V. Bernabei

Pet therapy in elderly patients with mental illness

Background:  To evaluate the effects of pet therapy on cognitive function, mood and perceived quality of life on elderly inpatients (mean age 84.7 years; 95.2% women) affected by dementia, depression and psychosis.

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.

Vision and hearing impairments are associated with depressive--anxiety syndrome in Italian elderly.

Objective: The aim of this study was to evaluate the association between vision and hearing impairment and depressive–anxiety syndrome in a large population participating in the Faenza Project, Northern Italy. Method: The study population consisted of 7389 participants not affected by dementia, 4408 (59.7%), of whom were women, mean age ± standard deviation (±SD) 71.9 (±7.7) years. Information about previous or current psychiatric symptoms, including sleeping and eating habits, non-verbal language and ability in activity of daily living was used to investigate depressive and anxiety syndrome. A semi-structured interview was administered to survey the presence of sensory impairment. Logistic regression analyses were used to evaluate the association between sensory impairment and depressive–anxiety syndrome estimating Odds ratio (OR) and 95% confidence interval (95% CI). Results: The prevalence of vision and hearing impairment was 1.4% and 0.2%, respectively, with an increasing trend in people aged 75+ years (p < 0.001). The prevalence of depressive syndrome was higher among vision-impaired participants (20.2% vs. 9.3%, p < 0.001), especially women (22.9%) and persons aged 75+ years (22.1%). The prevalence of anxiety syndrome was higher in the hearing-impaired group (25.0% vs. 11.0%, p = 0.09). Vision-impaired participants, especially women and participants aged 75+ years had have a twofold higher probability to have depressive syndrome (OR = 2.03, 95% CI = 1.21–3.38), and hearing-impaired individuals showed an increased probability of presenting anxiety syndrome (OR = 2.71, 95% CI = 0.86–8.55), although these results were not statistically significant. Conclusion: This studys findings suggest that sensory impairment in older adults can increase their probability of experiencing depressive and anxiety syndrome. Correction of these deficits could improve the quality of life in this population.

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.

A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia

BACKGROUND In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population. METHODS A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia. RESULTS Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14). CONCLUSION A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.

P02-163 The use of MMSE to identify mild cognitive impairment (MCI). A population-based study

Aims To evaluate the prevalence of MCI and its subtypes in the Faenza Project, using the Mini-Mental State Examination (MMSE). Methods Subjects living in the municipality of Faenza were clinically assessed. The diagnosis of MCI was achieved according to international criteria using a double-step procedure: first, we excluded subjects with dementia, functional impairment and MMSE Results 2,720 (40.3%) participants met MCI criteria. Prevalence were 4% (amnestic MCI), 26.5% (single non-memory MCI), 4.4% (multidomains amnestic MCI), and 5.4% (multidomains non-amnestic MCI). Conclusions MCI is common among Italian elderly. In our study prevalence are higher than reported in other population-based studies. The use of MMSE with different operational criteria, diverse sampling and assessment procedure might explain such discrepancy. The role of MMSE to identify persons with mild cognitive deficits deserves concerns. However, MMSE is largely used in both clinical practice and research and has been suggested as a useful screening tool for assessing the degree of cognitive impairment in the guidelines for the Report of the Quality Standards Subcommittee of the American Academy of Neurology.

P01-364 - A Pet therapy intervention on elderly inpatients: an epidemiological study

Objectives The aim of the present study is to evaluate the effects of Pet Therapy intervention on cognitive function, mood and perceived quality of life on elderly subjects (mean age 84.7 years; 95.2% women) living in a nursing home. Methods Participants were 21 subjects affected by mental illness including dementia, depression and psychosis (diagnosis based on the International Statistical Classification of Disease - ICD-10). The Mini-Mental State Examination (MMSE) and the 15-items Geriatric Depression Scale (GDS) were administered to ten persons (pet-group) and eleven subjects (control-group) together with a self-perceived quality of life questionnaire. The pet-group underwent a dog-assisted educational intervention lasting 90 minutes, once a week for six weeks. MMSE and GDS mean scores were compared between and within groups by Students t-test. Results The mean age ± standard deviation of the overall sample was 84.7±9.9 years. Mean schooling level was 4.0±3.4 years. Dementia was the most frequent diagnosis (47.6%), followed by psychosis (33.3%) and depression (19.0%). Both pet-group and control-group improved on GDS and MMSE. Within the pet-group, GDS symptoms decreased by 50% (from 5.9 to 2.7, p=0.013), whereas mean MMSE score increased by 4.5 (p=0.060). The between group comparison showed positive effect of Pet intervention on GDS (p=0.070). Furthermore, most of the participants reported an improvement of their perceived quality of life. Conclusions According to the most recent literature, our findings suggest that Pet Therapy program can be efficient in improving depressive symptoms and cognitive function in residents of long-term care facilities with mental illness.

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.

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.

P03-300 - Correlates of non-fatal suicidal behaviors in patients admitted to an acute psychiatric unit: a control-case study

Objectives To investigate the prevalence of non-fatal suicide behaviors (NFSBs) among patients admitted to an acute psychiatric ward in Bologna, Northern Italy. Methods 30 attempters (mean age 45.10±16.12 years) consecutively hospitalized (May-July 2009) were compared to 117 controls randomly selected among patients admitted in the same ward for other reasons than NFSBs. Socio-demographical and clinical information were collected through the retrospective consultation of case-histories. Attempters were clinically interviewed and the Suicide Intent Scale (SIS) was administered. Clinical diagnoses were achieved using the International Classification of Disease-10th Revision (ICD-10) criteria. Associations between non-fatal suicide behaviors and covariates were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI). Results Cases were more often women (63.3%), Italians (83.3%), unemployed (63.3%) and had a lower education (70.8%) than controls. Among attempters, most frequent diagnoses were personality disorders (56.7%) and mood disorders (50%); the 56.7% of cases was affected by concomitant organic disease (OR compared to controls:2.58; 95%CI=1.13-5.85). Stressful life-events were three-fold more frequent in cases than in controls; incongruous drugs assumption was the most common suicidal behaviours. A previous NFSB was highly prevalent in cases (46.7% p Conclusions NFSBs are associated with distinct socio-demographic and clinical profiles. Routine assessment of intentionality might help to identify subjects at higher risk of relapse.