Depression and Cerebrovascular Disease: a phenomenological study

The main topic of this thesis is the clinical presentation of depression in subjects with cerebrovascular disease. It concerns patients with post-stroke depression, depression in subjects with vascular risk factors or in subjects with vascular lesions on MRI- or CT-scan. Some of the studies presented do indicate that there might be a specific symptom profile of depression in these subjects. These subjects show more so-called 'motivational' symptoms of depression and less 'mood' symptoms. This relation is more prominent in a clinical sample. In population-based studies, we only found this relation in one study, but could not confirm it in another. The motivational symptoms are also found to be related to more prominent cognitive disturbances in stroke or vascular subjects. In the general discussion the complex relation between vascular damage of the brain and its cognitive and affective consequences is described. Various levels of explanation are at hand and! the findings of this study could contribute to a part of the complex, explanatory etiological pathway that leads to development of post-stroke and vascular depression or dementia

COVID-19:Clinical Challenges in Dutch Geriatric Psychiatry

The COVID-19 pandemic has changed everyday life tremendously in a short period of time. After a brief timeline of the Dutch situation and our management strategy to adapt geriatric mental health care, we present a case-series to illustrate the specific challenges for geriatric psychiatrists

Acoustic characteristics of depression in older adults’ speech:The role of covariates

Depression in older adults is often associated with various physical conditions and is hence different from depression at a younger age. Ageing may come with cognitive decline, medication use, and frailty, which are known to be predictors of late-life depression. One common symptom of depression is psychomotor retardation, that may also affect speech production. Most speech studies on depression so far have focused on younger or middle-aged adults. In this study, we used speech data from a large longitudinal Dutch study on late-life depression and its comorbid symptoms to compare speech acoustics in persons with depression (PWD) and controls. We investigated whether groups differed by taking several covariates into account (e.g., frailty, slowness, and medication use). Group differences were found in within-vowel F2 range, speech rate and mean pause duration. These data indicate that speech acoustics can be used to differentiate PWDs and controls, even with low-quality speech data

Big Five personality traits and medically unexplained symptoms in later life

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Psychiatric characteristics of older persons with Medically Unexplained Symptoms:a comparison with older patients suffering from Medically Explained Symptoms

BACKGROUND.: Empirical studies on the clinical characteristics of older persons with medically unexplained symptoms are limited to uncontrolled pilot studies. Therefore, we aim to examine the psychiatric characteristics of older patients with medically unexplained symptoms (MUS) compared to older patients with medically explained symptoms (MES), also across healthcare settings. METHODS.: A case-control study including 118 older patients with MUS and 154 older patients with MES. To include patients with various developmental and severity stages, patients with MUS were recruited in the community (n = 12), primary care (n = 77), and specialized healthcare (n = 29). Psychopathology was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria (Mini-International Neuropsychiatric Interview) and by dimensional measures (e.g., psychological distress, hypochondriasis, and depressive symptoms). RESULTS.: A total of 69/118 (58.5%) patients with MUS met the criteria for a somatoform disorder according to DSM-IV-TR criteria, with the highest proportion among patients recruited in specialized healthcare settings (p = 0.008). Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4 vs. 24.8%, p = 0.008), this difference disappeared when adjusted for age, sex, and level of education (odds ratio = 1.7 [95% confidence interval: 1.0-3.0], p = 0.070). CONCLUSIONS.: Although psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Therefore, treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in

Impact of childhood trauma on multidimensional frailty in older patients with a unipolar depressive-, anxiety- or somatic symptom

Item does not contain fulltextObjectives: Frailty marks an increased risk for adverse health outcomes. Since childhood trauma is associated with the onset of physical and mental health diseases during the lifespan, we examined the link between childhood trauma and multidimensional frailty. Method: A cross-sectional study embedded in a clinical cohort study (ROM-GPS) of older (>=60 years) patients (n=182) with a unipolar depressive-, anxiety- and/or somatic symptom disorder according to DSM-criteria referred to specialized geriatric mental health care. Frailty was assessed with the Tilburg Frailty Indicator (TFI), comprising a physical, psychological, and social dimension. Physical, sexual and psychological abuse and emotional neglect before the age of 16 years was measured with a structured interview. Results: Of 182 patients, 103 (56.6%) had experienced any childhood trauma and 154 (84.6%) were frail (TFI sum score >=5). Linear regression analyses, adjusted for lifestyle, psychological and physical-health factors, showed that the presence of any type of childhood trauma was not associated with the TFI sum score, however when considered separately, physical abuse was (ß=0.16, p=.037). Regarding the specific frailty dimensions, any childhood trauma was associated with social frailty (ß=0.18, p=.019), with emotional neglect as main contributor. Conclusion: These findings demonstrate a complex link between different types of childhood trauma and multidimensional frailty among older psychiatric patients. Regarding the three dimensions of frailty, social frailty seems most affected by childhood trauma. This may have been underestimated until now and should receive more attention in clinical care and future research.7 p

The impact of a history of child abuse on cognitive performance:a cross-sectional study in older patients with a depressive, anxiety, or somatic symptom disorder

Background: Child abuse is a major global burden with an enduring negative impact on mental and physical health. A history of child abuse is consistently associated with worse cognitive performance among adults; data in older age groups are inconclusive. Since affective symptoms and cognitive functioning are interrelated among older persons, a synergistic effect can be assumed in patients with affective symptoms who also have suffered from child abuse. This study examines the association between a history of child abuse and cognitive performance in such patients. Methods: Cross-sectional data were collected from the ‘Routine Outcome Monitoring for Geriatric Psychiatry & Science’ project, including 179 older adults (age 60–88 years) with either a unipolar depressive, any anxiety, or somatic symptom disorder referred to specialized geriatric mental health care. A history of physical, sexual, and psychological abuse, and emotional neglect was assessed with a structured interview. Cognitive functioning was measured with three paper and pencils tests (10-words verbal memory test, Stroop Colour-Word test, Digit Span) and four tests from the computerized Cogstate Test Battery (Detection Test, Identification Test, One Card Learning Test, One Back Test). The association between a history of child abuse and cognitive performance was examined by multiple linear regression analyses adjusted for covariates. Results: Principal component analyses of nine cognitive parameters revealed four cognitive domains, i.e., visual-verbal memory, psychomotor speed, working memory and interference control. A history of child abuse was not associated with any of these cognitive domains. However, when looking at the specific types of child abuse separately, a history of physical abuse and emotional neglect were associated with poorer interference control. A history of physical abuse was additionally associated with better visual-verbal memory. Conclusions: The association between a history of child abuse and cognitive performance differs between the different types of abuse. A history of physical abuse might particularly be a key determinant of cognitive performance in older adults with a depressive, anxiety, or somatic symptom disorder. Future studies on the impact of these disorders on the onset of dementia should take child abuse into account. Trial registration: ROM-GPS is registered at the Dutch Trial Register (NL6704 at www.trialregister.nl)