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Background Agitation is a common challenging behaviour in dementia with a negative influence on patient’s quality of life and a high caregiver burden. Treatment is often difficult. Current guidelines recommend restrictive use of psychotropic drug treatment, but guideline recommendations do not always suffice. Objective To explore how physicians decide on psychotropic drug treatment for agitated behaviour in dementia when the guideline prescribing recommendations are not sufficient. Methods We conducted five online focus groups with a total of 22 elderly care physicians, five geriatricians and four old-age psychiatrists, in The Netherlands. The focus groups were thematically analysed. Results We identified five main themes. Transcending these themes, in each of the focus groups physicians stated that there is ‘not one size that fits all’. The five themes reflect physicians’ considerations when deciding on psychotropic drug treatment outside the guideline prescribing recommendations for agitated behaviour in dementia: (1) ‘reanalysis of problem and cause’, (2) ‘hypothesis of underlying cause and treatment goal’, (3) ‘considerations regarding drug choice’, (4) ‘trial and error’ and (5) ‘last resort: sedation’. Conclusion When guideline prescribing recommendations do not suffice, physicians start with reanalysing potential underlying causes. They try to substantiate and justify medication choices as best as they can with a hypothesis of underlying causes or treatment goal, using other guidelines, and applying personalised psychotropic drug treatment.

Objective: Research suggests that in depression, vascular burden predicts a lower efficacy for medication (MED) and a more favourable outcome for electroconvulsive therapy (ECT). Therefore, we investigated the influence of the following vascular risk factors (VRF): hypercholesterolemia, hypertension, smoking, diabetes mellitus, cardiovascular disease, and cerebral vascular accident/transient ischemic attack, on remission from major depression after ECT versus MED. Methods: The study sample consisted of 81 inpatients with a DSM-IV unipolar major depression diagnosis (mean age 72.2 years, SD = 7.6, mean Montgomery–Åsberg Depression Rating Scale score 32.9, SD = 6.2) participating in a randomized controlled trial comparing nortriptyline versus venlafaxine and 43 inpatients (mean age 73.7 years, SD = 7.5, mean Montgomery–Åsberg Depression Rating Scale score 30.6, SD = 7.1) from an randomized controlled trial comparing brief pulse versus ultrabrief pulse ECT. The presence of VRF was established from the medical records. The remission rate of patients with VRF was compared with those of patients without VRF. Results: The remission rate was 58% (19/33) in the ECT group with ≥1 VRF and 32% (23/73) in the MED group with ≥1 VRF (χ2 = 6.456, p = 0.011). Comparing patients with no VRF versus ≥1 VRF, the remission rate decreased from 80 to 58% (χ2 = 1.652, p = 0.276) in ECT patients and from 38 to 32% (χ2 = 0.119, p = 0.707) in MED patients. Applying different cut-offs for the number of VRFs yielded the same trends. Logistic regression revealed no interaction between VRF and treatment condition. Conclusion: The superior efficacy of ECT over pharmacotherapy in major depression in older age was independent of the presence of VRF. Copyright © 2017 John Wiley & Sons, Ltd.

OBJECTIVE: To examine the influence of specific chronic somatic diseases and overall somatic diseases burden on the course of depression in older persons. METHODS: This was a prospective cohort study with a 2-year follow-up. Participants were depressed persons (n = 285) from the Netherlands Study of Depression in Older Persons. The presence of chronic somatic diseases was based on self-report. Diagnosis of depression was assessed with the Composite International Diagnostic Interview, and severity of depression was measured with the Inventory of Depressive Symptomatology Self-report. RESULTS: Cardiovascular diseases (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.02-2.72, p = 0.041), musculoskeletal diseases (OR = 1.71, 95% CI = 1.04-2.80, p = 0.034), and the number of chronic somatic diseases (OR = 1.37, 95% CI = 1.16-1.63, p

BackgroundInformation about differences between younger and older patients with bipolar disorder and between older patients with early and late age of onset of illness during long-term treatment is scarce. ObjectivesThis study aimed to investigate the differences in treatment and treatment outcome between older and younger manic bipolar patients and between early-onset bipolar (EOB) and late-onset bipolar (LOB) older patients. MethodThe European Mania in Bipolar Longitudinal Evaluation of Medication study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode. Patients were assessed at 6, 12, 18, and 24months post-baseline. We calculated the number of patients with a remission, recovery, relapse, and recurrence and the mean time to achieve this. ResultsOlder patients did not differ from younger bipolar patients in achieving remission and recovery or suffering a relapse and in the time to achieve this. However, more older patients recurred and in shorter time. Older patients used less atypical antipsychotics and more antidepressants and other concomitant psychiatric medication. Older EOB and LOB patients did not differ in treatment, but more older LOB patients tended to recover than older EOB patients. ConclusionOlder bipolar manic patients did not differ from younger bipolar patients in short-term treatment outcome (remission and recovery), but in the long term, this may be more difficult to maintain. Distinguishing age groups in bipolar study populations may be useful when considering treatment and treatment outcome and warrants further study. Copyright (c) 2014 John Wiley & Sons, Ltd.

OBJECTIVE: To determine at admission the number of discrepancies in medication use, comparing the structured history of medication use (SHIM) procedure with the usual procedure for taking the medication history in a clinical setting. DESIGN AND METHODS: A prospective observational study was conducted at the inpatient old age psychiatric clinic of a psychiatric teaching hospital in The Hague, The Netherlands, and at the geriatric ward of the University Medical Center Utrecht, The Netherlands. For every patient, the medication history taking at admission by the treating physician was followed by and compared with the SHIM procedure administered by the researcher. The SHIM procedure consists of a structured interview with the patient about the actual use of medication, incorporating the information from the community pharmacy and the patient's medications brought to the interview. The main outcome was the number of discrepancies in recorded medication use between the SHIM and the usual procedure. Secondary outcome measures were potential clinical relevance and actual clinical consequences. RESULTS: 100 (UMC Utrecht) and 50 (The Hague) patients were included. Their mean age was 82 years (UMC Utrecht) and 69 years (The Hague). Discrepancies were found in 92% (UMC Utrecht) and 78% (The Hague) of the patients. 72% (UMC Utrecht) and 82% (The Hague) of all discrepancies were potentially clinically relevant. Clinical consequences occurred in 21% (UMC Utrecht) and 24% (The Hague) of the patients. CONCLUSION: The SHIM procedure enables an accurate overview of the medication used by elderly patients, and contributes to the prevention of clinically relevant adverse drug events.