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Major depression as a risk factor for early institutionalization of dementia patients living in the community
- Authors:
- DORENLOT Pascale, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.471-478.
- Publisher:
- Wiley
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients. Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months). Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent. Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.
Life-time history of suicide attempts and coronary artery disease in a community-dwelling elderly population
- Authors:
- ARTERO S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(2), February 2006, pp.108-112.
- Publisher:
- Wiley
Numerous studies have observed a strong relationship between coronary artery disease (CAD) and psychiatric disorder; notably depression, anxiety and panic attacks. No study has, however, explored the question of whether persons suffering from CAD might also be at high risk of suicide attempts. The aim of the present study is to examine the relationship between CAD within a general population cohort and life-time history of psychiatric disorder and suicidal behaviour. A representative sample of 1843 non-institutionalized persons over 65, drawn at random from the electoral roll, was given a standardized neurological and psychiatric examination based on DSM-IV criteria. The clinical examination also included an electrocardiogram (ECG) and a questionnaire relating to life-time medical history. Cardiac events were validated by the general practitioner. Within this general population sample the prevalence of suicide attempts was 3.9%. A significant positive association was observed between life-time prevalence of CAD and suicide attempts. Suicide attempts were associated with major depression co-morbid anxiety and depression but not anxiety alone. A logistic regression analysis showed that the relationship between suicide attempts and CAD persists after adjustment for depression and anxiety. CAD is associated with suicidal behaviour independently of depression, however, longitudinal studies are required to clarify the direction of causality and to integrate genetic, biological, environmental and psychological factors into an aetiological model.
Prevalence of DSM—IV psychiatric disorder in the French elderly population
- Authors:
- RITCHIE K., et al
- Journal article citation:
- British Journal of Psychiatry, 184(2), February 2004, pp.147-152.
- Publisher:
- Cambridge University Press
France has high rates of psychotropic drug consumption and suicide in the elderly population, but it has not yet been possible to determine whether this is due to exceptionally high morbidity rates. The aim was to describe the first longitudinal population study of psychiatric disorder undertaken in France, and to estimate current and lifetime prevalences and age of onset of psychiatric disorder. A study group of 1873 non-institutionalised persons aged 65 years and over was randomly recruited from the Montpellier district electoral rolls. The Mini International Neuropsychiatric Interview was used to assess current and lifetime symptoms. Cases identified by the application of DSM — IV criteria were re-examined by a clinical panel. Forty-six per cent of the study population had experienced a mental disorder in their lifetime, and 3.7% had made a suicide attempt. Lifetime prevalence of major depression was 26.5% and 30% for anxiety disorders. Current prevalence rates were 14.2% for anxiety disorders, 10.7% for phobia, 3% for major depression and 1.7% for psychosis. Results show veryhigh rates of lifetime but not current major depression. Rates of currentphobia and suicidal ideation in the very elderly are also high compared with other studies. The rates reported are likely to be underestimates.