259 / 290
Results:
N = 51 patients; 82.4% women; mean age 88 years old; 8.6
medicines per patient; 6 patients: more than 1 medicine withdrawal;
34 immediate replacement; 10: dose reduction; 9: posology frequency
reduction. Removal of 44 benzodiazepines, 5 hypnotics, 2 tricyclic
antidepressant. 100% started trazodone as an alternative treatment.
Prescription follow up monitoring: 42 patients maintained prescrip-
tion switch recommendation.
Conclusion:
In patients presenting psychotropic adverse side effects,
trazodone could be an adequate therapeutic alternative on psycho-
tropic withdrawal. The stay in Orthogeriatric Units due to hip fracture
could be a suitable moment to assess the convenience of withdrawal,
reduction or substitution of some chronic medications, specially
psychotropics.
P-848
Prevalence and risk factors of depression in elderly inpatients
H. Salma
1
, C. Fadwa
1
, M. Sameh
2
, A. Lobna
1
, G. Radhwan
2
, B. Zouhair
2
,
A. Othmen
1
.
1
Psychiatric Department
“
B
”
of CHU Hédi Chaker,
2
Internal
Medicine department of CHU HédiChaker, Sfax, Tunisia
Objectives:
Depression in the elderly is a widespread problem that is
associated with several psychosocial and medical factors. The aims of
this study were to estimate the prevalence of depression and to
identify its associated factors in elderly hospitalized patients.
Methods:
A descriptive and analytic study including 60 inpatients
aged over 65, who were hospitalized in the Internal Medicine depart-
ment of CHU Hédi Chaker, Sfax, during the period from September
2015 until January 2016. Data collectionwas conducted via a question-
naire exploring sociodemographic and medical data. Depression was
assessed by the 15-item Geriatric Depression Scale (GDS-15).
Results:
The average age of patients was 73, 48 ± 6,57 years. The
socioeconomic level was mostly middling (83,3%). In our study, 18.4%
of patients were living alone. Social and family problems were
reported by 18.3% of patients. According to GDS-15, 21.7% of cases
suffered from severe depression (score >12). A significant association
was found between Female sex (p = 0,004), social or family problem
(p = 0,000), social isolation (p = 0,001) and being dependent for
activities of daily living(p = 0,005) with severe depression.
Conclusion:
Depression is very common in elderly hospitalized
patients. A systematic screening for this trouble in this population
seemed to be necessary.
P-849
Deciding on the treatment for challenging behaviors in patients
with dementia
S. Janus
1
, J. van Manen
1
, J. van Til
1
, S. Zuidema
2
, M.I. Jzerman
1
.
1
University of Twente,
2
University of Groningen, Netherlands
Introduction:
There is concern about prescribing antipsychotics for
patients with neuropsychiatric symptoms. For patients with dementia,
physicians have to make the treatment decision together with proxies.
It is unknown whether physicians, nurses and proxies would make
the same treatment choice for the patient. Therefore, this study
compares the ranking of attributes of antipsychotic treatment
according to its importance for the treatment decisions between
these groups.
Method:
16 and 10 attributes were selected for physicians/nurses and
proxies respectively. A scenario depicting a patient with dementia
demonstrating neuropsychiatric symptoms was shown and respon-
dents had to choose an appropriate treatment (antipsychotics/
non-pharmaceutical treatment). The attributes were rated by the
respondents according to their choice using a Best-Worst Scaling case
1 design.
Results:
41 physicians, 81 nurses and 59 proxies filled in the
questionnaire. The antipsychotic treatment option was chosen by
71% of the physicians, 71% of the nurses and 52% of the proxies. The
respondents who chose antipsychotics rated
“
leading to a result the
fastest
”
and
“
most effective
”
as most important. Only proxies rated
the factor
“
having a low negative impact on the patient
”
as important.
Of the respondents choosing the non-pharmaceutical treatment,
nurses and elderly care physicians ranked
“
appropriateness
”
and
“
of
little burden to the patient
”
as important. Proxies ranked
“
effective-
ness
”
and
“
least negative impact on the patient
”
as important.
Conclusion:
Effectiveness and negative impact of the two treatments
were ranked differently. Proxies should be informed about side effects
of psychotropics, and consented in a shared-decision making process
about the preferred treatment option.
P-850
The outcomes of a care pathway for depression screening among
respiratory insufficiency patients in pulmonary outpatient clinic
H. Kerminen
1,2
, E. Jämsen
1
–
3
, P. Jäntti
2
, A.K. Mattila
4
, S. Leivo-Korpela
5
,
J. Valvanne
1,2,6
.
1
Department of Internal Medicine, Tampere University
Hospital,
2
University of Tampere, School of Medicine and the Gerontology
Research Center,
3
Hatanpää Hospital, Service Line of General Practice and
Geriatrics,
4
Department of Adult Psychiatry, Tampere University Hospital,
General Hospital Psychiatry Unit,
5
Department of Respiratory Diseases,
Tampere University Hospital,
6
Purchaser for the Promotion of Senior
Citizens Welfare, City of Tampere, Tampere, Finland
Introduction:
Major depression is prevalent, but often undiagnosed,
among patients with chronic respiratory insufficiency. We developed
a care pathway for identifying depression in patients visiting a
tertiary care pulmonary outpatient clinic. Patients with Depression
Scale (DEPS) scores suggesting depression were offered a referral to
psychiatry service.
Methods:
149 patients (mean age 71 years, 60% males) visited the
clinic during a five-month period. The most prevalent diagnoses were
COPD (50%), sleep apnoea (34%), and obesity-hypoventilation (26%).
47% were using long-term oxygen therapy and 60% non-invasive
ventilation. We evaluated the outcomes of the care pathway by
retrospectively reviewing patient records.
Results:
DEPS was administered to 98 patients (66%), of whom 24%
scored
≥
12 exceeding the cut-off for referral. Twelve patients refused
referral. Of the eight patients referred, five patients were finally
evaluated by a psychiatric nurse, and they all were deemed depressive.
Age, gender, body mass index and pulmonary disease diagnoses were
comparable in groups scoring <12 and
≥
12 in DEPS. 12/25 of patients
with smoking history >40 pack-years had positive screen, compared
to 5/29 with 20
–
40 pack-years and 7/44 with lesser or no smoking
history (p = 0.007). History of depression (7/16 vs.17/82, p = 0.060) and
poorer lung function (FEV1% 32.5 vs. 51, p = 0.098, n = 57) seemed to be
associated with higher DEPS scores.
Key conclusions:
Depression screening was positive in one-fourth of
screened patients. Patients
’
compliance for further mood evaluation
in psychiatry outpatient clinic was poor. Screening, evaluation and
beginning of treatment should be done in parallel with the treatment
in pulmonary clinic.
P-851
Clozapine induced cardiomiopathy in Parkinson
’
s disease
U. Lertxundi, R. Hernández, F. Cibrian, M. García, C. Aguirre.
Pharmacy
and Internal Medicine, Araba
’
s Mental Health Network, Basque
Pharmacovigilance Unit
Introduction:
Cardiomyopathy is considered to be a very rare, poten-
tially fatal adverse reaction (ADR) associated with clozapine, although
the real incidence might be greatly underestimated. So far, this ADR
has only been described in relatively young schizophrenic patients,
with higher incidence reported rates in Oceania. But clozapine is also
used to treat psychotic symptoms in elderly patients, like patients with
Parkinson
’
s Disease (PD).
Method:
We searched for cardiomyopathy cases associated with
clozapine in PD existing in the European pahrmacovigilance database
(Eudravigilance), which includes spontaneously reported ADR from
the European Economic Area and in the case of clozapine, for which
the marketing authorization holder is in Switzerland (Novartis),
notifications from anywhere in the world. The Pharmacovigilance
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S253