- Email: [email protected]
Serum BDNF is Positively Associated with Negative Symptoms in Older Adults with Schizophrenia
2016 AAGP Annual Meeting cognitive functions. As for DHEA high level of normal range of levels was related to better results for memory both verbal and visual in the examined women after menopause. APOE polymorphism did not modify the relationship between DHEA concentration and scores for cognitive functions. Conclusions: Hormonal balance variations after menopause may influence brain processes concerned with cognition especially memory and psychomotor speed. Effects observed may be related to androgens influence on higher cortical functions in the changed hormonal dynamics of postmenopausal period.
Poster Number: NR 12
Access to Psychiatrist Services for Older Adults in Long-Term Care: A Population Based Study Dallas Seitz, MD, PhD1; Julia Kirkham, MD1; Clive Velkers, BSc1; Simone Vigod, MD, MSc2; Paul Kurdyak, MD, PhD2; Chris Perlman, PhD3 1
Queen’s University, Kingston, ON, Canada University of Toronto, Toronto, ON, Canada 3 University of Waterloo, Waterloo, ON, Canada 2
Introduction: There is a high burden of mental health disorders (MHD) among older adults in long-term care (LTC) settings. Despite the high need for psychiatric care, there may be limited access to consultations and follow-up care provided by psychiatrists for this population. At the present time there is limited information available about the overall access to psychiatric services among older adults in LTC or the factors that are associated with receiving psychiatric care in this population. Methods: We completed a retrospective cohort study involving all adults age 66 years and older who resided in LTC facilities in the province of Ontario, Canada between 2012 - 2013. We used linked administrative databases at the Institute for Clinical Evaluative Sciences which contains detailed information about demographics, psychiatric and medical history, medication use, physician outpatient and inpatient services, hospitalization data, and information derived from the Resident Assessment Instrument—Minimum Dataset version 2.0. Among this population we then determined the percentage of LTC residents who received any psychiatric care in the 90 days following participants admission to LTC or at the time of their first annual reassessment. Psychiatric care was categorized as new consultation or follow-up care and the location of the psychiatric service was described. The characteristics of participants who did and did not receive any psychiatric service were then described and compared. Multivariable logistic regression was then utilized to determine the odds ratio and 95% confidence intervals for factors associated with receiving psychiatric services. Results: A total of 65,896 unique participants were included in the study cohort. Among these participants, 28,054 (42.6%) had identified psychiatric need. Overall, 2,870 (4.4%) of older adults in LTC received any psychiatric service within 90 days including 2.1% who received a new consultation and 2.8% who received follow-up care and majority of services were provided in LTC. Receipt of any psychiatric service was positively correlated with younger age, male gender, higher educational achievement and income, prior history of major mental disorders, previous receipt of psychiatric services, indicators of psychiatric need, and access to other specialist physician services. Residence in an urban LTC facility and residence in a LTC facility with a greater number of beds were also associated with increased access to psychiatric services. Conclusions: Access to psychiatric services in LTC facilities in Ontario is limited in comparison to the high need for these services. Several factors other than psychiatric history or symptoms are associated with access suggesting inequities in access to care for this vulnerable population. Improving the distribution of psychiatric services in Ontario may help address some of these inequities and additional psychiatric resources are likely required to meet the needs of the population. This research was funded by: This project was funded through the Ontario Research Coalition.
Poster Number: NR 13
Serum BDNF is Positively Associated with Negative Symptoms in Older Adults with Schizophrenia Sasha Binford, RN, PHN; Erin Hubbard, MA; Heather Leutwyler, RN, PhD, FNP-BC UCSF, San Franicsco, CA Introduction: Older adults with chronic schizophrenia are at greater risk for functional disability and poorer health outcomes than those without serious mental illness. This population makes up 1% to 2% of the elderly population in the United States
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Am J Geriatr Psychiatry 24:3, Supplement 1
2016 AAGP Annual Meeting and is projected to number approximately 15 million by 2030. The symptoms of schizophrenia can be disabling for individuals, significantly reducing their quality of life. Often, the negative symptoms are the most resistant to treatment and are considered a marker of illness severity, though challenging to objectively measure. Biomarkers can provide an objective indicator of health status. Brain Derived Neurotrophic Factor (BDNF) is a potential biomarker for schizophrenia and may serve as an important indicator of illness severity. Methods: A cross-sectional study with 30 older adults with schizophrenia. Participants were assessed on serum levels of BDNF and psychiatric symptoms (Positive and Negative Syndrome Scale, or PANSS). Pearson’s bivariate correlations (two-tailed) and linear regression models were used. Results: Average serum levels of BDNF for the sample were 24.4 ng/ml (SD =6.0). A significant positive association was found between higher serum levels of BDNF and greater severity for the negative symptom item that included passive, apathetic, and social withdrawal (p = .01). In multivariate analyses, the association remained significant. Conclusions: Although the association between BDNF and negative symptoms was not in the expected direction, the data corroborate findings from previous work in patients with chronic schizophrenia. It is possible that higher serum levels of BDNF reflect compensatory neuronal mechanisms resulting from neuro-developmental dysfunction. This research was funded by: This work was supported by the UCSF Academic Senate [Individual Investigator Grant], National Center for Research Resources [KL2R024130 to H.L.],the National Institute of Nursing Research [P30-NR011934-0 to H.L.], the National Institute on Aging (K23AG04438), and the Jane Norbeck Award from the UCSF School of Nursing. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Poster Number: NR 14
Socially ENGAGE: Pilot Trial to Demonstrate Feasibility of an Intervention for Social Engagement Kimberly A. Van Orden, PhD1; Yeates Conwell, MD1; Patricia Arean, PhD2 1
University of Rochester School of Medicine, Rochester, NY University of Washington, Seattle, WA
2
Introduction: Older adults who are socially isolated—defined as those with restricted social networks and/or loneliness—are at risk for numerous suicide risk factors, including reduced quality of life, physical illness, functional impairment, cognitive impairment, and depression, as well as suicide ideation, attempts, and suicide deaths. The premise of this work is that among depressed older adults, social disconnectedness is both a risk factor for late-life suicide and a potential intervention target. Despite the negative consequences for late-life mental health, little is known about how to reduce social isolation and increase social engagement. Here, we present the rationale and feasibility results of a project testing the use of the ENGAGE intervention (Alexopoulos & Areán, 2014; Alexopoulos, Raue, Kiosses, Seirup, Banerjee, & Areán, 2014) as a means of increasing social engagement, and thereby reducing risk factors for suicide. ENGAGE is designed to work primarily through “reward exposure,” which, in line with RDoC principles (e.g., Insel, 2014), targets the behavioral expression of positive valence systems’ dysfunction by having patients re-engage with pleasant, physical, or social activities they may have stopped doing because of depression. For this trial, subjects were focused solely on social activities because the hypothesis of the study is, in line with the Interpersonal Theory of Suicide (Van Orden et al., 2010), that targeting social engagement will increase positive connections and contributions to others, thus reducing two proximal risk factors for suicide—thwarted belongingness and perceived burdensomeness, thereby reducing suicide risk. We report here the experience and outcomes of the first three subjects enrolled, with the objectives of demonstrating that these older adults would complete 10 sessions, develop action plans based exclusively on social engagement, and demonstrate reductions in thwarted belongingness, depression, and suicide risk. We hypothesized that the changes in thwarted belongingness would temporally precede changes in depression and suicide risk. Methods: Three older adults (age 60 or older) who were seeking services at a geriatric mental health outpatient clinic participated. All three completed 10 in-home sessions of ENGAGE (over approximately 10 weeks) delivered either by a clinical psychologist (KVO) or a geriatric social worker. Both therapists received research-grade supervision in ENGAGE. Outcomes were measured at baseline, 3 weeks, 6 weeks (mid-treatment), and 10 weeks (post-treatment). Because post-treatment data was missing for one subject, outcomes at 3 and 6 weeks are presented. Depression symptom severity was measured with the Quick Inventory of Depressive Symptoms (QIDS). Suicide risk was measured with the short form of the Geriatric Suicide Ideation Scale (GSIS). Thwarted belongingness was measured with the Interpersonal Needs Questionnaire (INQ). Results: All three subjects were willing and able to generate social engagement goals each session; e.g., taking a walk to see a friend; going to get ice cream with her daughter; helping out by walking the neighbor’s dog, indicating the feasibility of focusing ENGAGE on social engagement exclusively. Regarding quantitative outcomes (Figure 1), depression severity decreased
Am J Geriatr Psychiatry 24:3, Supplement 1
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Poster Number: NR 12
Access to Psychiatrist Services for Older Adults in Long-Term Care: A Population Based Study Dallas Seitz, MD, PhD1; Julia Kirkham, MD1; Clive Velkers, BSc1; Simone Vigod, MD, MSc2; Paul Kurdyak, MD, PhD2; Chris Perlman, PhD3 1
Queen’s University, Kingston, ON, Canada University of Toronto, Toronto, ON, Canada 3 University of Waterloo, Waterloo, ON, Canada 2
Introduction: There is a high burden of mental health disorders (MHD) among older adults in long-term care (LTC) settings. Despite the high need for psychiatric care, there may be limited access to consultations and follow-up care provided by psychiatrists for this population. At the present time there is limited information available about the overall access to psychiatric services among older adults in LTC or the factors that are associated with receiving psychiatric care in this population. Methods: We completed a retrospective cohort study involving all adults age 66 years and older who resided in LTC facilities in the province of Ontario, Canada between 2012 - 2013. We used linked administrative databases at the Institute for Clinical Evaluative Sciences which contains detailed information about demographics, psychiatric and medical history, medication use, physician outpatient and inpatient services, hospitalization data, and information derived from the Resident Assessment Instrument—Minimum Dataset version 2.0. Among this population we then determined the percentage of LTC residents who received any psychiatric care in the 90 days following participants admission to LTC or at the time of their first annual reassessment. Psychiatric care was categorized as new consultation or follow-up care and the location of the psychiatric service was described. The characteristics of participants who did and did not receive any psychiatric service were then described and compared. Multivariable logistic regression was then utilized to determine the odds ratio and 95% confidence intervals for factors associated with receiving psychiatric services. Results: A total of 65,896 unique participants were included in the study cohort. Among these participants, 28,054 (42.6%) had identified psychiatric need. Overall, 2,870 (4.4%) of older adults in LTC received any psychiatric service within 90 days including 2.1% who received a new consultation and 2.8% who received follow-up care and majority of services were provided in LTC. Receipt of any psychiatric service was positively correlated with younger age, male gender, higher educational achievement and income, prior history of major mental disorders, previous receipt of psychiatric services, indicators of psychiatric need, and access to other specialist physician services. Residence in an urban LTC facility and residence in a LTC facility with a greater number of beds were also associated with increased access to psychiatric services. Conclusions: Access to psychiatric services in LTC facilities in Ontario is limited in comparison to the high need for these services. Several factors other than psychiatric history or symptoms are associated with access suggesting inequities in access to care for this vulnerable population. Improving the distribution of psychiatric services in Ontario may help address some of these inequities and additional psychiatric resources are likely required to meet the needs of the population. This research was funded by: This project was funded through the Ontario Research Coalition.
Poster Number: NR 13
Serum BDNF is Positively Associated with Negative Symptoms in Older Adults with Schizophrenia Sasha Binford, RN, PHN; Erin Hubbard, MA; Heather Leutwyler, RN, PhD, FNP-BC UCSF, San Franicsco, CA Introduction: Older adults with chronic schizophrenia are at greater risk for functional disability and poorer health outcomes than those without serious mental illness. This population makes up 1% to 2% of the elderly population in the United States
S144
Am J Geriatr Psychiatry 24:3, Supplement 1
2016 AAGP Annual Meeting and is projected to number approximately 15 million by 2030. The symptoms of schizophrenia can be disabling for individuals, significantly reducing their quality of life. Often, the negative symptoms are the most resistant to treatment and are considered a marker of illness severity, though challenging to objectively measure. Biomarkers can provide an objective indicator of health status. Brain Derived Neurotrophic Factor (BDNF) is a potential biomarker for schizophrenia and may serve as an important indicator of illness severity. Methods: A cross-sectional study with 30 older adults with schizophrenia. Participants were assessed on serum levels of BDNF and psychiatric symptoms (Positive and Negative Syndrome Scale, or PANSS). Pearson’s bivariate correlations (two-tailed) and linear regression models were used. Results: Average serum levels of BDNF for the sample were 24.4 ng/ml (SD =6.0). A significant positive association was found between higher serum levels of BDNF and greater severity for the negative symptom item that included passive, apathetic, and social withdrawal (p = .01). In multivariate analyses, the association remained significant. Conclusions: Although the association between BDNF and negative symptoms was not in the expected direction, the data corroborate findings from previous work in patients with chronic schizophrenia. It is possible that higher serum levels of BDNF reflect compensatory neuronal mechanisms resulting from neuro-developmental dysfunction. This research was funded by: This work was supported by the UCSF Academic Senate [Individual Investigator Grant], National Center for Research Resources [KL2R024130 to H.L.],the National Institute of Nursing Research [P30-NR011934-0 to H.L.], the National Institute on Aging (K23AG04438), and the Jane Norbeck Award from the UCSF School of Nursing. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Poster Number: NR 14
Socially ENGAGE: Pilot Trial to Demonstrate Feasibility of an Intervention for Social Engagement Kimberly A. Van Orden, PhD1; Yeates Conwell, MD1; Patricia Arean, PhD2 1
University of Rochester School of Medicine, Rochester, NY University of Washington, Seattle, WA
2
Introduction: Older adults who are socially isolated—defined as those with restricted social networks and/or loneliness—are at risk for numerous suicide risk factors, including reduced quality of life, physical illness, functional impairment, cognitive impairment, and depression, as well as suicide ideation, attempts, and suicide deaths. The premise of this work is that among depressed older adults, social disconnectedness is both a risk factor for late-life suicide and a potential intervention target. Despite the negative consequences for late-life mental health, little is known about how to reduce social isolation and increase social engagement. Here, we present the rationale and feasibility results of a project testing the use of the ENGAGE intervention (Alexopoulos & Areán, 2014; Alexopoulos, Raue, Kiosses, Seirup, Banerjee, & Areán, 2014) as a means of increasing social engagement, and thereby reducing risk factors for suicide. ENGAGE is designed to work primarily through “reward exposure,” which, in line with RDoC principles (e.g., Insel, 2014), targets the behavioral expression of positive valence systems’ dysfunction by having patients re-engage with pleasant, physical, or social activities they may have stopped doing because of depression. For this trial, subjects were focused solely on social activities because the hypothesis of the study is, in line with the Interpersonal Theory of Suicide (Van Orden et al., 2010), that targeting social engagement will increase positive connections and contributions to others, thus reducing two proximal risk factors for suicide—thwarted belongingness and perceived burdensomeness, thereby reducing suicide risk. We report here the experience and outcomes of the first three subjects enrolled, with the objectives of demonstrating that these older adults would complete 10 sessions, develop action plans based exclusively on social engagement, and demonstrate reductions in thwarted belongingness, depression, and suicide risk. We hypothesized that the changes in thwarted belongingness would temporally precede changes in depression and suicide risk. Methods: Three older adults (age 60 or older) who were seeking services at a geriatric mental health outpatient clinic participated. All three completed 10 in-home sessions of ENGAGE (over approximately 10 weeks) delivered either by a clinical psychologist (KVO) or a geriatric social worker. Both therapists received research-grade supervision in ENGAGE. Outcomes were measured at baseline, 3 weeks, 6 weeks (mid-treatment), and 10 weeks (post-treatment). Because post-treatment data was missing for one subject, outcomes at 3 and 6 weeks are presented. Depression symptom severity was measured with the Quick Inventory of Depressive Symptoms (QIDS). Suicide risk was measured with the short form of the Geriatric Suicide Ideation Scale (GSIS). Thwarted belongingness was measured with the Interpersonal Needs Questionnaire (INQ). Results: All three subjects were willing and able to generate social engagement goals each session; e.g., taking a walk to see a friend; going to get ice cream with her daughter; helping out by walking the neighbor’s dog, indicating the feasibility of focusing ENGAGE on social engagement exclusively. Regarding quantitative outcomes (Figure 1), depression severity decreased
Am J Geriatr Psychiatry 24:3, Supplement 1
S145