Depressionen im Alter

Zusammenfassung: Depressionen sind im Alter die häufigsten psychischen Erkrankungen. Manche Betroffene hatten schon in früheren Lebensabschnitten depressive Episoden oder andere psychische Erkrankungen. Das psychopathologische Erscheinungsbild unterscheidet sich von dem Jüngerer dahin gehend, dass somatische Beschwerden oder Klagen über kognitive Beeinträchtigungen häufig sind. Bekannte Risikofaktoren für eine Depression im Alter sind (neu auftretende) körperliche Erkrankungen, Schlafstörungen oder Partnerverlust. Depressionen komplizieren den Verlauf komorbider somatischer Erkrankungen. Wesentliche Folge ist eine hohe Suizidalität im Alter. Depressionen sind auch ein Risikofaktor für eine Reihe anderer Störungen, von der Demenz bis hin zur früheren Institutionalisierung. Das Wechselspiel zwischen Depression und Demenz sowie anderen hirnorganischen Erkrankungen ist komplex und noch nicht vollständig verstanden. Die Depression im Alter stellt an das Gesundheitssystem eine Fülle von Herausforderungen. Noch immer wird sie nur selten erkannt. Integrative Behandlungsansätze im Kontext somatischer Erkrankungen bzw. auch in verschiedenen Settings (z. B. Altenheim) gilt es noch zu entwickeln. Angesichts der steigenden Zahl älterer Menschen ist zu fordern, die Evidenz für die verschiedenen Behandlungsformen der Depression deutlich zu verbessern. In der Praxis überwiegt - eine häufig inadäquate - Pharmakotherapie. Psychotherapeutische Behandlungsangebote müssen weiterentwickelt und die Zahl entsprechend qualifizierter Therapeuten erhöht werde

Diagnosenübergreifende Psychoedukation: "Notbehelf" oder "Mittel der Wahl"?: Ergebnisse der Basler Psychoedukationsstudie

Zusammenfassung: Trotz günstiger Evidenzlage werden die traditionell diagnosehomogenen psychoedukativen Gruppenprogramme aufgrund der oft zu geringen Patientenzahl pro Diagnose nicht routinemäßig eingesetzt. In einer explorativen randomisierten und kontrollierten Studie wurde die Wirksamkeit eines diagnosengemischten Programms hinsichtlich klinischer Variablen, Rehospitalisierungshäufigkeit und "compliance" sowie verlaufsrelevanter subjektiver Einstellungen und Theorien mithilfe quantitativer und qualitativer Methoden bei Patienten der Universitären Psychiatrischen Kliniken Basel (N = 82) über einen 1-jährigen "Follow-up"-Zeitraum untersucht. Signifikante Gruppenunterschiede zeigten sich hinsichtlich Compliance nach 3Monaten und hinsichtlich der Suizidrate zugunsten der Interventionsbedingung. Die Ergebnisse bei den meisten anderen erhobenen klinischen Zielvariablen ergaben deutliche Vorteile für die Psychoeduationsgruppe. Eine erste Analyse qualitativer Daten fand als Akuteffekt eine signifikant günstigere Entwicklung in der Interventionsgruppe. Die bisher einzigen empirischen Daten über eine störungsübergreifende Psychoedukationsgruppe rechtfertigen deren klinischen Einsatz und weitere Untersuchunge

Depression in Old Age

Učestalost simptoma depresije povećava se sa starošću te pogađa 10-20 % populacije. Depresija često prati tjelesne bolesti, poremećaje sna, bol i druge psihičke poremećaje. Prognoza komorbidnih stanja pogoršava se s komorbiditetom. Prepoznavanje i liječenje depresije relevantno je u do 90 % slučajeva samoubojstava starijih osoba. Diferencijalna dijagnoza i terapija su složenije te zahtijevaju više strpljenja, kako liječnika tako i pacijenta. Sve metode liječenja su jednako učinkovite kao i kod mlađih odraslih osoba, ali EKT je uspješnija metoda. Postoji velika stopa podcjenjivanja dijagnoze i nedovoljnog liječenja. To se pogotovo odnosi na provođenje psihoterapije. Potrebno je više intervencija u prevenciji iz perspektive zdravstvene ekonomije. Više stigma predstavlja prepreku: starost, psihološki poremećaji, veći broj pacijenata ženskog spola.An increasing frequency of depressive symptoms with age is found, according to severity 10-20% of the population are affected. Depression frequently occurs with physical disease, sleep disturbances, pain and other mental disorders. The prognosis of comorbid conditions becomes worse with comorbidity. The recognition and treatment of depression is relevant for up to 90% of suicides in the elderly. The differential diagnosis and therapy is more complex and needs more patience on both sides, the therapist and the patient. All treatment methods are as efficacious as in younger adults, with ECT being even superior. There is a high rate of underdiagnoses and undertreatment. This applies strongly for the provision of psychotherapy. More interventions into prevention would be beneficial, also from the perspective of health economy. Multiple stigmas are obstacles: age, mental disorders, mostly female patients

Cost of attempted suicide: a retrospective study of extent and associated factors

QUESTIONS UNDER STUDY: Suicidal behaviour is a major source of burden of disease. While most studies focus on cost associated with completed suicides, data on costs of, non-lethal, suicide attempts are lacking. The aim of this study was to assess direct annual cost of suicide attempts in Basel in 2003 from a health services perspective. METHODS: Retrospective cost-of-illness-study of the Basel cohort of the 2003 WHO/EURO-Multicentre Study on Parasuicide. We extracted cost information from the two major hospitals involved in treatment of these patients. We determined overall cost, compared cost medians and identified variables associated with higher cost by means of logistic regression. RESULTS: For 2003, treatment of suicide attempters in Basel's main hospitals amounted to 3,373,025 Swiss Francs (CHF), mainly attributable to psychiatric care. Mean and median cost per case were 19,165 CHF and 6,108 CHF, respectively. Based on these findings, the extrapolated direct medical costs for medical treatment of suicide attempts in Switzerland per year amount to 191 million CHF. Parameters associated with high costs were age above 65 (p<0.01), using a hard method (p<0.05), receiving intensive care (p<.05), and lethal intention (p<0.05). The ICD-10 diagnostic category F3 was associated with significantly higher costs than F1 (p<0.05) and F4 (p<0.05). CONCLUSIONS: Attempted suicide produces substantial direct medical costs, which are only a part of the financial burden. Prevention targeting mood disorders, the elderly and the use of hard methods may be most cost-effective. Further research should aim at identifying additional indirect costs and the cost-effectiveness of prevention measures

Clinical decision-making style preferences of European psychiatrists : Results from the Ambassadors survey in 38 countries

Background While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. Results SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.Peer reviewe

Pathways to care for people for dementia: an international multi-centre study

Objective: the aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: we recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries. The WHO “Encounter Form”, a standardized schedule that enables data concerning basic socio-demographic, clinical and pathways data to be gathered, was completed for each participant. Results: the median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy and practical advice) were delivered in less than 3% of situations. The analyses of the ‘pathways diagram’ revealed that the path of PwD to receiving care is complex, diverse across countries, and that there are important barriers to clinical care. Conclusions: the study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally and internationally

Dementia diagnostics in primary care : a representative 8-year follow-up study in Lower Saxony, Germany

AIM: To investigate whether primary-care physicians' competency regarding dementia diagnostics improved from 1993 to 2001. METHODS: In a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) were randomly assigned to 2 written case samples presenting patients with slight memory impairment (case 1a: female vs. case 1b: male) and moderate dementia [vascular type (case 2a) vs. Alzheimer's disease (case 2b)]. Potential diagnostic workup was inquired by a structured face-to-face interview. RESULTS: 'Basic' diagnostics like history taking or laboratory investigations were considered in the first place. In case 1, neuropsychological screening was significantly more frequently considered at follow-up (19.3% in 1993 vs. 31.1% in 2001); it still would have been applied rarely in case 2 (2a: 14.1 vs. 14.8%; 2b: 23.5 vs. 24.6%). Neuroimaging remained not to be considered as a standard procedure, and only a minority of FPs would have performed a screening for depression (2001: 1a: 6.7%; 1b: 11.3%; 2a: 0.0%; 2b: 1.6%). CONCLUSIONS: With regard to dementia diagnostics in primary care, guideline adherence remained low at follow-up. Structured training efforts aiming at FPs appear to be necessary

Selective optimization with compensation (SOC) competencies in depression

The metamodel of selective optimization with compensation (SOC) aims to integrate scientific knowledge about the nature of development and aging with a focus on successful adaptation. For the first time the present study examines how SOC competencies and depressive symptoms are associated. In particular, potential state or trait effects of SOC competencies are considered