
Florian RieseUniversity of Zurich | UZH · URPP Dynamics of Healthy Aging
Florian Riese
MD
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Introduction
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October 2006 - present
Publications
Publications (102)
This presentation highlights core pharmacological aspects of opioid and non-opioid pain medications in the elderly patient. Specifically, it covers pharmakinetics, pharmacodynamics and drug-drug interactions of select pain medications. The presentation aims to promote safe use of pain medications in the elderly.
Disclosure
No significant relations...
Background
The Mini Suffering State Examination (MSSE) has been explicitly recommended to assess suffering in dementia patients. This study aimed to develop a German version of the MSSE and assess its psychometric properties involving people with advanced dementia (PAD) in a nursing home setting.
Methods
The MSSE was translated into German, and 95...
[This corrects the article DOI: 10.1192/bji.2021.48.].
Background The Mini Suffering State Examination (MSSE) has been explicitly recommended to assess suffering in dementia patients. This study aimed to develop a German version of the MSSE and assess its psychometric properties involving people with advanced dementia (PAD) in a nursing home setting.
Methods The MSSE was translated into German, and 95...
Undergraduate psychiatric education is essential for the training of medical students and for their recruitment into psychiatry. A significant shortage of graduates choosing a career in psychiatry has been recently documented, and this trend might have many causes. When medical students have positive experiences of teaching, elective placements and...
Clinical psychiatric practice should be intricately linked with research work. Although psychiatric trainees and early career psychiatrists (ECPs) are in the frontline of clinical services, little is known about how much access they have to research opportunities. A semi-structured questionnaire of 35 questions—exploring research goals achieved, fa...
Prognostication has been described as "Medicine's Lost Art." Taken with diagnosis and treatment, prognostication is the third leg on which medical care rests. As research leads to additional beneficial treatments for vexing conditions like cancer, dementia, and lung disease, prognostication becomes even more difficult. This article, written by a gr...
Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions su...
Cognitive impairment indicates disturbed brain physiology which can be due to various mechanisms including Alzheimer's pathology. Combined functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) recordings (EEG-fMRI) can assess the interplay between complementary measures of brain activity and EEG changes to be localized to sp...
Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive infor...
Proteolytic processing of the amyloid precursor protein (APP) releases the APP intracellular domain (AICD) from the membrane. Bound to the APP adaptor protein Fe65 and the lysine acetyltransferase (KAT) Tip60, AICD translocates to the nucleus. Here, the complex forms spherical condensates at sites of endogenous target genes, termed AFT spots ( A IC...
In October 2019, a Swiss panel of experts met for the Dementia Summit in Brunnen, Switzerland, to discuss the latest scientific findings on basic and clinical research, as well as practical and political approaches to the challenges of dementia disorders in Switzerland. Here, we present the conference summary.
To study pathophysiological changes,...
The majority of people with intellectual disabilities (ID) and psychiatric disorders access mainstream mental health services across Europe. However, only 56% of countries provide postgraduate psychiatric training in ID according to a survey across 42 European countries. We explore the challenges of ID training and make recommendations for educatio...
Most long-term care (LTC) residents are of age >65 years and have multiple chronic health conditions affecting their cognitive and physical functioning. Although some individuals in nursing homes return home after receiving therapy services, most will remain in a LTC facility until their deaths. This article seeks to provide guidance on how to asse...
The concept of severe and persistent mental illness (SPMI) lacks a consensual definition. Variations in definitions stem above all from different meanings about the constituent features of the concept and how to operationalize them. Our objective was to clarify the concept of SPMI and to explore the level of concept maturity through pragmatic utili...
Background
Little empirical evidence of high levels of oral diseases of people in need of care and the impact of dementia is available. The resident assessment instrument minimum data set (RAI-MDS) is an evaluation tool for caregivers.Objective
The aim of this study was to show oral health of nursing home residents through RAI-MDS 2.0 data as a fun...
The provision of palliative care in psychiatry and the use of coercion in palliative care are underexplored areas. We report the case of a 65-year-old woman with cerebral metastatic breast cancer who was compulsorily admitted from a specialized palliative care ward to a psychiatric inpatient ward in Zurich, Switzerland. While in specialized inpatie...
Objectives
To understand and identify factors that promote and prevent research participation among early career psychiatrists (ECPs), in order to understand what would encourage more ECPs to pursue a research career.
Methods
We conducted an electronic search of databases (PubMed and the Cochrane library) using the keywords ‘doctors’, ‘trainees’,...
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....
Background:
Assisted dying and continuous deep sedation (CDS) are controversial practices. Little is known about the perceptions of physicians and surrogates about these practices for patients with advanced dementia.
Objectives:
To describe and compare physician and surrogate agreement with the use of assisted dying and CDS in advanced dementia....
Objective
Switzerland is among the few countries worldwide where a request for assisted suicide (AS) can be granted on the basis of a primary psychiatric diagnosis. Psychiatrists play an increasingly important role in this regard, especially when the request for AS arises in the context of suffering caused by severe and persistent mental illness (S...
Background
Some patients develop severe and persistent mental illness (SPMI) which is therapy-refractory. The needs of these patients sometimes remain unmet by therapeutic interventions and they are at high risk of receiving care that is inconsistent with their life goals. Scholarly discourse has recently begun to address the suitability of palliat...
It is estimated that 110,000 people in Switzerland are affected by dementia. Access to professional dementia care is good. The Swiss mandatory health insurance extensively covers medical inpatient and outpatient treatment and the cost of medicines, as well as nursing care. Due to the decentralized organization of the Swiss political and healthcare...
According to estimates of the World Health Organization, the number of people living with dementia will double almost every 20 years for the foreseeable future. While in 2010, there were 35.6 million people with dementia worldwide, this number is expected to increase to 65.7 million by 2030, and to 115.4 million by 2050. The primary aim of this boo...
Early career psychiatrists (ECPs) are defined as psychiatry trainees and psychiatrists in their first 7 years since finishing specialty training in their respective home countries. Although this may be a critical moment in the careers of new psychiatrists, it also can be an important period for development and achievement. The goal of this chapter...
Research has widely documented that cognitive performance steeply declines with nearing death. It is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents by performing a longitudinal la...
Background:
fact Boxes are decision support tools that can inform about treatment effects.
Objectives:
to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia.
Design:
randomized controlled trial.
Setting:
Swiss-German r...
In 10 volumes, jointly developed by relatives, practitioners, and researchers, information and guidance for relatives of persons with dementia at the end of life. 10 volumes on (1) Quality of life, (2) communication, (3) eating and drinking, (4) Health, (5) challenging behaviors, (6) spirituality, (7) legal and financial issues, (8) dying, (9) work...
Zusammenfassung:
Die körperliche Untersuchung unkooperativer älterer Patienten stellt Ärzte in der Praxis, im Spital oder im Pflegeheim regelmässig vor grosse Herausforderungen. Der Mangel an Kooperation selbst kann dabei ein wichtiger Hinweis auf eine unterliegende medizinische Problematik sein. Wichtige Elemente, um die Kooperation des Patienten...
Background:
Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both.
Objectives:
We analyzed heterogeneity in trajectories of terminal cognitive change in Swis...
The assessment of effects associated with cognitive impairment using electroencephalography (EEG) power mapping allows the visualization of frequency-band specific local changes in oscillatory activity. In contrast, measures of coherence and dynamic source synchronization allow for the study of functional and effective connectivity, respectively. Y...
Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The...
Advanced dementia is a terminal condition. Foregoing burdensome interventions such as artificial nutrition or admission to hospital at the end of life is part of high-quality palliative care. In advanced, decisions regarding such interventions are made by health care proxies (HCPs). Different attitudes in HPCs and nurses regarding burdensome interv...
About two-thirds of people with dementia die from pneumonia and one-third from dehydration. The DemFACTS study aimed to develop and test decision supports called fact boxes, in order to inform decision-makers, who have to make burdensome treatment decisions at the end-of-life of people with dementia and either pneumonia or insufficient fluid intake...
Mobile health interventions are regarded as affordable and accessible tools that can enhance standard psychiatric care. As part of the mHealth Psycho-Educational Intervention Versus Antipsychotic-Induced Side Effects (mPIVAS) project (www.psylog.eu), we developed the mobile application "PsyLOG" based on mobile "smartphone" technology to monitor ant...
Background: Palliative care aims to improve quality of life for patients suffering from a life-threatening disease. Taking as a precedent the treatment of the dying cancer patient, it has been advocated that the benefits of contemporary palliative care should also be available to patients with chronic diseases for which curative treatments are cons...
The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperative detection of delirium and management of delirio...
Background
Specific knowledge of urinary incontinence (UI) and its interrelation with physical and cognitive health is essential to working towards prevention of UI and to improving quality of treatment and care. The purpose of this study was to determine the association between UI and the activities of daily living (ADL) hierarchy scale, the cogni...
Background
The proportion of older people with advanced dementia who will die in nursing homes is constantly growing. However, little is known about the dying phase, the type of symptoms, the management of symptoms and the quality of life and dying in people with advanced dementia. The ZULIDAD (Zurich Life and Death with Advanced Dementia) study ai...
Background
As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry...
Background:
With higher life expectancy an increasing number of people with intellectual disability (PWID) are at risk for developing dementia.
Objective:
Since PWID are an often neglected patient population, the objective of this study was to investigate the prevalence of dementia in residential disability homes in Switzerland and to describe h...
Background
Empirical knowledge around palliative care provision and needs of people with intellectual disabilities is extremely limited, as is the availability of research resources, including expertise and funding. This paper describes a consultation process that sought to develop an agenda for research priorities for palliative care of people wit...
Despite all of psychiatry's efforts to prevent mental illness and to promote recovery, some patients will develop severe and persistent mental illness (SMI). These patients represent a particularly vulnerable population, at risk of either therapeutic neglect or overly aggressive care. We propose a complementary approach in the treatment of SMI; pal...
In response to the multitude of scientific, clinical, and social challenges that psychiatry faces today and the challenges in professional development that go along with them, several associations of early career psychiatrists (ECPs) have been created around the globe in recent years. Participation in these associations promotes local, national, an...
Good psychiatric care depends on good training. A psychiatric curriculum is the way to ensure that the required level of knowledge and skills are attained (i.e. those needed to hold the title of ‘psychiatrist’). This chapter mainly gives examples for early career psychiatrists, but suggestions can be applicable to other stages of the career and to...
The chapter proposes practical guidance for early career psychiatrists who wish to pursue an academic career in psychiatry. The most important successful factors and pitfalls influencing academic progress are highlighted. Beyond an understanding of the academic environment, the chapter emphasizes ethical conduct in the practice of medicine and in t...
Due to the ageing of the world population, the importance of old age psychiatry is steadily growing. A sound knowledge of its approaches is therefore essential for every psychiatrist. Key skills in old age psychiatry include effective communication with elderly patients, performing comprehensive geriatric assessments, working in multidisciplinary t...
This book brings together the different perspectives of a group of internationally renowned psychiatrists and of highly motivated early career psychiatrists, concerning the most relevant issues for psychiatric practice and education. Only by complementing education with experience can sound expertise in the field of mental health be reached. Howeve...
- Einführung - Gründe für die Anwendung partizipativer Forschungsmethoden - Diskussion - Fazit und Ausblick - Literatur
Geriatric psychiatry is the subspecialty of psychiatry that deals with mental health in older persons. Its importance is growing due to the aging of populations worldwide. The practitioners of geriatric psychiatry are physicians working in close collaboration with other medical and nonmedical professionals and carers. The principal mental health pr...
Alterations in brain structures, including progressive neurodegeneration, are a hallmark in patients with Alzheimer's disease (AD). However, pathological mechanisms, such as the accumulation of amyloid and the proliferation of tau, are thought to begin years, even decades, before the initial clinical manifestations of AD. In this study, we compare...
Changes in cerebral blood flow are an essential feature of Alzheimer's disease and have been linked to apolipoprotein E-genotype and cerebral amyloid-deposition. These factors could be interdependent or influence cerebral blood flow via different mechanisms. We examined apolipoprotein E-genotype, amyloid beta-deposition, and cerebral blood flow in...
Behavioural and psychological symptoms of dementia (BPSD) such as agitation, aggressive behaviour, repetitive vocalizations, apathy, etc. are a frequent challenge in the care for patients with dementia. BPSD are furthermore associated with individual suffering, reduced quality of life and caregiver burden. This talk will provide an update on curren...
Interactions between the pharmaceutical industry and physicians have recently received attention for their potential to create conflicts of interest in clinical practice, research and education. As a consequence, several medical and psychiatric associations including the EPA have published guidance papers to encourage best practice. In this context...
Early uptake of [(11)C]-Pittsburgh Compound B (ePiB, 0-6 minutes) estimates cerebral blood flow. We studied ePiB in 13 PiB-negative and 10 PiB-positive subjects with mild cognitive impairment (MCI, n = 23) and 11 PiB-positive and 74 PiB-negative cognitively healthy elderly control subjects (HCS, n = 85) in 6 bilateral volumes of interest: posterior...
BACKGROUND: Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample...
To the Editor We concur with the viewpoint of Dr Blazer¹ that independent research by early investigators needs to be promoted. For this, secondary data analyses can indeed be valuable, as also witnessed by the work of one of the authors of this letter (O.A.).² However, we are doubtful that it is necessarily the best way to promote independent rese...
Recent studies have shown that increased cognitive intraindividual variability (IIV) across accuracy scores from tests representing different cognitive domains (across-domain IIV) might indicate prodromal Alzheimer's disease (AD). Although IIV has been proposed to index cognitive control processes, IIV across accuracy scores from cognitive control...
Background: Amnestic mild cognitive impairment (aMCI) patients demonstrate lower global network interactions. However, graph theory (GT) analysis has not been used to examine networks compromised by strong amyloid (A β) deposition, such as the default mode network (DMN). In addition, no study directly compared GT and functional connectivity (FC) an...
The amyloid precursor protein (APP) intracellular domain (AICD) is released from full-length APP upon sequential cleavage by either α- or β-secretase followed by γ-secretase. Together with the adaptor protein Fe65 and the histone acetyltransferase Tip60, AICD forms nuclear multiprotein complexes (AFT complexes) that function in transcriptional regu...
The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians....
There are some doubts as to whether psychotherapy will remain in the armamentarium of future psychiatrists. Few studies have explored early career psychiatrists’ views and their experience with psychotherapy training. The Early Career Psychiatrists’ Council of the WPA carried out an online survey on training and practice in psychotherapy in 13 Euro...
To the Editor: Dr Köpke and colleagues1 demonstrated that an educational, multicomponent intervention reduced the use of physical restraints for nursing home residents without a concomitant increase in falls or use of psychotropic medication. The cost of the intervention was only about $1000 per nursing home and did not require an increase in nursi...
Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making.
Cross-sectional, se...