M. Forlani

Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: A review

OBJECTIVE The aim of this literature review was to assess the effects of Animal-Assisted Interventions (AAI) on elderly patients with dementia or various psychiatric disorders. METHODS We conducted a comprehensive literature search using the online PubMed network of the US National Library of Medicine & National Institutes of Health, Embase, PsycINFO, with the purpose of investigating AAI effects on cognitive functions, mood, and behaviour. RESULTS A total of 18 articles on dementia and 5 on psychiatric disorders were included in the present review. AAI were found to have positive influences on demented patients by reducing degree of agitation and by improving degree and quality of social interaction. Few studies have assessed the effects of AAI on mood, and even fewer have assessed its consequences on cognitive functions. The results that are available indicate a positive effect on communication and coping ability, but none on cognitive performance. A substitute pet robot yielded encouraging results, but its use requires further investigation. The few studies conducted for elderly patients presenting a variety of psychiatric diagnoses produced controversial findings. CONCLUSIONS In spite of the encouraging results of AAI, much more research examining the issue of optimal AAI duration, frequency of sessions, and suitable target group is needed.

Anxiety Symptoms in 74+ Community-Dwelling Elderly: Associations with Physical Morbidity, Depression and Alcohol Consumption

Objective Anxiety among community-dwelling older adults has not been studied sufficiently. The aims of this cross-sectional population-based study were to estimate the point prevalence of clinically relevant anxiety symptoms and to describe their socio-demographic and clinical features, with particular focus on the association with somatic illnesses. Methods Three-hundred-sixty-six non-demented older adults (mean age 83.7±6.2, range 74–99 years) from the Faenza Project (Northern Italy) were assessed using the Cambridge Mental Disorders of the Elderly Examination-Revised (CAMDEX-R) and the Geriatric Anxiety Inventory short form (GAI-sf). Multi-adjusted regression analyses were used to estimate Odds Ratio (OR) and 95% Confidence Intervals (95% CI). Results Clinically relevant anxiety symptoms occurred in one out of five participants (point prevalence 21.0%) and were significantly associated with depression (OR 5.6 per rank; 95% CI: 3.1–10.1), physical morbidity (OR 3.5 per illness; 95% CI: 1.0–11.9) and female gender (OR 2.8; 95% CI: 1.4–5.5). Further, there were significant associations with a consumption of alcohol exceeding 1 alcoholic unit/day. Conclusions Anxiety symptoms are very common in older subjects, especially when medically ill. Depression and alcohol consumption often co-occur with late-life anxiety symptoms, thus requiring special attention in daily clinical practice.

Investigation of an epistastic effect between a set of TAAR6 and HSP-70 genes variations and major mood disorders.

Epistasis, the interaction between genes, is a topic of current interest in molecular and quantitative genetics. We have further studied a previously investigated sample of 187 major depressive disorder (MDD) patients, 171 bipolar disorder (BD) patients, and 288 controls, and tried to analyze the interaction between a set of variations of independent genes: the trace amine receptor 6 (rs4305745, rs8192625, rs7452939, rs6903874, and rs6937506) and the heat shock protein 70 (rs562047, rs1061581, rs2227956). The multifactor dimensionality reduction (MDR) method was applied and the covariates associated with diagnosis were also controlled. A significant predictive value of specific interactions between genotypes located in the investigated genes was found. We then report preliminary evidence that the epistasis between trace amine receptor 6 and heat shock protein 70 variations may compose a risk profile for major mood disorders. The level of statistical significance (P < 0.001) and the testing balancing accuracy over 0.62 suggest a cautious optimism toward this result, although the possibility of false positivity warrants further analyses in independent samples.

Sex-specific issues in eating disorders: a clinical and psychopathological investigation

AbstractObjectiveTo highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities.MethodOut of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study.ResultsThe men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxative–diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males.DiscussionED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED. Level of Evidence Level V, cross-sectional descriptive study.

Never too late to be anxious: validation of the Geriatric Anxiety Inventory, Italian version

AIM The aim of this work was to validate the Italian version of GAI (GAI-It) and its short form (GAI-It SF) in an over 65-population. METHODS In 3 recruitment areas across Italy, two raters reciprocally blind to results assessed eligible subjects; a semi-structured diagnostic clinical interview was performed by a psychiatrist. RESULTS Among the 76 enrolled subjects (mean age 72.7±6.8 years), anxiety symptoms were very common: 69.7% (moderate/ severe HADS-Anxiety), 76.3% (moderate/severe STAI-state), 71.0% (moderate/severe STAI-trait), 61.8% (GAI), 55.3% (GAI-SF). Sensitivity, specificity and positive predictive value of GAI confirmed a good reliability of the Italian version, with Cronbachs Alpha equal to 0.93 for GAI-It and to 0.77 for GAI-It SF, indicating a very good and good construct validity, respectively, of the scales. The Pearson correlation index demonstrated a moderately positive correlation among GAI, GAI-SF and STAI. CONCLUSIONS Our data confirm the validity of GAI-It as a valuable instrument to assess anxiety in an elderly population, for clinical and research purposes.

Late-Life Mental Health Disorders. Data from a Population-Based Study

Although highly prevalent, so far mental disorder in late life has deserved little research interest, especially at the population level. Our study provides a reliable picture of the distribution of mental health disorders in a sample of 462 Italian older people aged 75+, women are 53.2%, from a population-based study, the Faenza Project. In our sample, one mental disorder is diagnosable in one out of 3 elderly. The most prevalent diagnosis was General Anxiety Disorder (20.7%) and Dementia (19.0%), with female significantly more affected than male. Also Cognitive Impairment No Dementia was highly prevalent with 13.9% of the sample showing these symptoms. The most frequent overlap was between GAD and Major Depressive Episode. The risk of suicide is very high among older, in our sample 7.3% had suicidal thoughts. In spite of that approximately 70% of older adults with mood and anxiety disorders did not use services. There is a need to improve awareness about mental disorders in late- life, both in the community and among health care professionals to find innovative strategies to promote a successful aging with the integration of geriatric psychiatry and primary care.

P-545 - Predictors of drop-out in patients with eating disorders (ED)

Introduction Drop-out is a serious problem in ED which remains poorly understood. Aims To describe socio-demographic and clinical factors associated with drop-out in order to prevent this phenomenon with individualized strategies. Methods A semi-structured clinical interview was administered to 92 adult out-patients attending a third level centre for ED. Measures of psychopathology (EDE12th, BDI, STAI, MINI, SCID-II) were collected to achieve diagnoses. The study population included completers (CO) and drop-outs (DO) which consist of patients that did not complete the baseline assessment Failing in Alliance (FA) and persons who Failed in Treatment (FT). Results The drop-out rate is 34,8%, including 17,4% of FA and 17,4% of FT. DO were less likely to have Anorexia Nervosa at Onset and Obsessive-Compulsive Personality Disorder, while serious Depressive Symptoms, Borderline Personality Disorder and Bulimia Nervosa predicted premature attrition. After multivariate analysis only the last three remain statistically significantly. Considering the period of drop out, we found that Bulimia Nervosa and Borderline Personality Disorder were independent correlated with FA respectively (OR=5,800; 95%CI 1,574–21,368) and (OR=5,782; 95%CI 1,135–29,449). Conversely FT had a higher probability to have serious Depressive Symptoms (OR= 12,289; 95%CI 1,187–127,207). Conclusions Drop-outs in ED include two different subpopulations: failure in alliance (FA) and failure in treatment (FT) characterized by different clinical characteristics. Bulimia Nervosa and Borderline Personality Disorder were predictors of FA, whereas serious Depressive Symptoms were predictors of FT.

P-1019 - Mental health in late-life. Data from an Italian population-based study

Background Technological and medical progresses stimulated a worldwide demographic transition with a high socio-economic impact. The Mental Health in Older People Consensus suggests that elderly mental health deserve attention from a research and a public health perspective. Aims To investigate mental disorders in a population-based sample of persons aged 75+ living in Faenza (Northern Italy). Methods The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) (Roth, 1986) was administered to 462 elderly (or/and their proxies/informants). Cognitive functions were tested using CAMDEX-Cognitive section (CAMCOG) and dementia diagnoses were achieved according to DSM-IV criteria. Among cognitively intact individuals, depression was diagnosed based on DSM-IV and ICD-10 criteria. Presence of general anxiety disorder was evaluated using the Geriatric Anxiety Inventory Short Form (GAI-sf) (Byrne, 2011). Results Dementia prevalence was 19.1% (95% Confidence Intervals: 16–23%). Even if only eight (2.2%) participants were affected by a major depressive episode (DSM-IV criteria), one out of four participants was clinically diagnosed as being depressed when ICD-10 criteria were applied: mildmoderate- and severe-depression prevalence was 16.4% (95%CI: 12.6–20.2%); 7.5% (95%CI: 4.8–10.2%); 1.1 (95%CI: 0.04–2.2%) respectively. Furthermore 20 (5.4%) participants complained sub-threshold depressive symptoms. Three persons had psychotics’ symptoms (two were depressed). Fifty-one participants (11.0%) felt that living was not worthy (95%CI: 8.0–14.0%) and 29 (7.0%) had suicidal thoughts (95%CI: 4.0–8.0%). Anxiety affected the 18.6% of the sample (95%CI: 14.0–22.0%). Depression and anxiety co-occurred in 36 persons (10.2% of the total population). Conclusions At least one mental disorder is diagnosable in one out of two community-dwelling elderly.

P01-508 - Leading cause of re-hospitalization in an Italian acute psychiatric unit: preliminary results

Objectives To describe the leading cause of re-hospitalization in an Acute Psychiatric Unit of a general hospital in Bologna, Northern Italy. Methods All repeated admissions (>3consecutive admissions in 18 months) were recorded thanks to the Hospital Informatic System. Case-history were reviewed to collect information, diagnoses were based on the ICD-10. Results In the indexed period, 392 admissions were registered for 152 patients (mean age 44; 46,1% women). At least one precipitating cause was present in 64% of admissions. The most frequent were psycho-social stress such as family conflicts, parental separations, relational problems, job or economic difficulties (39%). The co-occurrence of 2+ of such factors was common (20%). Tricky situation within the psychiatric rehabilitation service (20%), low compliance to treatments (7%), alcohol/drugs abuse (7%), and low insight (3%) were the remaining associated factors. All the re-admissions of patients with poor insight or reduced compliance were due to the same cause. Poor adherence to therapies was more frequent in bipolar disorder compared with other diagnosis (17%vs7%, p Conclusions Regardless of diagnoses, in almost a half of the admissions a single psycho-social stress is sufficient to lead to re-hospitalization; in personality disorders the contemporary presence of 2+ stressors is needed to overcome the capacity compensation of the patient. Low insight is frequently associated to re-admissions. Tailored treatments might reduce the frequency of re-hospitalization.

P02-232 - Alcohol and smoking habits in an elderly population

Background/aims To describe the prevalence of drinking and smoking habits in an Italian population aged 75+. A research by “Istituto Superiore della Sanita” found that drinking alcohol involves one-third of elderly over 65 years. In Italy, smoking habit in population over 65 involves 23% of men and 11% of women. Material and methods Cross-sectional study on a population of 462 subjects from the cohort of “The Faenza Community Aging Study” (De ronchi, 2005). All participants were interviewed with CAMDEX-R (Cambridge Examination for Mental Disorders of the Elderly - revised). Results 56,7% of interviewed subjects drank alcohol (men 74.8%, women 40.8%; p Hundred and twentynine subjects (28,7%) were moderate drinkers (≥2 A.U./day). The 20% of the drinkers (6,2% of the total population) consumed ≥ 3 alcohol units per day. When we asked them if they consider themselves like heavy drinker, only 3,9%, (80% men) answer “yes”. The 56,9% (50,4% of the total and 58,3% women) of drinkers had symptoms of anxiety and 44,1% were affected by depression. Furthermore, among smokers the 51,1% had symptoms of anxiety and the 38% of depression. Discussion/conclusion Drinking and smoking habits are an increasing attitude in elderly. These un-healthy habits might have severe implications and aggravate the clinical conditions in otherwise frail persons. Our data suggest to general practitioners and policy makers to be aware of this problem to actively investigate drinking and smoking habits in the general population, to launch preventive campaigns and to study aversion therapy.