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Obwohl in der Mehrzahl der Zulassungsstudien der antipsychotisch wirkenden Psychopharmaka die Gruppe der alten und sehr alten Menschen nicht adäquat repräsentiert war, werden diese Medikamente heute als Standardbehandlung bei schizophrenen Erkrankungen im höheren Lebensalter eingesetzt. Klinisch ist die Wirksamkeit der Antipsychotika bei schizophrenen Psychosen auch im hohen Alter gut belegt. Auch bei älteren Menschen bedarf die antipsychotische Behandlung einer sorgfältigen Nutzen-Risiko-Abwägung, bei welcher zunächst der Schweregrad der psychotischen Symptomatik erfasst werden sollte. Das individuelle Risiko einer Behandlung mit Antipsychotika wird im höheren Lebensalter maßgeblich durch komorbide Erkrankungen, insbesondere Herz-Kreislauf-Erkrankungen beeinflusst. Bei multimorbiden Patienten muss eine äußerst kritische Risikobewertung vorgenommen werden, da die Behandlung mit Antipsychotika das Risiko für kardiovaskuläre Komplikationen erhöhen kann. Im Einzelfall kann daher trotz bestehender psychotischer Symptome der Verzicht auf eine antipsychotische Behandlung angezeigt sein, wenn das Risiko der Behandlung den potenziellen klinischen Nutzen überwiegt. Von zentraler Bedeutung bei der medikamentösen Behandlung älterer psychotischer Patienten ist die fachärztliche Begleitung und Beratung im Hinblick auf die Therapieadhärenz: Die Effektivität einer antipsychotischen Therapie hängt maßgeblich von der korrekten und kontinuierlichen Einnahme des Medikaments in der verordneten Dosierung ab. Von entscheidender Bedeutung für den Erfolg einer medikamentösen Behandlung mit Antipsychotika ist die begleitende, kontinuierliche psychotherapeutische Behandlung.

OBJECTIVE Hypothermia is a potentially lethal adverse reaction to typical and atypical antipsychotic drugs (APD). Among predisposing factors are advanced age and comorbid somatic diseases. The aim of this study was to assess the incidence of hypothermia and quantify risk factors. METHOD Charts of N = 3002 psychogeriatric inpatients were screened for incidence of hypothermia (body core temperature

Objective Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation. Methods Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included. Results From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods. Conclusions In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.

BACKGROUND Increased expression of the astroglial Ca2+-binding protein S100B has been observed in various neurodegenerative diseases and also seems to play a role in the unfolding of pathophysiological events at early stages of Alzheimer's disease (AD). OBJECTIVE To examine the association of cerebrospinal fluid (CSF) levels of S100B with 1) established CSF core biomarkers total tau (tau), hyperphosphorylated tau (p-tau), and amyloid β1-42 (Aβ1-42) as well as neuron-specific enolase (NSE) CSF levels and 2) cognition in early AD and mild cognitive impairment (MCI) due to AD (MCI-AD). METHODS Retrospective study assessing 49 pooled charts of Memory Clinic and inpatients diagnosed with AD (N = 26) and MCI-AD (N = 23) according to the National Institute of Aging and Alzheimer's Disease Association (NIA-AA) criteria. Neuropsychological testing was performed with the Consortium to Establish a Registry for AD (CERAD)-Plus battery. RESULTS CSF levels of S100B correlated with NSE, but not the other CSF parameters. Stepwise multiple linear regression, adjusted for age, sex, and educational level, revealed that only increased CSF S100B was independently associated with lower CERAD-Plus total and Mini-Mental Status Examination scores together with poorer performance in wordlist learning (delayed recall and overall performance). We found no independent associations with other CSF biomarkers or cognitive domains. CONCLUSION Our data suggest that CSF S100B may have a diagnostic value particularly at early stages of AD reflecting the significance of neuroinflammatory/astroglial processes. Thus, CSF S100B may complement the established array of available AD biomarkers to improve early stage diagnosis.

Major depression disorder (MDD) is one of the most common causes of disability in people over 60years of age. Previous studies have linked affective and cognitive symptoms of MDD to white matter (WM) disruption in limbic-cortical circuits. However, the relationship between clinical cognitive deficits and loss of integrity in particular WM tracts is poorly understood. Fractional anisotropy (FA) as a measure of WM integrity was investigated in 17 elderly MDD subjects in comparison with 18 age-matched controls using tract-based spatial statistics (TBSS) and correlated with clinical and cognitive parameters. MDD patients revealed significantly reduced FA in the right posterior cingulate cluster (PCC) compared with controls. FA in the right PCC (but not in the left PCC) showed a significant positive correlation with performance in a verbal naming task, and showed a non-significant trend toward a correlation with verbal fluency and episodic memory performance. In control subjects, no correlations were found between cognitive tasks and FA values either in the right or left PCC. Results provide additional evidence supporting the neuronal disconnection hypothesis in MDD and suggest that cognitive deficits are related to the loss of integrity in WM tracts associated with the disorder.