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Oude Voshaar RC, Dhondt TDF, Fluiter M, Naarding P, Wassink S, Smeets MMJ, Pelzers LPRM, Lugtenburg A, Veenstra M, Marijnissen RM, Hendriks GJ, Verlinde LA, Schoevers RA, van den Brink RHS. Study design of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) project; a cohort study of older patients with affective disorders referred for specialised geriatric mental health care. BMC Psychiatry 2019; 19:182. [PMID: 31208389 PMCID: PMC6580500 DOI: 10.1186/s12888-019-2176-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Affective disorders, encompassing depressive-, anxiety-, and somatic symptom disorders, are the most prevalent mental disorders in later life. Treatment protocols and guidelines largely rely on evidence from RCTs conducted in younger age samples and ignore comorbidity between these disorders. Moreover, studies in geriatric psychiatry are often limited to the "younger old" and rarely include the most frail. Therefore, the effectiveness of treatment in routine clinical care for older patients and impact of ageing characteristics is largely unknown. OBJECTIVE The primary aim of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) - project is to examine the impact of ageing characteristics on the effectiveness of treatment for affective disorders in specialised geriatric mental health care. METHODS ROM-GPS is a two-stage, multicentre project. In stage one, all patients aged ≥60 years referred to participating outpatient clinics for specialised geriatric mental health care will be routinely screened with a semi-structured psychiatric interview, the Mini International Neuropsychiatric Interview and self-report symptom severity scales assessing depression, generalized anxiety, hypochondria, and alcohol use. Patients with a unipolar depressive, anxiety or somatic symptom disorder will be asked informed consent to participate in a second (research) stage to be extensively phenotyped at baseline and closely monitored during their first year of treatment with remission at one-year follow-up as the primary outcome parameter. In addition to a large test battery of potential confounders, specific attention is paid to cognitive functioning (including computerized tests with the Cogstate test battery as well as paper and pencil tests) and physical functioning (including multimorbidity, polypharmacy, and different frailty indicators). The study is designed as an ongoing project, enabling minor adaptations once a year (change of instruments). DISCUSSION Although effectiveness studies using observational data can easily be biased, potential selection bias can be quantified and potentially corrected (e.g. by propensity scoring). Knowledge of age-related determinants of treatment effectiveness, may stimulate the development of new interventions. Moreover, studying late-life depressive, anxiety and somatic symptom disorders jointly enables data-driven studies for more optimal classification of these disorders in later life. TRIAL REGISTRATION Dutch Trial Register: NL6704 ( www.trialregister.nl ). Retrospectively registered on 2017-12-05.
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Affiliation(s)
- Richard C. Oude Voshaar
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ton D. F. Dhondt
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Mario Fluiter
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Paul Naarding
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | - Sanne Wassink
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | - Maureen M. J. Smeets
- 0000 0004 0468 1456grid.491215.aMental Health Center GGZ Centraal, Ermelo, The Netherlands
| | - Loeki P. R. M. Pelzers
- 0000 0004 0468 1456grid.491215.aMental Health Center GGZ Centraal, Ermelo, The Netherlands
| | - Astrid Lugtenburg
- 0000 0004 0465 6592grid.468637.8Mental Health Center GGZ Drenthe, Assen, The Netherlands
| | - Martine Veenstra
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0004 0465 6592grid.468637.8Mental Health Center GGZ Drenthe, Assen, The Netherlands
| | - Radboud M. Marijnissen
- 0000 0004 0466 1666grid.491369.0Mental health Center Pro Persona, Arnhem/Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- 0000 0004 0466 1666grid.491369.0Mental health Center Pro Persona, Arnhem/Nijmegen, The Netherlands
| | | | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob H. S. van den Brink
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lindner R. [Gerontopsychosomatic consultation/liaison service in inpatient acute geriatrics : Effects of trust and support on patient-nurse interaction]. Z Gerontol Geriatr 2018; 51:404-410. [PMID: 29671085 DOI: 10.1007/s00391-018-1393-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Geriatric and psychosomatic medicine follow a biopsychosocial paradigm. Despite this similar "Menschenbild" in general, collaboration between geriatrics and psychosomatics is still rare. OBJECTIVES This comparative interventional study aims to find possible effects of psychosomatic work in geriatrics on the interaction between patients and nursing staff and contentment of patients with treatment in general. MATERIAL AND METHODS In the period of one year 238 geriatric patients (return rate 22.2%) of the intervention ward (psychosomatic consultation-/liaison service) and the control ward (TAU) were investigated with an anonymized questionnaire. Two questions were evaluated, concerning the patients trust in the nurses and their experience of being able to speak with them about their anxieties and concerns. This is interpreted as an indicator for the advancement of patients' contentment with treatment. RESULTS In comparison with the control ward during the intervention the answers to both questions showed an increasing trust in the nurses and an increasing experience of speaking about anxieties and concerns with the nurses. This is evaluated as some evidence for the promotion of the patients' contentment with the treatment CONCLUSION: A psychosomatic consultation-/liaison service in geriatric medicine generates a positive effect on the relationship between patients and nursing staff, especially concerning trust and acceptance in existential situations of illness and limitation in hospital.
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Affiliation(s)
- Reinhard Lindner
- Medizinisch-Geriatrische Klinik, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung, Universität Hamburg, Hamburg, Deutschland. .,Fachbereich Humanwissenschaften, Institut für Sozialwesen, FG Theorie, Empirie und Methoden der Sozialen Therapie, Universität Kassel, Arnold-Bode-Str. 10, 34127, Kassel, Deutschland.
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Söllner W, Wunner C, Wentzlaff E, Reichhart C, Stein B. [Psychosomatic medicine in old age]. Z Gerontol Geriatr 2017; 50:713-725. [PMID: 29170825 DOI: 10.1007/s00391-017-1337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/22/2017] [Accepted: 10/11/2017] [Indexed: 11/26/2022]
Abstract
Approximately 25% of people over 65 years old suffer from psychiatric disorders but in cases of simultaneously occurring somatic diseases the prevalence is increased. Sickness, loss of important reference persons and life crises in older age often reactivate traumatic experiences from earlier life stages. It can be difficult to differentiate between psychological disorders and the psychological symptoms accompanying somatic illness. The biographic medical history and estimation of cognitive skills within a geriatric basis assessment should be standard in geriatric diagnostics. Psychological disorders are often overlooked or inadequately treated in older people. In the case of psychopharmacological treatment, effects on somatic sickness as well as drug-drug interactions have to be kept in mind. Psychotherapeutic approaches focusing on resources and social support particularly in group therapy seem to be very helpful.
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Affiliation(s)
- Wolfgang Söllner
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - Christina Wunner
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Elisabeth Wentzlaff
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Corinne Reichhart
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Barbara Stein
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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Lindner R, Foerster R, von Renteln-Kruse W. [Ideal types of interaction patterns of psychosomatic patients in geriatric inpatient treatment]. Z Gerontol Geriatr 2014; 46:441-8. [PMID: 23640170 DOI: 10.1007/s00391-012-0381-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cooperation between psychosomatic and geriatric medicine is still sporadic and rarely institutionally integrated. At the same time, however, nearly half of geriatric inpatients suffer from psychopathological symptoms of clinical relevance. The patterns of interactions between patients and professionals of the geriatric team prior to a psychosomatic intervention that lead to a specific consultation are still rarely known. The aim of this paper was to identify these relational patterns, which can again occur during interaction with the psychosomatic patient. MATERIAL AND METHODS Protocols from the consultation sessions of 76 geriatric in-patients, treated over a period of 1 year, were used as the basis data for the development of interactional patterns with the systematic, qualitative method of forming ideal types by understanding. RESULTS Three groups with a total of 11 interactional patterns were formed: (1) "conflictuous interaction" with patients who re-enact their inner conflicts (e.g., autonomy or conflicts on power and subjugation), (2) "the problem can not be dealt with" with patients who forget or deny and repress their mental problems in other ways, and (3) "avoiding contact" with patients who have different forms of psychosocial withdrawal. CONCLUSION Extension of the geriatric functional diagnostic approach on interactional-psychodynamic aspects is possible and fosters a differentiated view on the psychosomatic situation of geriatric patients.
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Affiliation(s)
- R Lindner
- Medizinisch-Geriatrische Klinik, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung, Universität Hamburg, Sellhopsweg 18-22, 20257, Hamburg, Deutschland.
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Hilderink P, Collard R, Rosmalen J, Oude Voshaar R. Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: a systematic review. Ageing Res Rev 2013; 12:151-6. [PMID: 22575906 DOI: 10.1016/j.arr.2012.04.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/09/2012] [Accepted: 04/23/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review current knowledge regarding the prevalence of somatization problems in later life by level of caseness (somatoform disorders and medically unexplained symptoms, MUS) and to compare these rates with those in middle-aged and younger age groups. METHOD A systematic search of the literature published from 1966 onwards was conducted in the Pubmed and EMBASE databases. RESULTS Overall 8 articles, describing a total of 7 cohorts, provided data of at least one prevalence rate for somatoform disorders or MUS for the middle-aged (50-65 years) or older age (≥65 years) group. Prevalence rates for somatoform disorders in the general population range from 11 to 21% in younger, 10 to 20% in the middle-aged, and 1.5 to 13% in the older age groups. Prevalence rates for MUS show wider ranges, of respectively 1.6-70%, 2.4-87%, and 4.6-18%, in the younger, middle, and older age groups, which could be explained by the use of different instruments as well as lack of consensus in defining MUS. CONCLUSION Somatoform disorders and MUS are common in later life, although the available data suggest that prevalence rates decline after the age of 65 years. More systematic research with special focus on the older population is needed to understand this age-related decline in prevalence rates.
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Noll-Hussong M, Glaesmer H, Herberger S, Bernardy K, Schönfeldt-Lecuona C, Lukas A, Guendel H, Nikolaus T. The grapes of war. Somatoform pain disorder and history of early war traumatization in older people. Z Gerontol Geriatr 2012; 45:404-10. [PMID: 22782661 DOI: 10.1007/s00391-012-0303-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Persistent pain is not a normal part of aging. Nevertheless, many older patients have long-lasting, more or less medically unexplained pain symptoms and, consequently, are often severely disabled, incur high health care costs, and have high comorbidity rates. Moreover, the effects of early traumatization, especially due to wars, and even below the level of posttraumatic stress disorder (PTSD) are apparent. However, the developmental and neurobiological underpinnings of somatoform pain disorder, especially in pain-prone elderly patients, and its correlations with a history of war traumatization even decades after the incident remain unclear. Furthermore, a management strategy for this disorder tailored to older people and their special needs is lacking. Adequate therapeutic regimens such as adjusted psychotherapeutic procedures for elderly patients can only be promoted through a better understanding of the neurobiological and biographical underpinnings of this still controversial disorder.
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Affiliation(s)
- M Noll-Hussong
- Klinik und Poliklinik fuer Psychosomatische Medizin und Psychotherapie, University of Ulm, Am Hochstr. 8, 89081, Ulm, Germany.
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Schaefert R, Hausteiner-Wiehle C, Häuser W, Ronel J, Herrmann M, Henningsen P. Non-specific, functional, and somatoform bodily complaints. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:803-13. [PMID: 23248710 PMCID: PMC3521192 DOI: 10.3238/arztebl.2012.0803] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/19/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND 4-10% of the general population and 20% of primary care patients have what are called "non-specific, functional, and somatoform bodily complaints." These often take a chronic course, markedly impair the sufferers' quality of life, and give rise to high costs. They can be made worse by inappropriate behavior on the physician's part. METHODS The new S3 guideline was formulated by representatives of 29 medical and psychological specialty societies and one patient representative. They analyzed more than 4000 publications retrieved by a systematic literature search and held two online Delphi rounds and three consensus conferences. RESULTS Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality. A strong consensus was reached on most subjects. In the new guideline, it is recommended that physicians should establish a therapeutic alliance with the patient, adopt a symptom/coping-oriented attitude, and avoid stigmatizing comments. A biopsychosocial diagnostic evaluation, combined with sensitive discussion of signs of psychosocial stress, enables the early recognition of problems of this type, as well as of comorbid conditions, while lowering the risk of iatrogenic somatization. For mild, uncomplicated courses, the establishment of a biopsychosocial explanatory model and physical/social activation are recommended. More severe, complicated courses call for collaborative, coordinated management, including regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse), graded activation, and psychotherapy; the latter may involve cognitive behavioral therapy or a psychodynamic-interpersonal or hypnotherapeutic/imaginative approach. The comprehensive treatment plan may be multimodal, potentially including body-oriented/non-verbal therapies, relaxation training, and time-limited pharmacotherapy. CONCLUSION A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. The appropriate treatment depends on the severity of the condition. Effective treatment requires the patient's active cooperation and the collaboration of all treating health professionals under the overall management of the patient's primary-care physician.
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Affiliation(s)
- Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstrasse 2, Heidelberg, Germany.
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Abstract
The etiopathology of somatoform disorders can only be understood against the background of an integrated biopsychosocial model. Cultural and historical influences must be taken into account as well as contemporary settings of scientific or medical priorities. In this context the emphasis on neurobiological findings can be interpreted as the non-accidental struggle for legitimacy of both patients and physicians. Altogether the available data on factors influencing the formation and maintenance of somatoform symptoms has to be described as both diverse and unspecific and thus points to a challenging research program in the coming years.
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Editorial: Neue Perspektiven auf Körper, Körpererleben und Körperkrankheiten. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2011. [DOI: 10.13109/zptm.2011.57.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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