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To implement and evaluate the impact of an enhanced thera-

peutic environment within an acute mental health unit on rates of

violence and patients

sense of safety.

Project Design:

A Quality Improvement project using PDSA cycles was

used to address patients

safety concerns and ward violence. Over a

six month period a project team worked with staff and patients

to enhance the therapeutic environment including: creating an

indoor garden, improved signage, staff training audit and feedback of

ward environment using observation and the Ward Atmosphere

Scale (completed by patients and staff). Outcome measures included

monthly rates of violence and aggression, anti-psychotics prescrib-

ing and staff sickness. Patients

and staff perception of safety was

measured using the Ward Atmosphere Scale (WAS).


Recorded incidence of physical aggression reduced by 40.4%

and incidences of verbal aggression by 59.3% (47

28 and 81


respectively). Patients self-reporting of

feeling safe

on the ward

increased to 100%. Rates of staff sickness reduced by 64% whilst

prescribing of anti-psychotics was reduced by 26.9% on admission.

There has been sustained improvement following the project.


The enhancement of the therapeutic environment

combining staff training and environmental changes improved out-

comes for patients and staff. Involving the patients and staff in all

stages of the redesign created a sense of ownership and pride.


Catatonia, an underdiagnosed disease

M. Valdés-Aragonés


, M.A. Caballero-Mora


, C. Ramón-Otero




Hospital Universitario de Getafe, Madrid, España


Catatonia is a neuropsiquiatric syndrome, characterized

by mutism, stupor, refusal to eat or drink, posturing, and excitement

or hypokinesis. In spite of its important symptoms, it is not diagnosed

correctly, delaying the treatment and increasing secondary compli-

cations. Benzodiazepines and ECT have been the main treatment for



Male 89 years old. Personal history of Alzheimer disease with

behavioral symptoms in treatment with risperidone. He walks with

a cane and is dependent for basic activities of daily living, he lives

in nursing home. Consultation for rigidity of 8 days of evolution,

negativism, oppositional and fluctuation in the level of consciousness.

He suffered a fall two days ago with a head trauma and symptoms

of respiratory tract infection. On physical examination, the rigidity,

mutism, oppositional, waxy flexibility, maintenance of antigravity

positions, positive Grasping and sweating are emphasized. Cranial CT,

electrocardiogram and chest radiography are normal, in analytical

highlights a sodium 124 mEq/L and CK 634 U/L. Initially, respiratory

tract infection is treated, hyponatremia and neuroleptics are removed,

but despite everything, evolution is torpid, so reassessing the patient

is diagnosed catatonia, with a score on the scale Bush-Francis 16/69.

It starts treatment with lorazepam 2 mg every 8 hours, responding

favorably and reversing symptoms.


Catatonia is an underdiagnosed disease which poses a

diagnostic challenge and we must think about it, as it produces a large

potentially reversible functional impairment with the establishment

of an appropriate early treatment.


Loneliness and self-stigma among older adults with mental health

problems in care homes

V. Tzouvara.


s College London


Loneliness associates with negative effects on older


s health, while mental illness stigma associates with poor

quality of life including increase social avoidance and isolation. There

is, therefore, a potential inter-relationship between loneliness and

mental illness self-stigma in older age, yet a limited number of studies

aimed at examining it.


The aim of this study was: (a) to examine the inter-relationships

between loneliness and self-stigma among older adults with mental

health problems in nursing homes, and (b) to explore how this

population experiences loneliness and self-stigma.


A mixed-methods approach was utilised. The first phase

involved a questionnaire survey (n = 16), while the second phase

involved a qualitative study (n = 10).


Low levels of self-stigma (56.3%) were reported. However, a

substantial number of older adults scored high on the self-stigma scale

(43.8%). A relationship between stereotype endorsement and marital

status (sig. = .010) was identified. More than half of the sample (68.8%)

reported feelings of loneliness. There was also a correlation between

loneliness, age (sig. = .062) and religiosity (sig. = .044). Seven themes

emerged from the qualitative analysis:

social loneliness





emotional reactions


coping mechanisms


degree of

insight into illness


understanding and view towards mental illness



behavioural reactions



The small sample size of the quantitative study reveals the

various methodological challenges in implementing research in long

term care facilities. However, the qualitative study provides useful

insights into the topic.


The study offers the platform for further investigation on

the topic, while discusses implications for policy and practice.


Geriatric depression under-diagnosis: a population study

E. Crisostomo


, M. Vasques


, J. Soares


, A.V. Vieira


, M.T. Verissimo






Medicina 7.2

Hospital Curry Cabral -CHLC,





Previous prevalence estimates of geriatric depression

have varied, showing that depression among the elderly might be

under-diagnosed and under-treated. Nonetheless there are few

population-based studies in Portugal.


The aim of this population-based study was to investigate

the depression prevalence among the elderly patients aged 65 or over

from a primary care facility in a rural setting (UCSP-Mira), applying a

well-defined instrument

the Geriatric Depression Scale 30 (GDS30).

The patients were randomly selected in the waiting room between 1st

December 2015 and 31st March 2016. Any patient not registered at

UCSP-Mira was excluded. Previous medical records were compared

with the calculated scores and the probable undiagnosed depression

rate was assessed. The previous use of antidepressants was character-

ized according to pharmacological major group, and related to the

population identified morbidities.


The depression prevalence rate registered at UCSP-Mira 13,3%.

116 nondemented individuals were enrolled; this sample represented

5% of the elderly population registered at UCSP-Mira; approximately

half of the community-based elderly people who complied with the

test had self-reported indications of depression (GDS30 > 11). Over

89% presented morbidities when compared with 64% among those

who had not self-reported depression. A high percentage of elderly

patients were prescribed antidepressants regardless of previous

medical diagnosis or self-assessed depression.


The obtained results showed high rates of under-

diagnosis, which leads to an inadequate pharmacological approach.

This study raises medical awareness to this problem among the elderly

population, where diagnosis and further intervention is might be

more challenging.

Area: Urology and continence management


Urinary tract infections in elderly

B. Ben Dhaou


, Z. Aydi


, I. Rachdi


, F. Daoud


, L. Baili


, S. Kochbati



F. Boussema




Internal Medicine Department, Habib Thameur Hospital,

Faculty of Medicine, Tunis, Tunisia

Poster presentations / European Geriatric Medicine 7S1 (2016) S29