Behavioural and psychological symptoms of Alzheimer’s disease associated with caregiver burden and depression

OBJECTIVE: The aim of the study was to investigate the relationship between behavioural and psychological symptoms of Alzheimer’s disease with caregiver burden and depression. METHODS: In this prospective and clinic-based study, 71 patients over 65 years of age diagnosed with Alzheimer's disease according to DSM IV diagnostic criteria who were admitted to Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery between April 2014 and November 2014 and their 71 care givers were included in the study. Information on patients and caregivers were assessed using the sociodemographic and clinical data form. The Standardized Mini Mental State Examination (SMMSE) and the Global Deterioration Scale (GDS) were used to determine disease severity and stage. The Neuropsychiatric Inventory (NPI) was used to assess the behavioural and psychological symptoms of the patients. Caregivers’ burden and depression were assessed using the Zarit Caregiver Burden Scale (ZCBS) and the Hamilton Depression Rating Scale (HAM-D). SPSS 22.0 program was used for the statistical analysis of data. RESULTS: The average age of the caregivers was 52, 81.7% (n: 58) were female and 53.5% (n: 38) were the patients’ daughters. Caregiver burden was found to be mild in 50.7% (n: 36), moderate in 15.5% (n: 11) and heavy in 33.8% (n: 24) of caregivers. Depression was found to be mild in 19.7% (n: 14), moderate in 19.7% (n: 14) and severe in 4.2% (n: 3) of caregivers. The most common behavioural and psychological symptoms were; apathy (60.6%), delusions (57.7%), depression / dysphoria (56.3%), hallucinations (53.5%), irritability (47.9%), anxiety (32.4%), abnormal motor behaviour (29.6%), agitation / aggression (26.8%), eating-appetite changes (26.8%) and elation / euphoria (1.4%). Patient caregivers in the group with more behavioural and psychological symptoms had more caregiving burden and depression. Symptoms having a significant effect on caregiver burden were delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, apathy, disinhibition, irritability, abnormal motor behaviour. Behavioural and psychological symptoms that correlate with caregiver depression are agitation/aggression, anxiety, disinhibition, irritability. In the correlation analysis between NPE and ZCBS factor groups, only the factor 4 showing the economic burden did not show any significant correlation. CONCLUSION: Results show that behavioural and psychological symptoms in Alzheimer’s patients increase the caregiver burden and cause caregiver depression. Preventive measures to prevent the emergence of such symptoms and effective ad rapid intervention are required. Further multi-center studies with a prospective design, involving different cultures, patients from a wider population, different care settings are required

Electroconvulsive therapy combined with antipsychotic therapy in the treatment of acute schizophrenia inpatients: symptom profile of the clinical response

OBJECTIVE: The aim of the study was to examine the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic (AP) medication on symptom profile in patients with a diagnosis of schizophrenia who had received acute psychiatric inpatient treatment. METHODS: In this prospective study, patients were evaluated for inclusion in the study who were diagnosed with schizophrenia according to DSM-IV diagnostic criteria and were to receive ECT. The patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression – Improvement (CGI-I) sub-scale before the first session ECT, once following every two subsequent sessions and after the final session. RESULTS: The patients showed significant improvements in BPRS scores at each evaluation compared with their scores at baseline, and a significant clinical improvement was found on the CGI-I sub-scale at the end of treatment. Across all SAPS sub-scores, significant decreases were found, and the symptoms related to hallucinations and positive formal thought disorder showed the most rapid response to treatment. Across all SANS sub-scores, significant decreases were found, and affective flattening or blunting symptoms responded most rapidly to treatment. CONCLUSION: One of the most important findings in the present study of hospitalized patients with acute schizophrenia was the good response to treatment, which provided significant improvements in both positive and negative symptoms. The most rapid response to treatment was found for hallucinations, positive formal thought disorder, and affective flattening or blunting symptoms. The most important limitation of our study may be the small number of cases. In future, well-standardized studies using a double-blinded, comparative, prospective design and including a sufficient number of patients are needed