentados con una dieta rica en colesterol. Este hallazgo sugiere la necesidad de una evaluacion mas cuidadosa antes de su posible aplicacion clinica.

L'efficacite du monoxyde d'azote (NO) pour empecher l' hyperplasie neointimale et pour diminuer l'atherosclerose a ete demontree dans plusieurs modeles animaux. Il s'agit d'un regulateur important de l'homeostasie vasculaire et il a des effets vasoprotecteurs contre l'atherosclerose. Cependant, des therapeutiques utilisant le NO dans ce but, n'ont pas ete employees en pratique clinique. Notre objectif etait de combiner un elastomere medical et un donneur de NO, le diethylenetriamine NO adjuvant (DETA/NO), afin de determiner si son administration perivasculaire pouvait attenuer l'atherosclerose et les dommages vasculaires. Des lesions intimales aortiques ont ete produites a l'aide d'un catheter de valvuloplastie pulmonaire pediatrique chez 22 lapins blancs mâles de Nouvelle Zelande sains, qui ont ete alimentes par un regime riche en cholesterol pendant 4 semaines. Un melange d'elastomere Silastic et de DETA/NO a ete applique localement en couvrant les aortes dans le groupe experimental. Apres 6 semaines dee regime riche en cholesterol, les aortes et des prises de sang ont ete prelevees pour une analyse anatomo-pathologique comparative avec le groupe controle. La surface moyenne d'atherosclerose et de dommages vasculaires etait de 6.68 × 105 μm2 dans le groupe d'experimental, compare a 3.44 × 105 μm2 pour les controles. Cependant, il n'y avait aucune difference statistiquement significative pour la surface d'atherosclerose entre les deux groupes. L'application perivasculaire du donneur de NO DETA/NO, avec la concentration que nous avons employe, n'a pas empeche l'atherosclerose chez les lapins nourris par un regime riche en cholesterol. Ceci incite a une evaluation plus soigneuse de cette therapie, avant de pouvoir l'utiliser en pratique clinique.

Nitric oxide (NO) has been shown to prevent neointimal hyperplasia and decrease atherosclerosis in several animal models. It is a major modulator of vascular homeostasis and has vasoprotective effects against atherosclerosis. However, NO-based therapies with such purposes have not been used in the clinical arena. Our objective was to combine a medical grade elastomer and an NO donor, diethylenetriamine NO adduct (DETA/NO), to determine whether its perivascular administration can attenuate atherosclerosis and vascular injury. Aortic intimal injury was produced using paediatric pulmonary valvoplasty catheter in 22 healthy male New Zealand White rabbits, which were fed a high-cholesterol diet for 4 weeks beforehand. A mixture of the elastomer Silastic and DETA/NO was applied locally to cover the aortas in the experiment group. After 6 additional weeks on the high-cholesterol diet, the aortas and blood samples were harvested for pathologic analysis and comparison with the control group. Mean atherosclerosis and vascular injury surface area was 6.68 x 10(5) microm2 in the experiment group, compared with 3.44 x 10(5) microm2 in the controls. However, there was no statistically significant difference in atherosclerotic surface area between the two groups. Perivascular application of the NO donor DETA/NO, in the concentration we used, did not prevent atherosclerosis in high cholesterol-fed rabbits. This finding prompts more careful assessment before possible clinical uses.

Serotonin selective reuptake inhibitors (SSRIs) have widely replaced older tricyclic antidepressants (TCAs) in the treatment of depression and anxiety over the years, given their safer cardiac profile [Glassman, 1998]. Even at therapeutic doses, TCAs commonly cause a slowing of intraventricular conduction through their sodium-channel blocking properties, leading to prolonged PR, QRS and QT intervals [Pacher and Kecskemeti, 2004]. Similarly, in vitro and animal studies have shown that citalopram and escitalopram, through their cardiotoxic metabolite, didesmethylcitalopram, can delay ventricular repolarization, prolong QT, and increase the risk of torsade de pointes by directly blocking potassium-hERG channels in cardiomyocytes [Overa, 1989; Witchel et al. 2002]. In 2011–2012, the US Food and Drug Administration (FDA) released a safety communication regarding citalopram and escitalopram and their increased risk for QTc prolongation and cardiac outcomes, especially in elderly and patients with comorbid medical illnesses [FDA, 2012]. The new FDA recommendations state that citalopram should not be used at doses greater than 40 mg per day in healthy adults, and not exceed 20 mg per day in the elderly, patients with hepatic impairment, or patients taking a CYP2C19 inhibitor. Health Canada released a similar warning for escitalopram in 2012, stating that doses greater than 10 mg should be avoided in these latter high-risk populations [Health Canada, 2012]. A retrospective cross-sectional study in elderly surgical patients published in 2014 showed no association between citalopram and escitalopram and cardiac outcomes in this vulnerable population [van Haelst et al. 2014]. However, this association has never been assessed in a sample of acutely medically ill inpatients, another highly vulnerable population.