A significant proportion of acutely ill hospitalised elderly patients have impaired consciousness and this has been associated with increased mortality. It remains unclear which factors underlie this relation. Identification of mortality predictors in this population is important to improve care.

Determine if advanced age, cognitive impairment, high burden of comorbidities and poor functional status are predictors of increased mortality during hospitalisation in acutely-ill medical hospitalised elderly patients with altered state of consciousness.

All male patients (> 65 years) admitted to a medical ward (> 48 h) between 01/03/2015 to 31/08/2015 with delirium or RASS lower than–2 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or medical condition precluding the evaluation. Baseline evaluation included socio-demographic variables, RASS, CAM, IQCODE-SF, DSM-IV-TR criteria for dementia, Charlson Comorbidity Index and Barthel Index. The variables were entered in a logistic regression model (significance level < 0.05).

The final sample consisted of 75 male subjects with altered state of consciousness, 14 of them died during hospitalisation. Dementia and Barthel Index were significantly associated with mortality during hospitalisation (P = 0.01 and P < 0.01, respectively). On the other hand, age and Charlson Co-morbidity Index were not associated significantly with mortality during hospitalisation (P = 0.22 and P = 0.1, respectively).

Acutely ill elderly patients with altered state of consciousness at admission have higher risk of death during hospitalisation if they have prior dementia or poor functional status. Health care should be improved to provide better response to this type of patients.

The authors have not supplied their declaration of competing interest.

Brain health has garnered increasing attention as a requisite condition for healthy aging. The rapid growth in mobile health and increasing smartphone ownership among older adults has paved the way for smartphones to be utilized as effective tools for improving mental fitness.

There are few studies that have explored the efficacy of smartphone-based cognitive training. The present study examined the memory-enhancing effects of smartphone-based memory training for older adults.

We explored whether newly developed application “Smartphone-based brain Anti-aging and memory Reinforcement Training (SMART)” improved memory performance in older adults with subjective memory complaints.

A total of 53 adults (mean age: 59.3 years) were randomised into either one of two smartphone-based intervention groups (SMART vs. Fit Brains®) or a wait-list group. Participants in the intervention groups underwent 15–20 minutes of training per day, five days per week for 8 weeks. We used objective cognitive measures to evaluate changes with respect to four domains: attention, memory, working memory (WM), and executive function (inhibition, fluency, etc.). In addition, we included self-report questionnaires to assess levels of subjective memory complaints.

The performance on WM test increased significantly in the SMART group (t[17] = 6.27, P < 0.0001) but not in the control groups. Self-reports of memory contentment, however, increased in the Fit Brains® group only (t[18] = 2.12, P = 0.048).

Use of an 8-week smartphone-based memory training program may improve working memory function in older adults. However, objective improvement in performance does not necessarily lead to decreased subjective memory complaints.

The authors have not supplied their declaration of competing interest.

Drug–drug interactions (DDIs) between antibiotics and psychopharmaceuticals in large national data have not been described yet.

In most European countries, there is no national data on DDIs in patients within nursing homes.

To present the most important DDIs in the Slovenian nursing homes to avoid serious DDIs in the future.

A retrospective study was carried in 2015 and with 233 patient on antibiotic treatment. All study data from the patients’ records were obtained from the patients’ charts. DDIs were determined by different interaction classes with Lexicomp Online™ 19.0 version and only X (major interactions) and D (minor interactions) were included.

A total of 233 patients (age = 83.5, SD = 9.8) were treated with antibiotics (only 2 without psychopharmaceuticals). The number of patients with at least 1 interaction was: 72 (30.9%) for X and 172 (73.8%) for D and the average number of medication/patient was 10.9 (SD = 3.9). Twenty-seven patients (11.5%) were treated with at least 1 X DDIs s (17 patients ciprofloxacin, 6 moxifloxacin, 3 azithromycin and 1 levofloxacin). Quetiapine and ciprofloxacin was most frequent DDIs occured in 12 patients. Twenty-seven DDIs were pharmacodynamic (QTc prolongation) and 3 pharmacokinetic (ciprofloxacin-tizanidine, ciprofloxacin and duloxetine in 2 patients; n = 3). Quetiapine was most frequent prescribed psychopharmaceutical in X DDIs.

DDIs between these two groups are seen very often. If an antidepressant should be used in these patients, we recommend sertraline instead of escitalopram and venlafaxine instead of duloxetine and mirtazapine instead of quetiapine. We also recommend a use of penicilins instead of ciprofloxacin and azithromycin.

The authors have not supplied their declaration of competing interest.

It has been said that nearly 30% of the patients with Alzheimer’ disease (AD) manifest loss of appetite, which might increase cognitive impairments and the incidence of neuropsychiatric symptoms, and malnutrition. As a result, a vicious cycle decreases functionality and quality of life in patients with AD. Cholinesterase inhibitors (ChEIs) is the first-line drugs in the treatment of AD. On the one hand, appetite or weight loss can be seen due to gastrointestinal side effects in the treatment of ChEIs. On the other hand, there are some reports in clinical-settings that patients with AD treated with rivastigmine transdermal patch showed the improvement of appetite loss.

To evaluate the efficacy of rivastigmine transdermal patch in AD patients with poor appetite.

In this 16-weeks, multicenter prospective study, patients with mild to moderate AD, who manifest loss of appetite and began to receive rivastigmine transdermal patch therapy, were enrolled. The amount of food, total time-eating, body weight, Mini Mental State Examination (MMSE) and Neuropsychiatric Inventory (NPI) were evaluated.

The amount of food eaten by treated patients significantly increased 10.5% at 8 weeks after the initiation of rivastigmine transdermal patch therapy.

This preliminary results might show favourable effects of rivastigmine transdermal patch therapy on AD patients with loss of appetite.

Study supported by Ono pharmaceutical co.

The Meeting Centre Support Programme (MCSP) is a community-based approach to support people living with dementia and their families. It was developed in the Netherlands and has been implemented in other European Countries (Italy, Poland and the UK) within the JPND-MEETINGDEM project.

To assess the relationship between background characteristics of people with dementia participating in MCSP, mood, quality of life (QoL) and experienced stigma, and to explore if and how the experienced stigma changed after 6 months of participation in MCSP.

A pretest (M1) post-test (M7) control group design with matched groups regarding severity of dementia was applied. In each country, a minimum of 25 participants using MCSP were compared with people with dementia receiving ‘usual care’. Data were collected with the Stigma Impact Scale, Cornell Scale for Depression in Dementia, Global Deterioration Scale and two QoL scales (QoL-AD & DQoL). Differences in background characteristics were taken into account in the analyses.

The preliminary analysis on 116 participants at baseline shows that the level of stigma was low to moderate. People felt more socially rejected in the UK than in Poland and Italy. The level of perceived stigmatization appeared negatively correlated with QoL areas and positively correlated with negative mood. Changes after 6 months will be presented.

It is expected that after 6 months people living with dementia participating in MCSP will experience less stigma, as in contrast with usual care MCSP promotes social integration of people with dementia and person-centered support.

The authors have not supplied their declaration of competing interest.

Intervention programs that highlight predictors of adjustment to aging (AtA) for minority older lesbian, gay and bisexual (LGB) populations are scarce.

The aim of this preliminary study is to build a structural model to explore whether socio-demographic, health and lifestyle-related variables, are correlates of AtA in a group of LGB older adults.

The sample comprised 287 LGB older adults aged 75 years old and older. Convenience sampling was used to gather questionnaire data. Measures encompassed the adjustment to aging scale, the satisfaction with life scale, demographics and lifestyle and health-related characteristics. Structural equation modeling was used to explore a structural model of the self-reported AtA, comprising all the above variables.

The structural model indicated the following significant correlates: perceived health (β = 0.456; P < 0.001), leisure (β = 0.378; P < 0.001), income (β = 0.302; P < 0.001), education (β = 0.299; P = 0.009), spirituality (β = 0.189; p <0 .001), sex (β = 0.156; P < 0.001), physical activity (β = 0.142; P < 0.001), satisfaction with life (β = 0.126; P < 0.001), and marital status (β = 0.114; P = 0.008). The variables explain respectively 76.4% of the variability of AtA.

These outcomes suggest that policy making and community interventions with LGB older adults may benefit of including variables, such as, perceived health, leisure and income, as these were pointed out as significant for this group of older adults for promoting adjustment to aging in late adulthood.

The authors have not supplied their declaration of competing interest.

Increasing longevity brings challenges for older adults’ satisfaction with life (SWL).

This study aims at exploring a structural model of predictors of SWL in a cross-national sample of older adults.

A community-dwelling sample of 1234 older adults was assessed regarding SWL, sense of coherence (SOC) and socio-demographic, lifestyle and health-related characteristics. Structural equation modeling was used to investigate a structural model of the self-reported SWL, comprising SOC, socio-demographic characteristics (age, sex, education, marital and professional status, household, adult children, income, living setting and religion), lifestyle and health-related characteristics (physical activity, recent disease and medication).

Significant predictors are SOC (β = .733; P < .001), religion (β = .725; P < .001), income (β = .551; P < .001), adult children (β = .546; P < .001), education (β = –.403; P < .001), living setting (β = –.292; P < .001) and medication (β = –.197; P < .001). The variables accounted for 24.8% of the variability of SWL. Moreover, differences between the four nationality groups (F(3, 671) = 3.671, P = .066) were not found concerning SWL.

Sense of coherence is the strongest predictor of self-reported SWL. Other predictors are religion, income, adult children, education, living setting and medication. The four nationalities did not present significant differences, concerning SWL. This study highlights the factors that influence older adults’ SWL, namely, SOC, religion and income, as promoters of aging well, within a salutogenic model of health for older populations.

The authors have not supplied their declaration of competing interest.

Increased caregiver burden and burn out in Alzheimer disease is associated with a spectrum of problems, like depression or anxiety.

To examine the relationship between the burden of care and burnout level of professional staff dealing with Alzheimer's disease patients in geriatric inpatient centers in Turkey.

Zarit Caregiver Burden Scale to measure the level of burden of care, and Maslach Burnout Inventory were used to measure the level of burnout. Relationships between the socio-demographic data of the sample group, burden of care and burnout level were investigated. Sample group was consisting of 203 caregivers working in 8 geriatric care centers in Istanbul.

The surveyed caregivers’ “burden of care giving” level was low (35.3 ± 9.9); “emotional exhaustion” level was weak (2.3 ± 0.8); “depersonalization” level was weak (1.9 ± 0.6); “a feeling of low personal accomplishment” level was weak (2.5 ± 0.8); “general burnout” level was weak (2.3 ± 0.5). There was positive correlation between caregiver burden and burnout level. According to the sociodemographic data, married women with children were especially in increased risk for burnout. Low level of education was associated with increased caregiver burden and burnout. Caregiver burden and depersonalization points were also higher with increasing age.

Supportive interventions are needed to decrease the burnout and caregiver burden especially for the caregivers with increased risk.

The authors have not supplied their declaration of competing interest.

Assessment of renal function in elderly with dementia is a difficult clinical problem due to the high prevalence of malnutrition and creatinine limits as a marker of glomerular filtration in this context.

To assess the correlation between renal function and dementia diagnosis.

To highlight differences between methods of assessment of renal function based on creatinine and cystatin C.

Cross-sectional study. Patients institutionalized at Bucharest City-Center of Socio-Medical Services (a nursing home) from 04/2014 to 11/2014 were included in the study. Dementia diagnosis was established by a psychiatrist. We determined serum creatinine by Jaffe method and serum cystatin C by nephelometry. Renal function was determined using several formulas based on serum creatinine/cystatin C: Cockcroft–Gault, MDRD, creatinine CKDEPI/cystatin/creatinine + cystatin, Berlin Initiative Study (BIS1, BIS2), Lund-Malmo LM-LBM. To highlight a link between dementia and renal function, we determined Spearman correlation coefficients.

Thirty-one patients were included in the study, mean age 78.6 (63–97) years, 64% women. The diagnosis of dementia (1 = positive, 0 = negative) had the following statistically significant correlations: CKDEPIcystatin: rho = –0.390, P = 0.015; CKDEPI creatinine-cystatin: rho = –0.332, P = 0.032; BIS2: rho = –0.346, P = 0.02. We did not find statistically significant correlations between the diagnosis of dementia and formulas for assessing renal function based on creatinine only.

Elderly patients with dementia present decreased kidney function as determined by formulas based on cystatin/cystatin + creatinine, but not on creatinine alone. Assessment of renal function using cystatin C might represent a useful method for detection of renal dysfunction in these patients and for proper dosage of medication.

The authors have not supplied their declaration of competing interest.

The global burden of mental disorders is large and continues to grow. Depression is the leading cause of disability worldwide. Every 40 seconds somebody dies from suicide. People with mental disorders are amongst the most marginalized in society. The stigma they experience puts them at an increased risk of poverty, discrimination and human right violations.

To study the presence of psychiatric disorders in the media.

We selected and analyzed the top media Twitter accounts of general news outlets, based on their number of followers. Our research strategy focused on the search of several psychiatric terms of interest (ex: “insomnia”) on each Twitter account. The search includes tweets from the beginnings of Twitter in 2007 up to May 2016, and yielded a database of more than 10,000 news.

The terms with the highest impact in mass media referred to suicide, depression, addictions and gender dysphoria. Disorders related to anxiety (Generalized anxiety, phobias, panic disorder, obsessive-compulsive disorder), dysthymia and bipolar disorder were the psychiatric disorders with the lowest impact. We noticed that the presence of psychiatric disorders in the media is increasing. However, it does not accurately reflect the actual impact it has on society.

The media can be a useful tool for the implementation of strategies for the promotion and prevention of mental disorders. However, we are not fully taking advantage of the benefits that mass media has to offer in order to educate and raise awareness about said disorders.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Previous research suggests that adult anxiety disorders begin in adolescence and the transition from primary school to secondary school is the first challenge many young adolescents face, which could test their resilience for the first time.

To examine students’ anxiety scores before and after their transition, and what protective and risk factors are present during this challenge.

To determine how the transition can impact anxiety in children, and if protective factors can help decrease the disruption that the transition can cause.

One hundred and eighty-four pupils completed questionnaires in their last term of primary school and during the first term of secondary school. At time 1: the attachment, school membership, and bullying and victimization measures were compared with pupils’ anxiety scores, along with whether their friends or siblings will be attending the same secondary school as them. These analyses will also be conducted once the pupils start secondary school, at time 2.

Secure attachment was associated with lower anxiety and transition anxiety (F(2.56) = 7.255, P = .002; F(2.52) = 19.245, P = .000; F(2.181) = 10.181, P = .000; F(2.53) = 20.545, P = .000). School membership was associated with lower transition anxiety (F(2.181) = 4.151, P = .017; F(2.181) = 3.632, P = .028). Low victimisation was also associated with low anxiety and transition anxiety (F(2.181) = 14.024, P = .000; F(2.181) = 14.529, P = .000; F(2.181) = 9.381, P = .000).

These preliminary results suggest that attachment, school membership and victimisation all impact on pupils anxiety before they transition to secondary school. Therefore, schools could work together to increase school membership and decrease victimisation, particularly for pupils who they suspect will struggle with the transition.

The authors have not supplied their declaration of competing interest.

The study aimed to assess the relationship between mental disorders symptoms with pain coping strategies in dentistry clinics.

One hundred and twenty people with dental pain that attended in dentistry clinics were randomly selected and responded to Rosenstein and Keefe's Pain Coping Strategies Questionnaire (PCSQ) and Derogatis's Symptom Checklist (SCL-90-R). PCSQ assesses six pain coping strategies: diverting attention, reinterpretation pain sensation, self-negotiation, ignoring pain, disastrous thought, hope–praying, and SCL-90 measures nine dimensions: somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The data were analysed with Pearson correlation coefficient and independent t-test.

Findings showed positive and significant relationship between disastrous thought with all mental disorders symptoms; and reinterpretation pain sensation with depression and anxiety. Also there is negative significant relationship between ignoring pain with obsessive compulsive, interpersonal sensitivity and somatization; and hope – praying with interpersonal sensitivity, depression, anxiety, paranoid ideation and psychoticism. Meanwhile there were significant differences in males and females. Females got more scores in ignoring pain than males, and males got more scores in anxiety, hostility and paranoid ideation tan females.

With regard to findings, it is recommended that in addition to drug treatment, for changing the attitudes and thinking in patients with dental pain, psychiatrists and psychologists apply psychological treatments specially cognitive-behavior therapy to reduce abnormal thinking level about pain so that the length during of treatment declines, and as a results reduce the personality and health problems that is related with dental pain before and in during of drug treatment.

The authors have not supplied their declaration of competing interest.

The work describes a successful experience in the utilization of art as a tool to work the prevention of the use of drugs. The experience was developed with children and adolescents between the ages of 3 and 17 who reside in a risky area near Latin America's biggest dump, located in the city of Taguatinga, FD, Brazil.

Create a therapeutic space to make possible the dialog with the children and adolescents, promoting the prevention and the consciousness about the harm of the use of psychoactive substances, providing clarification on the theme, through art, being the use of formal language and terms, like “illicit drugs”, unnecessary.

The children, who participated in the project, used, as expression tool, several painting items. The public was divided by age in two groups: the children received ludic approach, allowing the team nearness and interaction with them, in such a way that the former transmitted information and guidance about the harm on the use of psychoactive substances.

The results were satisfactory. All the children and adolescents involved in the project demonstrated adhesion to the use of the offered tools and established a communication link, which allowed the receptivity of information about prevention in the use of psychoactive substances.

Through the developed activities, it was observed that the strategy utilization of art as a language had better effiency than a formal approach since the children and adolescents could have a learning space in a spontaneous way, demonstrating interest.

The authors have not supplied their declaration of competing interest.

Metabolic syndrome (MetS) parameters are: elevated waist circumference (WC), triglycerides (TG), fasting glucose (FBG) and blood pressure (BP) and reduced high-density lipoprotein cholesterol (HDL). MetS parameters are associated with poor cognition and this association should be studied in the context of other factors. In particular, factors that are involved in maintaining poor lifestyle choices – MetS is largely a lifestyle illness. One factor important to consider is cognitive insight – an individual's ability to be flexible in how you think about yourself and others and to question your own thoughts.

To conduct an exploratory cross-sectional study investigating the influence of cognitive insight on the relationship between MetS parameters and cognition in non-psychiatric individuals.

To explore the nature of the relationship between cognition and MetS parameters and test whether cognitive insight moderates the association.

Our sample consisted of n = 156 participants with mixed-ancestry. Correlations between MetS parameters and cognition were tested. ANOVA was used to test interaction effects and logistic regression was done to test the predictive power of selected factors.

BP correlated with attention, delayed memory, and RBANS total scale score. The BCIS self-certainty subscale moderated the relationship between BP and immediate memory and attention. Age and BCIS self-certainty were the only predictors of elevated BP.

Good cognitive insight act as protective factor and reduce the impact of elevated BP on cognition. Cognitive insight may be a predictor of elevated BP.

The authors have not supplied their declaration of competing interest.

Fatigue is a common and debilitating problem in cancer survivors. Research show that this symptom endures even in disease-free patients affecting quality of life. Returning to work is physically and emotionally demanding for this population and fatigue levels seems to predict the time taken to return to work and the ability of the worker.

Our main objective was to explore the direct effect of the fatigue on work ability and quality of life of professionally active cancer survivors. Aims Fatigue levels, work ability and overall quality of life of survivors group were compared with a sample of individuals without cancer history. Relationship between fatigue symptoms and work ability and quality of life were examined within of the survivors group.

This cross-sectional study included 57 cancer survivors and 57 controls (n = 114) and data was collected from two Central Hospitals of Portugal. Participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue, the Work Ability Index and the Functional Assessment of Cancer Therapy-General.

Cancer survivors reported higher levels of fatigue than controls and worse work ability and quality of life (P < .001). Controlling the effect of the age and gender, fatigue of the cancer survivors group influenced negatively their overall quality of life (β= –.315, P= .013, R2= .143) but not their work ability.

Although the fatigue has not affected directly the work ability of the cancer survivors, two years or more after the conclusion of the treatments, this symptom has a significant effect on the quality of life.

The authors have not supplied their declaration of competing interest.

The British National Foundation for Educational Research poll found that two thirds of school teachers feel they lack the appropriate training to help identify mental health issues in pupils.1 National Foundation for Education Research, http://www.gov.uk/government/uploads/DFE-June2015.

I contacted 10 schools in London and teachers gave similar responses to the above poll, stating teachers did not feel confident identifying or managing common mental health issues in children and adolescents aged 5–18.

To deliver mental health training in a user friendly way to teachers and enable them to identify common mental health issues in young people.

Address underlying concerns teachers have regarding pupils mental health. Discuss strategies to manage common mental health issues.

I delivered a 2-hour training workshop to 25 teachers in two different schools in London, June 2016. The training included a lecture on emotional/behavioural and communication disorders in children. There was interactive discussion with teachers, discussing various scenarios, such as children becoming tearful, showing limited eye contact and displaying aggressive behaviour. We discussed how teachers were dealing with this and how better they could manage the situation.

I got excellent feedback from teachers, 100% of teachers found the training very useful and would like to have more training of this kind in the future. A multidisciplinary approach is needed to improve the management of mental health in young people.

There is a gap in the knowledge teachers have on mental health within the young people and the stigma of mental health makes it more difficult for teachers to address these issues.

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

Emotional control can play positive role in professional growth. Are there any negative effects of emotional control on the professional activity of physicians and teachers?

To reveal the specifics of emotional control in groups of physicians and teachers with different self-reported health levels.

The study involved 160 physicians and 179 school teachers. Gender ratio and mean age in both groups were similar. The instruments used: SF-36 health survey and Ban on the emotional expression questionnaire.

In general, physicians, and teachers more often than control group controlled the expression of their emotions. Physicians in comparison with teachers were more likely to restrict both positive (joy) and negative emotions (sadness, anger). Teachers with a high level of health by SF-36 had a minimal ban on the expression of sadness (P < 0.01). The maximum level of the ban on the expression of anger (P < 0.001) and fear (P < 0.05) and an aggregated ban of emotional expression was revealed in teachers with average level of health by SF-36 (P < 0.001). Expression of joy in teachers was not directly related to the self-reported health level (P > 0.05). Physicians who showed the maximum ban on the emotion expressions reported only the low health level by SF-36 (P < 0.05). It was more related to the ban on joy, and less to the ban on anger.

The revealed models of emotional expression control can strengthen both professional and everyday stresses in physicians and teachers. Different prevention programs are needed for these groups of professionals.

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

In 2011, the Royal College of Psychiatrists in UK published a five-year plan to boost recruitment to a 95% fill rate for core training posts. Psychiatric summer schools were one of the methods outlined to improve recruitment. These are 3-day courses allowing attendees to explore different subspecialties and showcase inspiring psychiatrists who are leaders in their field.

To evaluate whether attending a Psychiatry Summer School improves scores on the attitudes towards Psychiatry Scale (ATP-30) in Medical Students (MS) and Junior Doctors (JD).

Two free courses were held; one for MS in August 2016 and one for JD in November 2015. These involved interactive talks from consultant psychiatrists in various sub-specialties and a day in a forensic setting. All attendees were asked to complete ATP-30 before and immediately after attendance. A higher ATP-30 score indicates a more positive the attitude the minimum score is 30 and the maximum is 50. Paired scores were analysed using a paired t-test.

Thirty-three out of 45 attendees completed ATP-30 MS (n = 20/24) and JD (n = 13/21) before and after the course. The mean ATP30 score was 116 before attendance and 128 after the course, the mean difference was +12. When the two samples were compared using a paired t-test, there was a significant positive difference P < 0.0005.

Psychiatry summer schools can improve attitudes towards psychiatry in medical students and junior doctors.

The authors have not supplied their declaration of competing interest.