- Email: [email protected]
P.1.k.015 Sleep quality in psychiatric outpatients
P.1.k. Basic and clinical neuroscience − Epidemiology version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment packet (MMSE-KC), and Short Form of Geriatric Depression Scale (SGDS) were also evaluated. Participants were asked to rate their own degree of successful aging on a scale from 1 to 10 (1 = least successful, 10 = most successful). The study was approved by the appropriate research ethics committee. To assess the factors correlated with subjective successful aging, t-test and Pearson correlation were used. A stepwise multiple regression analysis was performed to determine predictors of subjective successful aging. Results: The mean score for self-rated successful aging was 5.91 in overall sample. In living alone group, mean score was 5.61, whereas 6.04 in living with others group. Subjective ratings of successful aging were significantly correlated with sex, spouse, education, rheumatism/arthritis, MMSE-KC score, and SGDS score in all participants. Subjective ratings of successful aging were significantly correlated with age, education, religion, MMSE-KC score, and SGDS score in living alone group and were significantly correlated with education, spouse, rheumatism/arthritis, MMSEKC score, and SGDS score in living with others group. Education and SGDS score were found to predict subjective successful aging in overall participant (b=0.137, p = 0.003; b=-0.422, p < 0.001). While MMSE-KC score and SGDS score were significant predictors (b=0.212, p = 0.020; b=-0.302, p = 0.001) in living alone group, SGDS score was a significant predictor of subjective successful aging in living with others group (b=-0.503, p < 0.001). Conclusions: Depression and education were important predictors of successful aging in all participants, and depression was a common predictor in living alone group and living with others group. Appropriate psychiatric management of depression in elderly is needed to enhance successful aging. References [1] Chaves, M.L., Camozzato, A.L., Eizirik, C.L., Kaye, J., 2009. Predictors of normal and successful aging among urban-dwelling elderly Brazilians. J Gerontol B Psychol Sci Soc Sci 64, 597–602. [2] Choi, H.K., 2013. The levels of community-residing elderly’s successful aging and their predictors: focusing on Korean concept of successful aging. Journal of biosocial science 24, 193–217. [3] Jeste, D.V., Depp, C.A., Vahia, I.V., 2010. Successful cognitive and emotional aging. World psychiatry 9, 78−84. [4] Strawbridge, W.J., Cohen, R.D., Shema, S.J., 1996. Kaplan GA. Successful aging: predictors and associated activities. Am J Epidemiol 144, 135–141. [5] Vahia, I.V., Meeks, T.W., Thompson, W.K., Depp, C.A., Zisook, S., Allison, M., Judd, L.L., Jeste, D.V., 2010. Subthreshold depression and successful aging in older women. Am J Geriatr Psychiatry 18, 212– 220.
P.1.k.014 Use of benzodiazepines in patients with hip fracture over 75 years A. Serrano1 ° , M. Su´arez Huerta2 1 Complejo Asistencial Universitario de Le´on, Psychiatry, Le´on, Spain; 2 Complejo Asistencial Universitario de Le´on, Traumatology, Le´on, Spain Introduction: The literature advises against the use of benzodiazepines (BDZ) in elderly patients as being a risk factor for falls [2], increase the risk of delirium and affect cognitive function; however we found that in clinical practice its use is widespread. Hip fractures are a common condition in a general hospital and elder people usually receives a large number of drugs. Identify all those factors that can affect the outcome of those patients is the first step to improve the clinical approach.
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Objectives: To evaluate the excess risk posed by the use of BDZ for hip fractures. To compare the clinical outcome during hospitalization of patients with hip fractures treated with BDZ respect to those without this treatment. Hypothesis: The use of BDZ in patients with hip fracture will be greater than the general population in their age group. The use of benzodiazepines will be associated with a longer duration of hospitalization. Factors for poor outcome will be the total number of drugs, male sex and use of benzodiacepines. Material and Methods: All patients who were admitted in the last year with hip fracture in the Hospital de Le´on were included. We collected the following data: Age, sex, length of stay, death, surgical procedure, psychopharmacological treatment and total number of drugs. We defined as a patient with poor outcome who had one or more of the following criteria: Death, length of the stay over 20 days or failure to perform surgical procedure. Results: The prevalence of BDZ among patients treated at a health center is 27.3% [1]. In our group of hip fractures was of 33.63%. We found a total of 559 patients, of whom 73.5% were women (N = 411) and 26.5% men (N = 148) and the mean age was 87.46±5.41 years. The proportion of women taking BDZ was significantly higher than men (p = 0.047). The proportion of death was not different (p = 0.77) nor the length of the stay (p = 0.74) in patients who were taking BDZ. We found a significant older age in the treatment group (p = 0.037). Among patients with poor outcome we did not found a significantly higher proportion who received BDZ (p = 0.86) although we identified as associated with poor outcome male sex (p = 0.0002) and the total number of drugs patterned (p = 0.0004). Age was not associated with poor outcome of the patients (p = 0.098). Conclusions: Consumption of BDZ is a risk factor for hip fractures. The use of BDZ is associated with female and older patients with hip fracture. The use of BDZ not raise the risk of death or poor outcome during hospitalization. Factors of poor outcome in hip fractures are male sex and the total number of patterned drugs. References [1] Bejarano Romero, F., Pi˜nol Moreso, J.L., Mora Gilabert, N., Claver Luque, P., Brull L´opez, N., Basora Gallisa, J, 2008. Elevado consumo de benzodiacepinas en mujeres ancianas asignadas a centros de salud urbanos de atenci´on primaria. Aten Primaria 40(12):617−21. [2] Bakken, M.S., Engeland, A., Engesæter, L.B., Ranhoff, A.H., Hunskaar, S., Ruths, S., 2014. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol 70: 1972–1979.
P.1.k.015 Sleep quality in psychiatric outpatients A. Fern´andez-Quintana1 ° , M.C. Garc´ıa-Mah´ıa1 , M. VidalMillares2 1 Clinical University Hospital La Coru˜na, Psychiatry, La Coru˜na, Spain; 2 Clinical University Hospital Santiago de Compostela, Psychiatry, Santiago de Compostela, Spain Introduction: Altered sleep patterns are prominent in the majority of psychiatric and behavioural disorders. Due to their cumulative long-term effects on daily functioning, sleep disorders adversely affect the quality of life of patients. Objectives: – To analyze the prevalence of sleep disorders in psychiatric outpatients treated in a Mental Health Clinic.
S362
P.1.k. Basic and clinical neuroscience − Epidemiology
– To study the comorbidity of sleep disorders with psychiatric diagnoses. Methods: The sample is composed of 225 patients treated in a Mental Health Clinic in La Coru˜na (Spain). All subjects met criteria for any of the mental disorders listed in Axis I of DSM-IV-TR. The sample was divided into three clusters for further analysis: 1. Patients with any of the mental disorders included in the Diagnostic Related Group (DRG) 430: Schizophrenia, Affective psychosis, Paranoid disorders and other functional psychosis. 2. Patients diagnosed with Depressive disorders. 3. Patients diagnosed with Anxiety disorders. 4. Patients with other diagnoses. Medical records were reviewed. Quality and patterns of sleep were evaluated using the Pittsburg Sleep Quality Index (PSQI) with a cut-off point 5−6. Results: A total of 225 patients were included in the study, of whom 36% were male and 67% were female. The mean age was 37.5 years (SD 9.32). Sleep disorders were found in 87% of patients, their prevalence was higher among women (p < 0.05). Women had a larger number of altered scales. The most altered subscales in women were Subjective Sleep Quality (p < 0.003) and Sleep Disturbances (p < 0.034). The most altered subscale in the overall sample was the Use of Sleeping Medication. Subscores in the PSQI reveal statistically significant differences between patients included in the DRG 430 and other clusters. Therefore, using contingency tables, we can assess that Subjective Sleep Quality (p < 0.004), Daytime Dysfunction (p < 0.000) and Use of Sleeping Medication (p < 0.008) are found to be more altered in patients diagnosed with mental disorders included in the DRG 430. The second cluster of psychiatric disorders which shows more sleep disturbances are depressive disorders, followed by anxiety disorders. The global score of PSQI is higher in diagnoses included in the DRG 430 compared to the other clusters analyzed in the sample (p < 0.034). Analysis of Variance determines statistically significant differences between the mental disorders included in the DRG 430 and the rest of psychiatric diagnoses, with greater alterations found in the following subscales: Subjective Sleep Quality (p < 0.000), Sleep Disturbances (p < 0.017) Daytime Dysfunction (p < 0.006), Sleep Latency (p < 0.004), Use of Sleep Medication (p < 0.007) and Global Punctuation (p < 0.001). Conclusions: Patients included in the sample have a high prevalence of sleep disorders, which are most commonly found among psychiatric diagnoses included in the DRG 430 group. These findings have relevant clinical implications, given poor quality sleep may have a powerful impact on the global functioning of psychiatric patients. Sleep disturbances in psychosis have been widely assesed as a critical factor in the course and outcome of these psychiatric disorders. References [1] Buysse DJ, Reynolds CF 3o , Monk THY, et al. “The Pitttisburgh Sep Quality Index: a new instrument for psychiatric practice and research”. Psychiatry Res. 1989 May; 28(2):193–213. [2] Hofstetter JR et al. “Quality of sleep in patients with schizophrenia is associated with quality of life and coping”. BMC Psychiatry 2005, 5:13.
P.1.k.016 Turkish reliability and validity of psychopathy checklist revised R. Tutuncu1 ° , A. Ates1 , A. Algul1 , H. Balibey1 , C. Basoglu1 Haydarpasa Training Hospital, Psychiatry, Istanbul, Turkey 1 GATA
Introduction: Psychopathy is a distinct personality organization and differs from antisocial personality disorders in many aspects. Its diagnosis is challenging but also very critical to predict criminality. In this context, Psychopathy Checklist Revised (PCL-R) is a useful tool in diagnosis of psychopathy. Its reliability and validity was showed in numerous populations but it was not studied in a Turkish population. Our aim was to show the Turkish reliability and validity of PCL-R. Method: 425 male subjects with antisocial personality disorder and 125 controls without any psychiatric diagnosis were included in the study. The Psychopathy Checklist—revised (PCL-R): It is the most common tool to assess pyschopathic characteristics and behavior patterns. It can be rated by a professional trained in the field of mental health. There are 20 items rated on a scale from 0 to 2 (0=absent, 1=maybe present, 2=definitely present). Total scores range from 0 to 40. PCL-R lists two factors and four facets. Factor 1 covers “remorseless use of others (core traits of psychopathy)” and Factor 2 covers “antisocial lifestyle”. The facet traits are described as follows: 1) Interpersonal facet traits are “superficial charm, grandiosity, lying, manipulation”, 2) Affective facet traits are “lack of guilt, shallowness, lack of empathy, failure to accept responsibility for own acts”, 3) Lifestyle facet covers “need for stimulation, parasitic lifestyle, lack of long-term goals, impulsivity irrresponsibility” and 4) antisocial facet traits are “poor behavioral controls, early behavioral problem, juvenile delinquency, conditional release, criminal versatility”. DSM-5 diagnostic criteria was used and PCL-R was administered to all participants. The reliability of the Turkish version of PCL-R was determined by test–retest and internal consistency methods. The ROC analysis performed to PCL-R, DSM-5 criteria was taken as a gold standard, the sensitivity, specificity and cut-off values of PCL-R were estimated. To evaluate the adequacy of the scale construct validity analyses by Exploratory Factor Analysis and Kaiser-Meyer-Olkin (KMO) and Barlett tests were applied. Reproductibility of test was evaluated by Pearson correlation coefficient. Re-test performed to 171 subjects two weeks after the first test. Results: As reliabilty analysis, the Cronbach’s alpha internal consistency coefficient was calculated to be as a = 0.977. Pearson correlation coefficient of test-retest was r = 0.94 (p < 0.001). Itemtotal correlations were seen to range from 0.18 to 0.94. Itemtotal score correlations were between 0.18–0.94. Its sensitivity and specificity was 98.3% and 100.0% respectively at the cutoff point of 20. In principle component analysis two factors had greater Eigen value than 1. These 2 factors accounted for 76,54% of the variance in PCL-R scores. Conclusion: Turkish PCL-R is a valid and reliable measure of psychopathy to detect psychopathic traits. But more studies about psychopathy are needed to be held in different Turkish sample groups. References [1] American Psychiatric Association, 2013. Alternative diagnostic and statistical manual of mental disorders − 5 (DSM-5) personality disorders. In: American Psychiatric Association, 2013. Diagnostic and statisti-
P.1.k.014 Use of benzodiazepines in patients with hip fracture over 75 years A. Serrano1 ° , M. Su´arez Huerta2 1 Complejo Asistencial Universitario de Le´on, Psychiatry, Le´on, Spain; 2 Complejo Asistencial Universitario de Le´on, Traumatology, Le´on, Spain Introduction: The literature advises against the use of benzodiazepines (BDZ) in elderly patients as being a risk factor for falls [2], increase the risk of delirium and affect cognitive function; however we found that in clinical practice its use is widespread. Hip fractures are a common condition in a general hospital and elder people usually receives a large number of drugs. Identify all those factors that can affect the outcome of those patients is the first step to improve the clinical approach.
S361
Objectives: To evaluate the excess risk posed by the use of BDZ for hip fractures. To compare the clinical outcome during hospitalization of patients with hip fractures treated with BDZ respect to those without this treatment. Hypothesis: The use of BDZ in patients with hip fracture will be greater than the general population in their age group. The use of benzodiazepines will be associated with a longer duration of hospitalization. Factors for poor outcome will be the total number of drugs, male sex and use of benzodiacepines. Material and Methods: All patients who were admitted in the last year with hip fracture in the Hospital de Le´on were included. We collected the following data: Age, sex, length of stay, death, surgical procedure, psychopharmacological treatment and total number of drugs. We defined as a patient with poor outcome who had one or more of the following criteria: Death, length of the stay over 20 days or failure to perform surgical procedure. Results: The prevalence of BDZ among patients treated at a health center is 27.3% [1]. In our group of hip fractures was of 33.63%. We found a total of 559 patients, of whom 73.5% were women (N = 411) and 26.5% men (N = 148) and the mean age was 87.46±5.41 years. The proportion of women taking BDZ was significantly higher than men (p = 0.047). The proportion of death was not different (p = 0.77) nor the length of the stay (p = 0.74) in patients who were taking BDZ. We found a significant older age in the treatment group (p = 0.037). Among patients with poor outcome we did not found a significantly higher proportion who received BDZ (p = 0.86) although we identified as associated with poor outcome male sex (p = 0.0002) and the total number of drugs patterned (p = 0.0004). Age was not associated with poor outcome of the patients (p = 0.098). Conclusions: Consumption of BDZ is a risk factor for hip fractures. The use of BDZ is associated with female and older patients with hip fracture. The use of BDZ not raise the risk of death or poor outcome during hospitalization. Factors of poor outcome in hip fractures are male sex and the total number of patterned drugs. References [1] Bejarano Romero, F., Pi˜nol Moreso, J.L., Mora Gilabert, N., Claver Luque, P., Brull L´opez, N., Basora Gallisa, J, 2008. Elevado consumo de benzodiacepinas en mujeres ancianas asignadas a centros de salud urbanos de atenci´on primaria. Aten Primaria 40(12):617−21. [2] Bakken, M.S., Engeland, A., Engesæter, L.B., Ranhoff, A.H., Hunskaar, S., Ruths, S., 2014. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol 70: 1972–1979.
P.1.k.015 Sleep quality in psychiatric outpatients A. Fern´andez-Quintana1 ° , M.C. Garc´ıa-Mah´ıa1 , M. VidalMillares2 1 Clinical University Hospital La Coru˜na, Psychiatry, La Coru˜na, Spain; 2 Clinical University Hospital Santiago de Compostela, Psychiatry, Santiago de Compostela, Spain Introduction: Altered sleep patterns are prominent in the majority of psychiatric and behavioural disorders. Due to their cumulative long-term effects on daily functioning, sleep disorders adversely affect the quality of life of patients. Objectives: – To analyze the prevalence of sleep disorders in psychiatric outpatients treated in a Mental Health Clinic.
S362
P.1.k. Basic and clinical neuroscience − Epidemiology
– To study the comorbidity of sleep disorders with psychiatric diagnoses. Methods: The sample is composed of 225 patients treated in a Mental Health Clinic in La Coru˜na (Spain). All subjects met criteria for any of the mental disorders listed in Axis I of DSM-IV-TR. The sample was divided into three clusters for further analysis: 1. Patients with any of the mental disorders included in the Diagnostic Related Group (DRG) 430: Schizophrenia, Affective psychosis, Paranoid disorders and other functional psychosis. 2. Patients diagnosed with Depressive disorders. 3. Patients diagnosed with Anxiety disorders. 4. Patients with other diagnoses. Medical records were reviewed. Quality and patterns of sleep were evaluated using the Pittsburg Sleep Quality Index (PSQI) with a cut-off point 5−6. Results: A total of 225 patients were included in the study, of whom 36% were male and 67% were female. The mean age was 37.5 years (SD 9.32). Sleep disorders were found in 87% of patients, their prevalence was higher among women (p < 0.05). Women had a larger number of altered scales. The most altered subscales in women were Subjective Sleep Quality (p < 0.003) and Sleep Disturbances (p < 0.034). The most altered subscale in the overall sample was the Use of Sleeping Medication. Subscores in the PSQI reveal statistically significant differences between patients included in the DRG 430 and other clusters. Therefore, using contingency tables, we can assess that Subjective Sleep Quality (p < 0.004), Daytime Dysfunction (p < 0.000) and Use of Sleeping Medication (p < 0.008) are found to be more altered in patients diagnosed with mental disorders included in the DRG 430. The second cluster of psychiatric disorders which shows more sleep disturbances are depressive disorders, followed by anxiety disorders. The global score of PSQI is higher in diagnoses included in the DRG 430 compared to the other clusters analyzed in the sample (p < 0.034). Analysis of Variance determines statistically significant differences between the mental disorders included in the DRG 430 and the rest of psychiatric diagnoses, with greater alterations found in the following subscales: Subjective Sleep Quality (p < 0.000), Sleep Disturbances (p < 0.017) Daytime Dysfunction (p < 0.006), Sleep Latency (p < 0.004), Use of Sleep Medication (p < 0.007) and Global Punctuation (p < 0.001). Conclusions: Patients included in the sample have a high prevalence of sleep disorders, which are most commonly found among psychiatric diagnoses included in the DRG 430 group. These findings have relevant clinical implications, given poor quality sleep may have a powerful impact on the global functioning of psychiatric patients. Sleep disturbances in psychosis have been widely assesed as a critical factor in the course and outcome of these psychiatric disorders. References [1] Buysse DJ, Reynolds CF 3o , Monk THY, et al. “The Pitttisburgh Sep Quality Index: a new instrument for psychiatric practice and research”. Psychiatry Res. 1989 May; 28(2):193–213. [2] Hofstetter JR et al. “Quality of sleep in patients with schizophrenia is associated with quality of life and coping”. BMC Psychiatry 2005, 5:13.
P.1.k.016 Turkish reliability and validity of psychopathy checklist revised R. Tutuncu1 ° , A. Ates1 , A. Algul1 , H. Balibey1 , C. Basoglu1 Haydarpasa Training Hospital, Psychiatry, Istanbul, Turkey 1 GATA
Introduction: Psychopathy is a distinct personality organization and differs from antisocial personality disorders in many aspects. Its diagnosis is challenging but also very critical to predict criminality. In this context, Psychopathy Checklist Revised (PCL-R) is a useful tool in diagnosis of psychopathy. Its reliability and validity was showed in numerous populations but it was not studied in a Turkish population. Our aim was to show the Turkish reliability and validity of PCL-R. Method: 425 male subjects with antisocial personality disorder and 125 controls without any psychiatric diagnosis were included in the study. The Psychopathy Checklist—revised (PCL-R): It is the most common tool to assess pyschopathic characteristics and behavior patterns. It can be rated by a professional trained in the field of mental health. There are 20 items rated on a scale from 0 to 2 (0=absent, 1=maybe present, 2=definitely present). Total scores range from 0 to 40. PCL-R lists two factors and four facets. Factor 1 covers “remorseless use of others (core traits of psychopathy)” and Factor 2 covers “antisocial lifestyle”. The facet traits are described as follows: 1) Interpersonal facet traits are “superficial charm, grandiosity, lying, manipulation”, 2) Affective facet traits are “lack of guilt, shallowness, lack of empathy, failure to accept responsibility for own acts”, 3) Lifestyle facet covers “need for stimulation, parasitic lifestyle, lack of long-term goals, impulsivity irrresponsibility” and 4) antisocial facet traits are “poor behavioral controls, early behavioral problem, juvenile delinquency, conditional release, criminal versatility”. DSM-5 diagnostic criteria was used and PCL-R was administered to all participants. The reliability of the Turkish version of PCL-R was determined by test–retest and internal consistency methods. The ROC analysis performed to PCL-R, DSM-5 criteria was taken as a gold standard, the sensitivity, specificity and cut-off values of PCL-R were estimated. To evaluate the adequacy of the scale construct validity analyses by Exploratory Factor Analysis and Kaiser-Meyer-Olkin (KMO) and Barlett tests were applied. Reproductibility of test was evaluated by Pearson correlation coefficient. Re-test performed to 171 subjects two weeks after the first test. Results: As reliabilty analysis, the Cronbach’s alpha internal consistency coefficient was calculated to be as a = 0.977. Pearson correlation coefficient of test-retest was r = 0.94 (p < 0.001). Itemtotal correlations were seen to range from 0.18 to 0.94. Itemtotal score correlations were between 0.18–0.94. Its sensitivity and specificity was 98.3% and 100.0% respectively at the cutoff point of 20. In principle component analysis two factors had greater Eigen value than 1. These 2 factors accounted for 76,54% of the variance in PCL-R scores. Conclusion: Turkish PCL-R is a valid and reliable measure of psychopathy to detect psychopathic traits. But more studies about psychopathy are needed to be held in different Turkish sample groups. References [1] American Psychiatric Association, 2013. Alternative diagnostic and statistical manual of mental disorders − 5 (DSM-5) personality disorders. In: American Psychiatric Association, 2013. Diagnostic and statisti-