Clinical pharmacological management of polypharmacy in old age depression

2016 ◽  
Vol 33 (S1) ◽  
pp. S39-S39
Author(s):  
P. Baumann ◽  
W. Greil
Keyword(s):  
Psychological Symptoms ◽  
Psychiatric Hospitals ◽  
Psychosocial Interventions ◽  
Geriatric Depression ◽  
Pharmacological Management ◽  
German Speaking ◽  
Competing Interest ◽  
Old Age Depression ◽  
Somatic Diseases ◽  
Psychogeriatric Patients

Polypharmacy is the rule in psychogeriatric patients, as they present frequently comorbidities such as depression, dementia [often including Behavioral and Psychological Symptoms of Dementia (BPSD)] and somatic diseases. Recommended treatments for geriatric depression are antidepressant medications, psychotherapy and psychosocial interventions [1]. Besides antidepressants, other psychotropic drugs are often co-prescribed, but somatic drugs are also needed for the treatment of other concomitant diseases. This situation increases the risk for adverse effects due to pharmacokinetic and pharmacodynamic interactions, especially since the organism of elderly patients displays a lowered homeostatic reserve and a decrease of functions, which allows resisting to xenobiotic influences.On the other hand, there are also studies which suggest that in hospitalized psychogeriatric patients, the incidence of severe adverse reactions is lower in patients > 60 y than in those < 60 y [2]. This is one of the results of the AMSP-study group, which in German speaking countries has developed a pharmacovigilance program in psychiatric hospitals.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Dietary Status of Adults With ADHD

2017 ◽  
Vol 41 (S1) ◽  
pp. s245-s245 ◽  
Author(s):  
J.N. Kjaer ◽  
L. Jakobsen ◽  
M. Lasgaard ◽  
P. Munk-Jørgensen
Keyword(s):  
Dietary Pattern ◽  
Representative Sample ◽  
Fruits And Vegetables ◽  
University Hospital ◽  
Sample Population ◽  
Co Morbidity ◽  
Public Health Survey ◽  
Competing Interest ◽  
Somatic Diseases ◽  
Physical Activity Scale

ObjectiveThe aim was to investigate the dietary status of adults with ADHD. Furthermore, we compared the group with a representative sample of a healthy adult Danish population.MethodData were collected from the ADHD database operated by the ADHD outpatient clinic at Aarhus university hospital. We used data from newly referred patients in a seven months period from April 2014 through October 2014. The collected data include weight, height, blood pressure, somatic or psychiatric co-morbidity, blood sample, physical activity scale. Concerning the diagnosis of ADHD: DIVA, ASRS, BRIEF-V. Inter99 was used to assess the dietary status. The representative sample was obtained as a part of a public health survey from 2010 called “how are you” conducted in the same region of Denmark as the location of the psychiatric hospital. Preliminary results, one hundred and forty-three patients were included in the study, 52% males. The mean age was 30.9 years. A larger proportion of ADHD patients fall in the category “unhealthy dietary pattern” compared to the representative sample population (26% vs. 12%), while the proportion in the “healthy dietary pattern” category is markedly lower (14% vs. 24%). The differences seem to be explained by lower than recommended intakes of fruits and vegetables.ConclusionOur findings suggest a general shift towards more unhealthy dietary patterns among patients with ADHD. This exposes them to higher risk of somatic diseases, notably diabetes mellitus and cardiovascular disease. Lifestyle interventions could be a necessary part of standard treatment for patients with ADHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Forensic care in Germany

2017 ◽  
Vol 41 (S1) ◽  
pp. S61-S61
Author(s):  
H. Dressing ◽  
H.J. Salize
Keyword(s):  
Psychiatric Hospital ◽  
Psychiatric Hospitals ◽  
Epidemiological Data ◽  
Mentally Ill Offenders ◽  
Legal Regulations ◽  
Forensic Patients ◽  
Penal Law ◽  
Forensic Psychiatric ◽  
Competing Interest ◽  
Legal Frameworks

Although the idea that offenders suffering from a mental disorder must primarily be considered as ill and should therefore be exempted from punishment is of considerable antiquity legal frameworks and key concepts, which are applied in this field, differ widely in European Union member States. The respective legal regulations and epidemiological data of Germany will be presented.In German penal law the question of the guilt of an offender is of central significance. Legal regulations on the placement and treatment of mentally ill offenders in a forensic psychiatric hospital are subsumed under the section “Measures on improvement and safety”. Section 63 of the German penal law provides for the temporally unlimited commitment to a forensic- psychiatric hospital.In accordance with section 64 of the German penal law addicted offenders can be committed to a detoxification center for a period of up to two years. The available epidemiological data show a clear increase in the admissions to forensic psychiatric hospitals and to detoxification centers since beginnings of the 1990s. Recently the German parliament passed a new law. The aim of the new law is to strengthen patients’ rights and to diminish the number of forensic patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Population Service Evaluation of the ADHD Pathway of Children and Young People's Services, Malta

2017 ◽  
Vol 41 (S1) ◽  
pp. S222-S223
Author(s):  
A. Saliba ◽  
D. Agius ◽  
E. Sciberras ◽  
N. Camilleri
Keyword(s):  
Neurodevelopmental Disorder ◽  
Reliability And Validity ◽  
Service Evaluation ◽  
Assessment Process ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
Nice Guidelines ◽  
Case File ◽  
Mean Waiting Time ◽  
Competing Interest

IntroductionADHD is the commonest neurodevelopmental disorder in young people (YP) aged 5–18 years. YP with untreated ADHD are 5 times more likely to develop co-morbid psychiatric disorders.ObjectivesTo carry out a population service evaluation of the assessment process and management of YP with ADHD at Child and Young People's Service (CYPS), Malta age 0–16 years for 2014.AimsTo describe the service input, assessment and treatment of YP attending CYPS and compare to ADHD NICE guidelines 2008.MethodsAll patients diagnosed with ADHD at CYPS throughout 2014 were included. The incidence of YP with ADHD on treatment age 3–16 years in Malta was calculated. Information was collected from; (i) retrospective case file review and (ii) methylphenidate and atomoxetine registry and compared with NICE guidelines.ResultsOne hundred and thirty-six YP were diagnosed with ADHD. The minimum 12-month incidence of ADHD on treatment (3–16 years) in Malta was 553 per 100,000. Pre-diagnosis assessments were more frequently performed by other YP services (n = 97, 71.3%, P ≤ 0.01). A psychiatrist or paediatrician confirmed the diagnosis in 113 (83.1%). Sixty-two (45.3%) of YP were prescribed medication, 50 (36.8%) were referred for parental skills course and 55 (40.4%) psychotherapy. Mean waiting time for first appointment was 187.6 days (CI ± 26.9, 0–720), and first specialist review was 301.0 days (CI ± 34.4, 0–800) (1–3).ConclusionsThe incidence for YP (3–16 years) with ADHD on treatment was lower than the US. Since most pre-diagnostic assessments were carried out by other services, this raised the question about the reliability and validity. We recommend a diagnostic MDT meeting following the multimodal assessment to diagnose ADHD. Medication prescribing followed NICE overall, standardising non-pharmacological management is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

EV466Characterization of the refugee population in a psychiatry clinic in Lisbon

2016 ◽  
Vol 33 (S1) ◽  
pp. S402-S402
Author(s):  
H. Prata-Ribeiro ◽  
A. Bento ◽  
A. Ponte ◽  
B. Costa Neves ◽  
L. Gil
Keyword(s):  
Psychiatric Hospitals ◽  
Adjustment Disorder ◽  
Developed Countries ◽  
Transcultural Psychiatry ◽  
Refugee Population ◽  
Extreme Stress ◽  
The Past ◽  
Competing Interest ◽  
The Developed Countries ◽  
Refugee Men

AbstractThe refugee population has been a growing concern to the developed countries in general and to Europe in particular. The recent mass migrations are changing the population that is getting to the psychiatric hospitals, not only culturally but also pathologically. The aim of this study is to characterize the refugee population that contacts with the clinic of transcultural psychiatry in Centro Hospitalar Psiquiátrico de Lisboa, understanding the most frequent pathologies and nationalities. The methods used consisted in analyzing the refugee population that attended a psychotherapeutic group and consultation in the Transcultural clinic of Centro Hospitalar Psiquiátrico de Lisboa during the past year. Analyzing the population, 66 refugees were in contact with the transcultural clinic, 44 of which were men, being the other 22 women, representing a total of 23 countries. The more frequent nationality was Iranian (20) and the most frequent diagnosis was “adjustment disorder and anxiety” (38). We can reach the conclusion that more refugee men contact with our psychiatric hospital than women, accounting for 66, 6% of the total; 30, 3% of the refugees were from Iran, followed by Pakistan with 10, 6%. The fact that the most frequent diagnosis is adjustment disorder and anxiety, accounting for 57, 6% of the sample, seems to point out the extreme stress refugees undergo.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical case: Phelan–McDermid and pharmacological management

2017 ◽  
Vol 41 (S1) ◽  
pp. S430-S430 ◽  
Author(s):  
A. Ballesteros ◽  
Á.S. Rosero ◽  
F. Inchausti ◽  
E. Manrique ◽  
H. Sáiz ◽  
...  
Keyword(s):  
Autism Spectrum Disorders ◽  
Clinical Symptoms ◽  
Stop Codon ◽  
Premature Stop Codon ◽  
Mood Stabilizer ◽  
Autism Spectrum ◽  
Pharmacological Management ◽  
Inhibitory Transmission ◽  
Spectrum Disorders ◽  
Competing Interest

IntroductionThe Phelan–McDermid syndrome is a chromosomal disorder consisting of a selection on chromosome 22q13.3 associated psychiatric and emotional level, behavioral and traits of autism spectrum disorders. During the neurodevelopmental such chromosomal deletion, which associated with haplo insufficiency Shank 3 causes alterations in the synaptogenesis altering the balance of activating and inhibitory transmission. Throughout the various studies, it is considered that this syndrome has a psychiatric disorder bipolar like.Case presentationHere, we present s 13-year-old female diagnosed with autism spectrum disorders in childhood and presented regression with catatonia features and behavioral disorders. Interestingly, she presented mutation/microdeletion of the SHANK3 gene, inducing a premature stop codon in exon 21. Different pharmacological treatments (antipsychotics at high doses and benzodiazepines) failed to improve clinical symptoms and lead to multiple adverse events. In contrast, lithium therapy reversed clinical regression, stabilized behavioral symptoms and allowed patients to recover their pre-catatonia level of functioning. After the first menstruation there was a cycling psychiatric worsening with a similar clinical pattern so risperidone as adjunctive therapy. As a result of this, this patient recovered clinical and socio-functional stability.ConclusionsThey are previous cases where there affective and behavioral improvement after use of mood stabilizer molecules such as valproate or lithium. There is also evidence of the benefit of risperidone low to have a beneficial effect on the balance of activatory and inhibitory transmission level doses of NMDA receptors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Diabetes: Psychiatric and somatic comorbidity

2016 ◽  
Vol 33 (S1) ◽  
pp. S396-S397
Author(s):  
J.Á. Monforte Porto ◽  
A. San Román Uría ◽  
C. Llanes Álvarez ◽  
P. Herguedas Vela ◽  
I.E. Escuer Núñez ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Rural Areas ◽  
Diabetic Patients ◽  
Liaison Psychiatry ◽  
Somatic Comorbidity ◽  
History Of ◽  
Principles Of Justice ◽  
Competing Interest ◽  
Somatic Diseases ◽  
Symptomatic Control

IntroductionDiabetes mellitus (DM) has been associated with major depressive disorder, schizophrenia, Alzheimer's, Parkinson's and mild cognitive impairment. To determine the psychiatric and somatic comorbidity in diabetic patients treated by our Liaison Psychiatry Unit.MethodsSociodemographic variables (age, sex, marital status, place of residence) and clinical (somatic disease that motivates the admission, comorbid somatic pathology, number of concomitant somatic diseases, drug consumption and its type, psychiatric history, previous psychiatric diagnosis, number of concomitant psychiatric disorders).Study DesignEpidemiological study of 172 diabetic patients, from the total of 906 consulted from 1 January 2012 until 31 December 2014.Bioethical considerationsThe study complies with the principles of justice, non-maleficence, autonomy and beneficence.ResultsThe average age is 72 years, 50% are women, 49.4% are married, and 54.1% live in rural areas. Somatic diseases that most frequently motivate admission at the hospital are the endocrine-metabolic (14%), gastrointestinal (12%) and cardiovascular (12.2%). A total of 32.5% of the sample have six comorbid somatic diseases and 55.2% five. A percentage of 14.5 of patients recognize consumption of toxic (cigarettes–12.2%–7.6% Alcohol). One hundred and eight patients have a history of psychiatric disorders (62.8%), especially anxiety disorders (28.4%), depression (14.5%) and organic mental disorders (11.1%).ConclusionsThere is a high psychiatric and somatic comorbidity in diabetic patients, therefore it would be desirable early diagnosis and treatment to provide symptomatic control of both types of pathologies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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