[Show abstract][Hide abstract] ABSTRACT: Dans la population âgée, le suicide représente l'une des trois principales causes de décès avec le cancer et les maladies cardio-vasculaires. La létalité d'un geste suicidaire y est plus de deux fois plus élevée que dans d'autres tranches de vie (1). Le taux de mortalité par suicide en France en 2009 était ainsi inférieur à 40/100 000 pour les individus âgés de ≤ 35 ans, autour de 40/100 000 jusqu'à l'âge de 65 ans, mais de 80/100 000 à 75 ans et 160/100 000 à ≥ 85 ans (2). Alors que l'on observe une réduction du taux de suicides à d'autres âges de la vie, celui de l'âgé ne se modifie pas significativement (2). T outefois, malgré sa relevance, ce sujet reste relativement peu abordé en littérature et méconnu du clinicien. Les hypothèses invoquées pour essayer d'expliquer cette lacune ont notamment été attribuées aux particularités de la suicidalité à l'âge avancé. Cela n'est pas cependant le seul argument. S. de Beauvoir écrivait ainsi sur le sentiment de résignation ou d'impuissance d'un regard extérieur envers ce qui peut être considéré comme un aboutisse-ment inexorable à proximité de la fin de la vie: « Certains suicides de vieillards succèdent à des états de dépression névrotique qu'on n'a pas réussi à guérir ; mais la plupart sont des réactions norma-les à une situation irréversible, désespérée, vécue comme intoléra-ble » (La Vieillesse. Gallimard, Paris, 1970, p. 440). Un des lieux emblématiques de la problématique du suicide à l'âge avancé est représenté par les Urgences somatiques et psychiatriques, où les per sonnes âgées traversant une crise suicidaire ont souvent leur premier contact avec les soins.
[Show abstract][Hide abstract] ABSTRACT: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement.
Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory.
Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder.
These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.
Aging and Mental Health 07/2015; DOI:10.1080/13607863.2015.1063103 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether ambulatory psychotherapy targeted to abandonment experiences and fears can reduce suicidality and improve outcome in borderline patients referred to the emergency room with major depressive disorder and self-destructive behavior severe enough to require medical/surgical treatment and a brief psychiatric hospitalization. A total of 170 subjects were randomized at hospital discharge into three treatment groups: treatment as usual (TAU), abandonment psychotherapy delivered by certified psychotherapists, and abandonment psychotherapy delivered by nurses. Assessments were performed before randomization and at 3-month follow-up. Continued suicidality and other outcome measures were significantly worse in the treatment-as-usual as compared to both abandonment psychotherapy groups, but there were no differences between the two psychotherapy groups. These results suggest the efficacy of manualized psychotherapy that specifically targets the abandonment fears and experiences that are so common as precipitants to suicidal and self-destructive acts in borderline patients. It does not appear that formal psychotherapy training is associated with better outcomes.
Journal of personality disorders 06/2015; DOI:10.1521/pedi_2015_29_196 · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neurologic diseases expose at a high risk of suicidal behaviors and they constitute a privileged domain for exploring the heterogeneity of underlying mechanisms. They are in fact characterized by strictly biological injuries that may be involved in cerebral systems considered at the basis of neurobiological vulnerability for suicide. At the same time, they oblige a numberof existential topics to emerge, as the hopelessness in respect of several particularly severe conditions without an etiologic treatment. A clinical approach reserving an unconditional listening can prevent a suicidal attempt. Furthermore, it can illustrate the role of the liaison's psychiatrist, who tries to transform a hopelessness situation into a patient's personal questioning and try to be present when therapeutic action is not longer possible.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Many patients visit psychiatric emergency services several times per year, which raises questions about the limits of this treatment setting. Previous studies have focused on recurrent visits over one year of follow-up. This study examined sociodemographic and diagnostic predictors of recurrent visits (three or more visits a year) to a psychiatric emergency service over three consecutive years.
This three-year retrospective cohort study used data from computerized administrative and medical records of 4,322 patients who visited the psychiatric emergency service of the University Hospitals of Geneva, Switzerland, at least once in 2008.
A total of 210 (5%) of the 4,322 patients had three or more visits in 2008. Of these, 22% also had recurrent use (three or more visits per year) in 2009, 2010, or 2011, and 78% did not. Recurrent visits were not predicted by sociodemographic characteristics, such as age, gender, marital status, professional activity, and citizenship. Two variables were significant predictors of recurrent visits: a diagnosis of a personality disorder and recurrent use of the emergency service in the 18 months before study entry in 2008.
Patients with personality disorders and past recurrent use of emergency services appeared to rely more on psychiatric emergency services for continuous psychiatric care than patients without past recurrent use of emergency services and patients with mood, substance use, anxiety, or psychotic disorders. Creation of a follow-up treatment program for this clinical population within the psychiatric emergency setting itself may provide better access to care for these patients.
[Show abstract][Hide abstract] ABSTRACT: Background Time spent watching TV by Europeans has been calculated to be 22.1 h per week on average and it has shown to be correlated with a series of physical and mental problems in adults. Very little research is available in population over 65. This study aimed at evaluating the association between TV viewing and mental disorders and cognitive performance, taking into account the general physical activity level and socio-demographic characteristics in Europe. Methods Within the MentDis-ICF65+ study, a subsample of 1383 subjects aged 65-84 years were assessed by the Composite International Diagnostic Interview (CIDI65+) and the International Physical Activity Questionnaire (IPAQ) for physical activity evaluation. Time spent in watching TV was assessed through a self report instrument. Results Forty-three per cent of the total sample watched TV for 5-7 days a week for 2 or more hours every day. Females, people who lived alone, older subjects and those with lower education significantly watched TV for a longer time. Stepwise multiple regression showed statistically significant inverse correlation between Mini-Mental State Examination scores and TV viewing time (p < 0.001). Apart from a negative association with Major Depressive Disorder, no particular associations were found between TV viewing and psychopathological diagnoses. Conclusions Given the relationship of time spending watching TV with cognitive impairment, awareness should be raised about the possible negative effects of TV viewing on the elderly and programs to reduce TV viewing time should be set up.
Mental Health and Physical Activity 12/2014; 8. DOI:10.1016/j.mhpa.2014.11.002
[Show abstract][Hide abstract] ABSTRACT: Objectives Television (TV) viewing is one of the most widespread ways of spending leisure
time. There is a growing evidence of a negative association between TV and physical and
mental health. The demoralisation syndrome has so far been associated with severe physical
illnesses. However, it could be an important problem also in the elderly. This study aimed at
evaluating the association between time spent watching TV and the level of demoralisation
within the general 65-84 years population in three countries (Italy, Germany, Switzerland).
Methods Within the MentDis_ICF65+ study (Andreas, Haerter et al. 2013), a subsample of
1383 subjects aged 65-84 years has been evaluated by the Demoralization Scale (DS) by
Kissane (Kissane, Wein et al. 2004) and the International Physical Activity Questionnaire
(IPAQ) (Craig, Marshall et al. 2003) for physical activity evaluation. Time spent watching
TV was assessed through a self-report instrument.
Results Demoralization average score was 24.31 (SD 9.08), 41.5% watched more than 2
hours of TV per day on average. The ANOVA showed a significant difference in terms of
demoralization between people watching TV for more (25.39 (SD 9.76)) or less than 2 hours
(23.54 (SD 8.49), p<0.001). Various socio-demographic variables (gender, level of education,
financial situation etc), and other variables such as physical activity levels, showed a
statistically significant association with the DS score. A stepwise multiple regression was
applied controlling for possible covariates: the association between TV viewing time and
demoralisation score (p<0.001) was confirmed.
Conclusions The findings showed low levels of demoralization in the general elderly
population. Higher demoralization scores appear to be associated with longer TV viewing.
This result should be taken into account in future research and when designing programs for a
more active and healthier ageing.
Andreas, S., M. Haerter, et al. (2013). "The MentDis_ICF65+ study protocol: Prevalence, 1-year
incidence and symptom severity of mental disorders in the elderly and their relationship to
impairment, functioning (ICF) and service utilisation." BMC Psychiatry 13(62).
Craig, C. L., A. L. Marshall, et al. (2003). "International physical activity questionnaire: 12-country
reliability and validity." Med Sci Sports Exerc 35(8): 1381-1395.
Kissane, D. W., S. Wein, et al. (2004). "The Demoralization Scale: a report of its development and
preliminary validation." J Palliat Care 20(4): 269-276.
XVI World Congress of Psychiatry, Madrid, Spain; 09/2014
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Beyond its well-documented association with depressive symptoms across the lifespan, at an individual level, quality of life may be determined by multiple factors: psychosocial characteristics, current physical health and long-term personality traits.
Quality of life was assessed in two distinct community-based age groups (89 young adults aged 36.2 ± 6.3 and 92 older adults aged 70.4 ± 5.5 years), each group equally including adults with and without acute depressive symptoms. Regression models were applied to explore the association between quality of life assessed with the World Health Organization Quality of Life - Bref (WHOQOL-Bref) and depression severity, education, social support, physical illness, as well as personality dimensions as defined by the Five-Factor Model.
In young age, higher quality of life was uniquely associated with lower severity of depressive symptoms. In contrast, in old age, higher quality of life was related to both lower levels of depressive mood and of physical illness. In this age group, a positive association was also found between quality of life and higher levels of Openness to experience and Agreeableness personality dimensions.
Our data indicated that, in contrast to young cohorts, where acute depression is the main determinant of poor quality of life, physical illness and personality dimensions represent additional independent predictors of this variable in old age. This observation points to the need for concomitant consideration of physical and psychological determinants of quality of life in old age.
Aging and Mental Health 06/2014; 19(2):1-8. DOI:10.1080/13607863.2014.920295 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Violent explosions rocked the city of Brazzaville (the capital of the Republic of the Congo) on 4 March 2012, officially causing more than 280 deaths and leaving approximately 15,000 people displaced. Two months after this event, despite a large number of people suffering from considerable psychological distress, few people had called for, or had received, appropriate mental health care or any external psychosocial support. A field evaluation, following this emergency, led to a critical review of the limited capacity of the mental health care system in Brazzaville to respond to the population's needs. This evaluation also allowed a review of the current state of affairs in regard to mental health and psychosocial support by health care actors in Brazzaville. The crisis has, in this way, facilitated an increasing awareness and triggered a process of deeper examination of how to improve mental health care in the Republic of the Congo.
[Show abstract][Hide abstract] ABSTRACT: The period of mourning after perinatal loss is not synonym for depression. The article illustrates a way of caring for bereaved parents, which takes into account the temporality and individual nature of the bereavement process. The use of rituals and symbolic gestures allows for calling into existence the loss of a human being, who is gone without leaving many reminders. Psychotherapeutic care by the liaison-psychiatric service is part of the multidisciplinary care program proposed by the maternity of the University Hospitals of Geneva. These encounters offer parents the possibility to continue to include the dead in the membership of our lives.
[Show abstract][Hide abstract] ABSTRACT: Sandplay therapy is a technique conceived by Dora Kalff and inspired by the analytical psychology of C.G.Jung. This psychotherapeutic approach is used in a treatment program for eating disorders (ESCAL) offered by the University Hospitals of Geneva. Sandplay offers patients the possibility to express their emotions by a creative mean and facilitates the verbal expression of their personal life history within a protected setting, individual or in groups. Sandplay gives access to psychotherapeutic processes by a creative and playful approach. This article describes the technique, illustrated by a clinical case history.
[Show abstract][Hide abstract] ABSTRACT: The occurrence of depression in younger adults is related to the combination of long-standing factors such as personality traits (neuroticism) and more acute factors such as the subjective impact of stressful life events. Whether an increase in physical illnesses changes these associations in old age depression remains a matter of debate.
We compared 79 outpatients with major depression and 102 never-depressed controls; subjects included both young (mean age: 35 years) and older (mean age: 70 years) adults. Assessments included the Social Readjustment Rating Scale, NEO Personality Inventory and Cumulative Illness Rating Scale. Logistic regression models analyzed the association between depression and subjective impact of stressful life events while controlling for neuroticism and physical illness.
Patients and controls experienced the same number of stressful life events in the past 12 months. However, in contrast to the controls, patients associated the events with a subjective negative emotional impact. Negative stress impact and levels of neuroticism, but not physical illness, significantly predicted depression in young age. In old age, negative stress impact was weakly associated with depression. In this age group, depressive illness was also determined by physical illness burden and neuroticism.
Our data suggest that the subjective impact of life stressors, although rated as of the same magnitude, plays a less important role in accounting for depression in older age compared to young age. They also indicate an increasing weight of physical illness burden in the prediction of depression occurrence in old age.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the prevalence and clinical characteristics of the DSM IV major depressive disorder (MDD) among patients admitted to the General Internal Medicine Service of the Geneva University Hospital.
557 patients admitted to the IM of the Geneva University Hospital aged 18 to 70 were investigated. Each subject was assessed by a clinical psychologist using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire.
69 patients (12.4%) met diagnostic criteria for MDD (men: 8.8%, women: 16.9%, p=.004). Among subjects with major depression, depressed mood (97%), fatigue (91%), and diminished interest and pleasure (81%) were the most prevalent symptoms. Recurrent thoughts of death were present in 48% of depressed patients.
This study raises further evidence that an elevated proportion of patients admitted to an acute care general internal medicine facility meet DSM IV criteria for MDD with nearly half of depressed patients suffering from recurrent thoughts of death. It emphasizes the necessity of a targeted, continuous, and active support given by the psychiatry liaison service in the internal medicine setting.
European Journal of Internal Medicine 06/2013; 24(8). DOI:10.1016/j.ejim.2013.05.016 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
The EU currently lacks reliable data on the prevalence and incidence of mental disorders in older people. Despite the availability of several national and international epidemiological studies, the size and burden of mental disorders in the elderly remain unclear due to various reasons. Therefore, the aims of the MentDis_ICF65+ study are (1) to adapt existing assessment instruments, and (2) to collect data on the prevalence, the incidence, and the natural course and prognosis of mental disorders in the elderly.
Using a cross-sectional and prospective longitudinal design, this multi-centre study from six European countries and associated states (Germany, Great Britain, Israel, Italy, Spain, and Switzerland) is based on age-stratified, random samples of elderly people living in the community. The study program consists of three phases: (1) a methodological phase devoted primarily to the adaptation of age- and gender-specific assessment tools for older people (e.g., the Composite International Diagnostic Interview, CIDI) as well as psychometric evaluations including translation, back translation; (2) a baseline community study in all participating countries to assess the lifetime, 12 month and 1 month prevalence and comorbidity of mental disorders, including prior course, quality of life, health care utilization and helpseeking, impairments and participation and, (3) a 12 month follow-up of all baseline participants to monitor course and outcome as well as examine predictors.
The study is an essential step forward towards the further development and improvement of harmonised instruments for the assessment of mental disorders as well as the evaluation of activity impairment and participation in older adults. This study will also facilitate the comparison of cross-cultural results. These results will have bearing on mental health care in the EU and will offer a starting point for necessary structural changes to be initiated for mental health care policy at the level of mental health care politics.
[Show abstract][Hide abstract] ABSTRACT: Androgen deprivation is a therapeutic option for patients with prostate cancer, however with a range of side effects that negatively affects their physical and psychological condition. A multidisciplinary care program, ADAPP ("Androgenic deprivation in prostate cancer patients"), has been created with a special focus on managing these side effects. This article describes the intervention of the liaison psychiatry within this program, with care options ranging from psychological support to intensive psychotherapy to address patients' intrapsychic dynamics throughout this care program. Clinical cases are reported to illustrate the relevance and the necessity of this specialized counselling.
[Show abstract][Hide abstract] ABSTRACT: Pregnancy and new motherhood may be crisis and vulnerability periods and therefore increase the risk of psychiatric disorders. Liaison psychiatry plays a major role in the first psychiatric evaluation of mothers in order to specify a diagnosis and to initiate a treatment when necessary. This article describes the care of mothers suffering from peripartum psychiatric disorders by the liaison psychiatry in the maternity ward, an outpatient practice, as well as an in-patient care unit where mother and baby can stay together. The multidisciplinary approach and its constellation around the mother-baby dyad are detailed and two clinical cases are reported.
[Show abstract][Hide abstract] ABSTRACT: Despite improvement of life expectancy of human immunodeficiency virus (HIV) infected people since the implementation of antiretroviral treatment, psychological suffering prevails and needs to be considered as part of the treatment to guarantee its efficiency. Mental disorders and social stigmatization substantially affect patients' quality of life and their adherence to treatment. The article details the benefits of a routine screening for mental disorders within this population, who is often reluctant to consult psychiatric services. The different treatments provided by the Geneva University Hospital (HUG) are introduced. A clinical case report illustrates the relevance of a multidisciplinary care program and the role of the liaison psychiatry in this field.
[Show abstract][Hide abstract] ABSTRACT: Background:
We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance.
HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As "gold standard" we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0-0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ(2) tests.
On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53-0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58-0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted.
The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further study.
International Psychogeriatrics 09/2012; 25(1):1-6. DOI:10.1017/S1041610212001536 · 1.93 Impact Factor