Participation in Physical, Social, and Religious Activity and Risk of Depression in the Elderly: A Community-Based Three-Year Longitudinal Study in Korea

Background: We examined the longitudinal association between participation in individual or combinations of physical, social, and religious activity and risk of depression in the elderly. Methods: Elderly subjects aged ≥ 60 years who completed the Living Profiles of Older People Survey in Korea (n = 6,647) were included. The baseline assessment, Wave 1, was conducted in 2008, and a follow-up assessment, Wave 2, was conducted in 2011. We defined participation in frequent physical activity as ≥ 3 times weekly (at least 30 minutes per activity). Frequent participation in social and religious activity was defined as ≥ 1 activity weekly. The primary outcome was depression at 3-year follow up. Results: Multivariable logistic regression analysis showed that subjects who participated in frequent physical, social, and religious activity had an adjusted odds ratio of 0.81 (95% confidence interval [CI], 0.69-0.96), 0.87 (95% CI, 0.75-1.00), and 0.78 (95% CI, 0.67-0.90), respectively, compared with participants who did not participate in each activity. Participants who participated in only one type of activity frequently and participants who participated in two or three types of activities frequently had an adjusted odds ratio of 0.86 (95% CI, 0.75-0.98) and 0.64 (95% CI, 0.52-0.79), respectively, compared with participants who did not participate in any type of physical, social, and religious activity frequently. Conclusion: Participation in physical, social, and religious activity was associated with decreased risk of depression in the elderly. In addition, risk of depression was much lower in the elderly people who participated in two or three of the above-mentioned types of activity than that in the elderly who did not.ope

Diagnosis and Treatment for Behavioral and Psychological Symptoms of Dementia

Dementia is a common neuropsychiatric disorder characterized by progressive impairment of cognitive abilities and distinct behavioral and psychological symptoms. In particular, various behavioral and psychological symptoms of dementia (BPSD) add to the burden of family and society. Moreover, the number of dementia patients is rapidly growing with increasing elderly population. The main symptoms of BPSD are anxiety, depression, delusions and hallucinations. BPSD produce significant problems for both patients and caregivers. Aggravated BPSD accelerates impairment of cognitive function and induces early nursing home placement, increasing cost for care while decreasing quality of life. The pathophysiology of BPSD is determined by genetic, structural, or environmental factors. Diagnosis of BPSD used “NPI, BEHAVE-AD and BRSD of CERAD”. The management of BPSD requires both pharmacological and non-pharmacological treatment. When BPSD are mild, non-pharmacological strategies are essential, but for patients with moderate to severe BPSD, pharmacological intervention should also be emphasizedope

One-year experience of geriatric mental health clinic in a university hospital

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Comparison of Cognitive Function in Dementia and Major Depressive Disorders Using The 7 Minute Screen Test

The 7 Minute Screen Test (7 MS) has been reported to have the highest sensitivity and specificity among tests for the early screening of Alzheimer's disease. This test encompasses several cognitive regions including memory, temporal orientation, verbal fluency, and visuospatial and visuoconstructional abilities. This study was undertaken in order to evaluate the diagnostic efficiency of the 7 Minute Screen in the differentiation of dementia and depression. The 7 Minute Screen and the Mini-Mental State Examination (MMSE) were performed with 26 inpatients exhibiting Alzheimer's type dementia (N=8), vascular dementia (N=8), major depressive disorder (N=10). The test battery consisted of the Benton Temporal Orientation (BTO), the Enhanced Cued Recall (ECR), the Clock Drawing (CD), and the Category Fluency (CF) tests. 1) No statistically significant differences were detected in the 7MS subtest scores of the 3 groups (p>0.05). On the Benton Temporal Orientation, the highest mean scores were obtained by the vascular dementia group. With regard to memory, the lowest mean scores were obtained in the vascular dementia group, but the Alzheimer's dementia group obtained the lowest Uncued Recall scores. However, the vacular dementia group scored lowest on Cued Recall. On the Clock Drawing and Category Fluency tests, the lowest mean scores were obtained by the Alzheimer's dementia group. 2) In the Alzheimer's type dementia group, Benton Temporal Orientation test scores were negatively correlated with the MMSE (r=-0.730, p<0.05), and the Clock Drawing scores were correlated positively with level of education (r=0.740, p<0.05). In the vascular dementia group, Cued Recall (r=0.784, p<0.05), total memory (r=0.804, p< 0.05) and Category Fluency (r=0.885, p<0.005) were positively correlated with MMSE scores. In the major depressive disorder group, we noted a negative correlation between Cued Recall scores and age (r=-0.725, p<0.05). The 7 Minute Screen proved superior to the Mini-Mental State Examination at detecting mild cognitive deficits. It might also prove useful in the discrimination of differences between dementia and depression. Our results suggest that 7MS is a useful test for the early prediction of dementia. However, further validation is necessary, as individual 7MS tests may be influenced by education level, age, and sex.ope

Smoking Status in Psychiatric Inpatients

Objectives：There is a trend to make health care facitilities smoke-free because of the overwhelming data associating tobacco smoking and passive smoking with serious helath risks except closed psychiatric units. This study was designed to estimate the feasibility of smoking bans on psychiatric inpatient units as a pilot study by assessing smoking incidence, nicotine addiction score and smoking pattenrs of the psychiatric inpatients. Methods：The psychiatric inpatients admitted to one mental hospital from June 1 to June 30, 1994 answered to the questionnaires including Fagerstroms Tolerance Questionnaire (8 items) and modified smoking motives questionnaires (21 items). Also the medical records of the patients were examined for sociodemographic data and diagnosis. Results：The smoking incidence of the psychiatric inpatients was 72.7%. After admission to the closed unit, 42.7% of the patients increased the amount of smoking. The mean Fagerstrom Tolerance Questionnaire was 4.89±2.38, which was less than nicotine addiction score. Many patients smoked for relief of their stresses. Conclusion：There is a need to set a smoke-free or smoke-control psychiatric unit. These data indicate that smoking can be stopped on inpatient psychiatry units if the patients’ stresses could be well controlled by some methods other than smoking.ope

Change in the QTc Interval after Quetiapine Administration

Objective: Among causes of sudden death presumed to be related with use of atypical antipsychotics, all drugs which could induce torsade de pointes had been known to prolong QTc interval, Therefore, to monitor the changes of QTc interval on EKG seemed to be an important marker for the antipsychotic-induced cardiotoxicity, further to prevent sudden death due to fatal ventricular arrythmia, There are several studies and case reports about cardiac toxicity in some patients who were administered newly developed atypical antipsychotics. The aims of this study were to know whether quetiapine causes changes in QTc interval, and to identify affecting factors. Methods: For the 31 inpatients (21 females, 10 males) with schizophrenia (N=25) or schizoaffective disorder (N=S), schizoph?reniform disorder (N=!) according to DSM-IV, the EKG monitoring was successively taken on baseline and the 2nd, 4th and 6th weeks after quetiapine administration, and serial changes of every EKG parameters including QTc interval was comparatively analyzed, Furthermore, variables such as cardiovascular risk factors (weight gain, hyperlipidemia, thyroid function, etc,), dose of drugs, drug combination, severity of psychotic symptoms, changes in the activity of autonomic nervous system despite of sex and age were also successively assessed on baseline and the 2, 4, and 6 weeks after quetiapine administration, Results: I) Every EKG parameters (heart rate, PR interval, QRS and QT) including QTc interval and diastolic blood pressure were not changed significantly on the 2, 4, and 6 weeks after quetiapine administration as compared with baseline, The systolic pressure was significantly declined form the 2 weeks after quetiapine administration as compared with baseline (p<O,OS), 2) Among variables aff-ecting the EKG parameters including QTc interval, age, dose of drugs, hyperlipidemia and thyroid function were not correlated with. However, the body weight on the 6 weeks after quetiapine administration had significant negative correlation with QT ()(=-OA27)and QTc interval ()(=-OA06), and the drug combination on the 6 weeks after quetiapine treatment had significant positive correlation with QRS ()(=0.393) and QT ()(=OAI5), while severity of psychotic symptoms on the 4th week had correlation with QT ()(=O.380) (p<O,OS, respectively), Other-wise, the QTc interval on the 6 weeks after was significantly prolonged in female patients (p<O,OS). Conclusion: Even though the administration of quetiapine did not cause significant changes in the QTc interval in this study, we need to pay attention toward the possibly related factors.ope

Diagnosis and Treatment of Elderly Depression

The diagnosis and treatment of elderly depression has gained growing importance because of its major impact on the patients's wellbeing, personal, social, and familial achievements. Depressive disorders are characterized by mood-affect, thought-cognition, psychomotor activity and somatic manifestations. Especially geriatric depression is more represented by thought-cognition and somatic manifestations. And it is also associated with comorbid mental or physical conditions that may lead to a decrease in life expectancy. Diagnosis of geriatric depression consists of history taking, laboratory, neurocognitive test, brain imaging technique and genetic study. As for its treatment, physical treatment such as pharmacological treatments, electroconvulsive therapy, and phototherapy have been emphasized but should also include psychosocial intervention such as supportive, family and cognitive-behavioral psychotherapy.ope

Association of Schizophrenia with Pathological Aging : A Behavioral and Histological Study Using Animal Model

Objectives : Phencyclidine(PCP) or PCP-like substances such as ketamine have been known to rekindle the cognitive dysfunction in schizophrenia. The aims of this study were to identify whether PCP-like substances can produce cognitive deficit in schizophrenia, to discuss relation with aging process, and finally to speculate underlying neurochemical mecha-nisms by various drug responses. Methods : In experiment I, radial maze tests were done in 24 Sprague-Dawley rats for 3 days to get baseline data. Being divided into 4 groups(6 rats respectively) of normal aged, normal adult controls, atropine-treated and ketamine-treated, the radial maze tests were repeated on every week for 6 weeks, and then the rats were sacrificed by intracardiac perfusion with phosphate-buffered 10% formaldehyde solution for histology. The brain specimen was stained with hematoxylin-eosin to count cells in the prefrontal cortex and hippocampus. In experiment II, radial maze tests were done for 48 rats before any drug treatment and only after ketamine administration. Thereafter, haloperidol, bromocriptine, clonidine, nimodipine, tacrine, valproic acid, naloxone and fluoxetine were intramuscularly injected on every other day in addition to ketamine. Radial maze tests were repeated on every week for 6 weeks, and then rats were prepared by the same procedure for histology. Results : 1) Reaction times of radial maze tests of atropine-treated rats were significantly prolonged than those of normal aged(p<0.05) or normal adult controls(p<0.05). Cell numbers of prefrontal cortex & hippocampus in ketamine-treated rats were significantly reduced than those in normal aged (p<0.05) or normal adult controls(p<0.005). 2) Reduced cell numbers by ketamine became significantly raised by tacrine administration in prefrontal cortex & hippocampus(p<0.05), while there were no significant changes on radial maze tests. Cell numbers also tended to be raised by nimodipine, fluoxetine and haloperidol administration. Conclusions : In conclusion, the visuospatial memory disorders in ketamine-induced psychotic rats might be partly asso-ciated with aging process. Furthermore, the responses to the various drugs suggested cholinergic system might have an important role in the neurochemical mechanism of the cognitive dysfunction in ketamine-induced psychosis. Otherwise, calcium metabolism as well as serotonergic and dopaminergic systems seemed to be possibly related.ope

Psychosocial Aspects of Normal Ageing

The normal ageing process has biopsychosocial aspects. The successful psychosocial ageing means the integration and dignity by maintaining the quality of life with a good physical status, mental functions, and self performances throughout the old ages. For this, elderly individuals need the following four-dignity, money, proper medical services, and appropriate works to do. Ageing as a physical change is relatively unimportant compared with ageing as a psychosocial event, although physical losses are serious and will ultimately sacrifice the victims. To maintain active and creative ageing, we should have a positive attitude for ageing and preparing the adversaries from psychosocial ageing such as decreased cognitive functions, role deprivation, loss of dignity, and especially even death.ope

Practice Guideline for the Mental Disorders in the Elderly

Geriatric psychiatry is a branch of psychiatry for the diagnosis and treatment of mental disorders occurring in the elderly. Geriatric psychiatry involves health promotion and disease prevention strategies in both biomedical and behavioral areas. Geriatric psychiatry is dedicated to promote the mental health and well being of older people and improving the care of those with late-life mental disorders, including typical dementia, depression, anxiety, late-life psychosis, and sleep disorder. Patients with chronic pain, Parkinson's disease, heart disease, diabetes, stroke or other medical disorder are also cared by geriatric psychiatrists. Older adults have special physical, emotional and social needs. Therefore, the therapeutic guideline in geriatric psychiatry should be established through a multidisciplinary approach encompassing disease diagnosis, treatment, prevention, and rehabilitation, ultimately to improve the quality of life.ope