Older people with mental ill health are more likely to receive lower quality of healthcare, inappropriate prescriptions and reduced access to services, leading to increased rates of mortality1,2,3. The NHS mandate 2015 to 2016 emphasises the need to deliver care, which is joined up and seamless for users of services4.

To identify the common medical comorbidities on the Old Age Psychiatry Wards and to assess the management outcomes.

We audited all patients referred to the Liaison Geriatrician from 2008 to October 2015 from the Mount Hospital Leeds, which consists of 4 Old Age Psychiatry Wards. Data was collected in October 2015 and included referral date, patients’ age and sex, number of referrals, reason for referral and the outcome.

We assessed 339 (142 F, 197 M) patients with a mean age of 77 (range: 56–94). Cardiovascular problems were the biggest group of referrals (in particular oedema, hypotension and rhythm disturbances) (34%) followed by central nervous system problems (11%), respiratory (8%), gastrointestinal (8%) and infection (8%). Some unusual problems were diagnosed including a spontaneous pneumothorax, primary biliary cirrhosis. The most common intervention was advice on treatment or investigation, very few patients needed acute admission and some unnecessary admissions were aborted as a result of the physician's intervention.

This audit emphasises the need for a joint coordinated approach between psychiatry and medicine in managing health problems in older people. A dedicated Geriatric Liaison service can improve care, avoid unnecessary acute admissions and is more convenient for patients who would otherwise attend repeated outpatient appointments.

References are not available for this abstract.

The authors have not supplied their declaration of competing interest.

The aim of this study is to investigate the association between depression, physical factors and mortality in elderly people living in the community.

Prospective longitudinal multicenter study for 5 years. Cohort of 293 people aged 65 years and older living in the province of Huesca (Spain). Individual face-to-face interviews and with appropriate caregiver. The following information was collected:

– demographic data;

– psychosocial factors: sex, age, education, marital status, live-in family members, social relationships, life events;

– physical factors: severity of physical illness, comorbidity (Cumlative Illness Rating Scale);

– psychiatric factors: cognitive function (Spanish version of Mini-Mental State Examination), depression (Geriatric Depression Scale), diagnostic criteria according DSM-IV-TR.

Statistical analyses:

– a bivariate analysis;

– a multivariate analysis. Cox regression model (explanatory variables).

Two hundred ninety-three participants, simple representative of people aged 65 years old or more in province of Huesca (Spain). Monitored 5 years follow-up study. Sixty-four people died (21.8%), annual mortality rate: 5.3%. Depression: 66 people (22.5%), (32.2% women, 13.3% men). Cognitive impairment: 51 people (17.4%). Bivariate: factors associated (P < 0.005) with mortality: functional impairment, living in nursing home, sensorial impairment, polypharmacy, severe physical illness and psychiatric comorbidity: depression (34.8 vs 18.1%), cognitive impairment (49.1 vs 15.8%). Association between some factors and mortality was nullified after multivariate statistical model; the case for depression (Hazard Ratio: 1.1), cognitive impairment (HR: 1.2) or functional impairment (HR: 1.3).

Depression and cognitive impairment are associated with mortality in elderly community living people in bivariate analysis, therefore, this association disappears after multivariate analysis. Severity physical illness seems to nullify the effect of other variables, such as depressive symptomatology.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Depression in late life follows a relapsing course and it has been related to impaired cognitive control. Information processing speed, memory and executive abilities are most frequently impaired.

Cognitive changes are difficult to confirm during depressive episode, as signs of both disorders largely overlap. Therefore, it makes more sense to assess cognition after a remission has been reached. Electrophysiology may be particularly convenient as a tool in such studies, as it can separate central cognitive processing from the motor processing.

The study of cognition was focused on executive function and speed of information processing. It was measured with Stroop-related event related potentials (ERPs) and reaction times (RTs) in a modified computer version of the Stroop test which is highly sensitive to frontal functions.

Thirty-four patients with late-onset depression were included after they had reached remission. They were compared to twenty-four age-, gender- and education-matched healthy controls. Each participant completed a single item computer version of the Stroop task using verbal response mode. EEG and RT were simultaneously recorded.

Revealed abnormal late positive Stroop-related potentials in the period of about 500–600 ms period corresponding to the latency of the so-called P300b wave.

Study supports the view that patients with late onset depression are also cognitively impaired and that this impairment persists in the period of early remission. Using more sensitive ERP measurement of the Stroop task, we demonstrated impaired information processing at an earlier, pre-response related stage.

The authors have not supplied their declaration of competing interest.

Cognitive impairment impacts on patient outcomes [1] but is under-recognised in acute hospitals [2]. Data on rates and degree of impairment among hospital inpatients remain sparse. This information is vital for strategic planning of health services as the European population ages.

To examine the rates and degree of cognitive impairment among patients aged 65 and older who were admitted to an acute general hospital and to assess its impact on patient outcomes.

All patients aged over 65 who were admitted over a 2-week period were invited to participate. Those who met the inclusion criteria were screened for delirium then underwent a cognitive screening battery. Normative values for age and level of education were obtained from the TILDA study [3]. Demographic and outcome data were obtained from medical records.

One hundred and forty-eight patients underwent cognitive screening. Thirty-nine over 148 (26%) met the DSM-IV criteria for dementia of whom only 16 (41%) had a previously-documented impairment. Thirty over 148 (20%) had evidence of cognitive impairment that did not meet criteria for dementia, only 3 (10%) of whom were previously documented. Seventy-three over 148 (49%) were normal. Six over 148 (4%) were not classifiable. The impact of cognitive status on length of hospital stay, number of readmissions in 6 months and discharge destination was investigated. Impact on length of stay was significant (P = 0.017) but significance was not achieved against number of readmissions or discharge destination.

Cognitive impairment is pervasive and under-recognised in the acute hospital and impacts on length of hospital stay. Longer interval analysis is necessary to investigate further implications.

References 1–3 available upon request.

The authors have not supplied their declaration of competing interest.

Dementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.

Determine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.

All male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.

The final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).

There is a high prevalence of dementia and an appreciable rate of delirium among these patients.

The authors have not supplied their declaration of competing interest.

Depression and mild cognitive impairment are common among the elderly. Half the patients with late-life depression also present some degree of cognitive decline, making the distinction between these conditions difficult.

To conduct a database review in order to understand the relationship between these entities, and treatment approaches.

To create and implement clinical guidelines at our institution, to evaluate and treat elderly patients presenting with depression and mild cognitive impairment.

A PubMed database search using as keywords “late life depression”, “depression”; “cognitive impairment”; “mild cognitive impairment” and “dementia” between the year 2008 and 2015.

Late-life depression and cognitive impairment are frequent among the elderly (10–20%). Depression is also common in the early stages of dementia decreasing as the cognitive decline progresses. The causal relationship between these entities is not well understood and some authors advocate a multifactorial model (genetic risk factors; neuroendocrine changes; vascular risk factors) and the cognitive impairment of said changes is dependent on the individual's cognitive reserve. Regarding treatment of depression in patients with cognitive impairment, most authors advocate a stepped approach with watchful waiting and then, if symptoms persist, the introduction of pharmacotherapy and psychosocial intervention.

The relationship between cognitive impairment and depression is still not clear and probably multifactorial. The diagnosis of depressive symptoms in patients with severe cognitive impairment can be difficult and most forms of pharmacological treatment in this population are not beneficial, making it important to carefully evaluate the benefits of introducing new medication.

The authors have not supplied their declaration of competing interest.

Anosognosia is a common symptom in patients with dementia, although data on prevalence vary widely. It is associated with decreased compliance to medical diagnosis and treatment. The rejection of assistance challenges professionals as well as caring relatives.

Anosognosia increases with progression of disease but is also found in early stages. The underlying mechanisms are not completely understood; past studies described an association with executive dysfunction.

Our study aims to identify the frequency of anosognosia in our memory clinic.

We evaluated disease awareness using the Clinical Insight Rating Scale in 124 patients presenting with diagnosis of Alzheimer's disease in our memory clinic. We correlated the degree of awareness with standardized cognitive, affective, and functional parameters.

One hundred and fourteen patients (90.9%) showed decreased awareness, in 51.7% of our sample awareness was seriously impaired or even entirely lacking. In accordance with the literature, anosognosia correlated significantly with the result of the Mini-Mental-Staus-Examination as indicator of global cognitive functioning (r = −0.291, P < 0.05) and with the need for assistance in everyday-life (r = .364, P < 0.05). We found no correlation with depressive symptoms or age.

The phenomenon of anosognosia is frequent in the setting of a memory clinic and has special impact on clinical practice as it is well correlated with executive functioning and global cognition and, thus, is a relevant factor for the initiation of medical care for patients with dementia.

The authors have not supplied their declaration of competing interest.

Cardiovascular risk prediction tools are important for cardiovascular disease (CVD) prevention, however, which algorithms are appropriate for people with severe mental illness (SMI) is unclear.

To determine the cost-effectiveness using the net monetary benefit (NMB) approach of two bespoke SMI-specific risk algorithms compared to standard risk algorithms for primary CVD prevention in those with SMI, from an NHS perspective.

A microsimulation model was populated with 1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years without CVD. Four cardiovascular risk algorithms were assessed; (1) general population lipid, (2) general population BMI, (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those high-risk (> 10%) were assumed to be prescribed statin therapy, others received usual care. Individuals entered the model in a ‘healthy’ free of CVD health state and with each year could retain their current health state, have cardiovascular events (non-fatal/fatal) or die from other causes according to transition probabilities.

The SMI-specific BMI and general population lipid algorithms had the highest NMB of the four algorithms resulting in 12 additional QALYs and a cost saving of approximately £37,000 (US$ 58,000) per 1000 patients with SMI over 10 years.

The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of a SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.

The authors have not supplied their declaration of competing interest.

The quoted prevalence of intellectual disability (ID) among adults with psychiatric illness varies widely. Some believe that these people are protected from certain intellectual and psychological stress by having ID, and therefore, are less prone to develop psychiatric illness. However, in the past decades, the more prevailing view is that people with ID are more vulnerable to psychosocial stress than people without ID, and therefore, are more likely to develop psychiatric symptomatology. According to various population surveys the probability of suffering a mental disability increase with age. Delusional disorder is as well a disease related to advanced stages of life.

The aims of the present study is to establish the prevalence of functional intellectual disability among adults who fulfil DSM 5 delusional disorder criteria.

Our data come from a case register study of delusional disorder in Andalucia (Spanish largest region). By accessing digital health data, we selected 1927 cases, which meet criteria DSM 5 for delusional disorder collecting whether in its history intellectual disability was registered by the referent psychiatrist.

Of our sample, 2.6% had reflected some kind of intellectual disability in their digital clinical record.

These percentage has been found to concur with other epidemiological studies linking mental retardation and psychotic spectrum disease although there are no epidemiological data published to the best of our knowledge that correlate delusional disorder specifically and intellectual disability.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Studies have found that the cognitive function levels of intellectually challenged children add a burden to the family and affect quality of life.

The purpose of this study was to determine the family burden felt by mothers of children, ages 6–16, whose mental capacity evaluation indicates an IQ of 35–79 to explore the mother's quality of life and discover the factors that yield an impact in this context.

The main objective of this study therefore was to ascertain the family burden and quality of life experienced by the parents of children with mentally retarded or borderline mental capacity.

The WISC-R test was used in the research to determine the intellectual capacity of children, 6–16 years of age. The sample comprised 131 children and adolescents between the ages 6–16 with IQs in the interval of 35–79 and their mothers. The parents accompanying their children were assessed using the Family Burden Assessment Scale, the World Health Organization Quality of Life instrument and a sociodemographic questionnaire that was filled out during face-to-face interviews.

The quality of life of the mothers was found to be average. At the same time, as the IQ level of the children went up, the less the mothers felt they were under a family burden. It was seen that the mothers experienced the most difficulty in the domains of “perception of inadequacy” and “emotional burden.”

Mothers with intellectually disabled children need psychosocial support. Providing all members of the family with counseling services to help them cope with the issues and responsibilities involved in the care of disabled children may make a significant difference in quality of life.

The author has not supplied his/her declaration of competing interest.

Family hosts for people with mental diseases is a quite new institution in Greece [1,2].

The study investigated Greek people's attitudes toward mentally ill people and their institutionalisation

The survey investigated Greek society's attitudes and bias concerning Family Host Programs for the mentally ill.

Questionnaires were administered to a sample of six hundred (600) people in the cities of Patras, Pyrgos and Mesologgi, Southern Greece from May the 27th to June the 12th

Of the respondents, 47.3% were men while 52.7% were women. Most citizens were not familiar with the term “Host Family” and were not aware of this new institution (62.7%). However, many knew a person that suffered from mental illness environment (35.7%), but they thought that mentally ill people would be rather a “burden” to foster families (32.2%).

Although many people knew well a person with mental illness, they were not aware of psychiatric reforms and community based programs. In conclusion, psycho-educational programs contributing to repel bias towards psychiatric patients should be implemented.

The authors have not supplied their declaration of competing interest.

The elderly persons continue to invest substantially in emotional relationships.

The overall objective of this research study was to investigate the attitudes of elderly persons towards family relations.

One hundred and ninety-seven healthy elderly individuals participated to the present study from different region in Greece. The age range was 66–93 years old. The questionnaire included: (a) the Family Environment Scale (Family Environment Scale, Form R-FES), (b) The Experience of Shame Scale (ESS), (c) the Other As Shamer Scale (OAS), (d) Quality of Life (SF-36).

Univariate and multivariate analysis was applied for the statistical analysis of the data, which showed that: the elderly persons who are satisfied with their lives in past, they exhibit lower overall price external shame feelings of emptiness (empty – OAS) (P = .002), they perceived reaction of others when they make mistakes (Mistakes – OAS) (P = .000), conflict (Conflict – [Form R-FES]) (P = .000). Elderly persons who are satisfied with their life in this time show higher levels of orientation towards active recreational activity (Active-Recreational Orientation – R-FES) (P = .000). Elderly persons who declared that family relation is important for them exhibit lower levels of feeling vacuum (empty – OAS) (P = .009), and higher levels of orientation for achievements (Achievement Orientation) (R-FES) (P = .010), social role (SF – SF36) (P = .000), Mental Health summary Scale (SF_MCS-SF36) (P = .000).

From the findings of this study, it is apparent how important is the study of the quality of life in old age.

The authors have not supplied their declaration of competing interest.

Anxiety disorders are among the most common mental disorders in Germany. Different sectors and disciplines participate in mental healthcare of these patients, but there is a lack of empirical evidence of the treatment outcomes in different settings.

The study focuses on analyzing the care pathways of patients with anxiety disorders and the effects of such pathways on critical events like sick leave, early retirement and mortality.

The analysis aims at developing recommendations for optimizing treatment with a view to minimize the rate of occurrence of critical events during the care pathway.

Secondary data of three statutory health insurance companies and of the German Pension Funds of the years 2005–2007. The analyses are based on 744,742 persons with at least one diagnosis of an anxiety disorder.

The analyses reveal a low rate of changes between primary and specialized care. There was a high number of care pathways (n = 2.608).The most common type was care by primary care physicians/somatic specialists only (60.5% of patients), followed by a treatment by a psychiatrist only (9.5%). Patients, who were only treated by general practitioners/somatic specialists, had significantly lower rates of sick leave and early retirement. This may indicate that cases with more favourable prognoses are found with this care pathway.

Analyses of care pathways using secondary data can contribute to identify potential for optimizing mental health care services and provide information about intersectoral interface problems, which should be considered in the quality management of mental healthcare.

The authors have not supplied their declaration of competing interest.

Social interactions have an important effect on the subjective well-being of individuals. However, in periods of financial crisis these interactions are reduced, affecting thus the mental health of the individuals as well.

To investigate the effect of the reduction in social interactions, as a result of the economic crisis, on the subjective well-being of non-insurance health care seekers in Greece.

Two hundred and sixty-six individuals participated in this study, 90 (35.6%) males and 163 (64.4%) females, with a mean age of 47. Analysis of data was conducted with Anova, using the SPSS software.

The findings showed that reductions in social interactions, caused by the financial crisis, led to significant reductions in the subjective well-being of individuals as well (F(1.259) = 13.276, P < 0.001 for social activities and F(1,258) = 14.531, P < 0.001 for peer socialization). More specifically, individuals whose social interactions were greatly affected by the financial crisis reported significantly lower subjective well-being than individuals who reported a medium effect (M = −2.952, SD = .764, P < 0.001). Furthermore, individuals who reported that the economic crisis had a great effect on their peer socialization reported significantly lower subjective well-being compared to both those who reported a medium (M = −1.868, SD = .658, P < 0.015) or low (M = −2.77, SD = .809, P < 0.001) effect of the crisis.

The results of this research showed that the financial crisis reduced the well-being of affected individuals through reductions in their social interactions. Further research is needed to investigate appropriate interventions to reduce the negative impact that the financial crisis has on the well-being of affected individuals.

The authors have not supplied their declaration of competing interest.

New guidelines aimed to minimize restraint in psychiatry clinics due to ethical reasons.

Further studies investigating factors affecting the decision of restraint and its potential benefits and harms are needed.

We aimed to determine current rates of restraint in psychiatric clinics and sociodemographic/clinical variables which may be related with restraint practices.

The study was conducted in 64-bed male and 28-bed female psychiatric inpatient units, between March 1–May 31 2015. Sociodemographic and clinical data forms were completed using case files and restraint records.

In a total number of 481 inpatients (351 males, 130 females), number of restrained patients was 98 (20.3%) (90 (25.7%) males, 8 (6.2%) females). There was no significant difference in sociodemographic characteristics between restrained and unrestrained patients, but duration of the illness and electroconvulsive therapy rates were significantly different. Substance abuse (44.4%) was higher in restrained male patients. Also, restraint rates were higher in patients having a diagnosis of substance-related disorder compared to other diagnoses. Restraints occurred most commonly in the first day (48%) of hospitalization.

The studies carried out in psychiatric hospitals suggested major differences in the rates and types of restraints among different countries and institutions. In our study, a higher restraint rate is obtained compared to other studies. Consistently with the literature, substance abuse was higher in restrained patients, and restraints occurred most commonly in the first day of hospitalization. Many factors including substance abuse should be considered to reduce restraint rates, which are still quite high in mental health hospitals in Turkey.

The authors have not supplied their declaration of competing interest.

Several community psychiatry projects have been developed in Lisbon; nevertheless, there are patients whose needs are not fulfilled by the existing structures. For this reason, our institution created a domiciliary care unit (PreTrarCa).

To assess if this program has an impact in admission rates, length of stay and follow-up appointments.

To improve the quality of care provided by PreTrarCA.

All active patients followed by PreTrarCA in 2015 were selected (n = 90); only those with F20 and F31 (ICD-10) diagnoses, admitted to the program after 2013, and who had information regarding duration of illness were chosen (n = 21). A control group with similar characteristics (age, gender, ICD-10 diagnosis, disease duration) was paired to our sample. Information concerning social/demographic data, disease duration, hospital admissions and appointments, before and after the patients started the program was retrospectively collected. All data and statistical analyses were performed via SPSS program.

Our patients were mostly female (n = 12); mean age 54,92; 10 and 11 had F-20 and F-31 diagnosis respectively. The test patients had fewer admissions (P = 0.027). No statistical significance was found concerning number of appointments, missed appointments or length of stay, between the groups before or after the patients had started the program.

Results suggest that domiciliary care may reduce costs associated with mental health care due to a decrease in admission rates. Our sample was paired to a similar group, which can account for the similar length of stay in both groups. Further studies should take into account other confounding variables.

The authors have not supplied their declaration of competing interest.

Intensive treatment in partial hospitalization unit may represent an efficient alternative to traditional inward hospitalization. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.

We aimed to study possible differences in the effectiveness of treatment in a partial hospitalization regime for different psychiatric disorders.

Three hundred and thirty-one patients were admitted to the Valdecilla acute psychiatric day hospital between January 2013 and January 2015. Clinical severity was assessed using BPRS-E and HoNOS scales at admission and discharge. Other relevant clinical and socio-demographic variables were recorded. For statistical comparisons, patients were clustered into 4 wide diagnostic groups (non-affective psychosis; bipolar disorder; depressive disorder; personality disorder).

We observed a significant difference in the status of discharge (χ2 = 12.227; P = 0.007). Thus, depressive patients were more frequently discharged because of clinical improvement, while patients with a main diagnose of personality disorder abandoned the treatment more frequently (23% vs. 4,0%)

When analysing the clinical outcome at discharge, we found that patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F = 5.305; P = 0.001) than those diagnosed of psychosis or depressive disorder. Interestingly, we found no significant differences between diagnoses in hospital re-admission in the following 6 months after being discharged.

Our results suggest that acute treatment in partial hospitalization regime may be more effective for bipolar and depressive disorder, and particularly less effective for those patients with a personality disorder.

The authors have not supplied their declaration of competing interest.

There have been a growing interest in the effectiveness of task-shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel.

To explore the reasons for task-shifting and the healthcare settings in which task-shifting are successfully applied as well as the challenges associated with task shifting.

Literature searches were conducted on PubMed and Google Scholar using the search term – ‘Task shifting’ and Task-shifting’.

Reasons for task-shifting including: a reduction in the time needed to scale up the health workforce, improving the skill mix of teams, lowering the costs for training and remuneration, supporting the retention of existing cadres by reducing burnout from inefficient care processes and mitigating a health system's dependence on highly skilled individuals for specific services. Clinical settings in which task-shifting models of care have been successfully implemented, include: HIV/AIDS care, epilepsy and tuberculosis care, hypertension and diabetes care and mental healthcare. Finally, challenges which hinder the successful implementation of task-shifting models of care, include professional and institutional resistance, concern about the quality of care provided by lower lever health cadres and lack of regulatory and policy frameworks as well as funding to support task-shifting programmes.

The review brings to light important health policy and research priorities which can be explored to identify the feasibility of using task-shifting models of care to address the critical shortage of health personnel in managing emerging communicable and non-communicable diseases, including opportunities for expanding mental health care in conflict and under-resourced regions globally.

The author has not supplied his/her declaration of competing interest.