Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased... more Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased HF% power, reflecting decreased parasympathetic input, and an increased VLF/HF-ratio are features of insomnia. These findings are most prominent in early N2 sleep. Sleep stage related HRV analysis delivers more sensitive markers for insomnia than common sleep EEG variables.
Material and methods PAFIP is an early intervention program for early stages of psychosis. One hu... more Material and methods PAFIP is an early intervention program for early stages of psychosis. One hundred and sixty-three were included, followed-up at regular intervals of six months for three years with administration of clinical and functional scales (BPRS, SAPS, SANS, CDRS, GAF and Drake). Patients were divided into three groups: (1) those non-users neither before the onset nor during follow-up (nn) PEP, (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn). Results No statistically significant differences were observed in terms of functionality at three-year follow-up endpoint but a trend to a better-preserved functionality in the sn group. The sn group presented lower scores in scales for positive symptoms with respect to the comparison groups. Conclusions The interruption in cannabis use may have a beneficial effect on short-term clinical prognosis and functionality on long term. Disclosure of interest The authors have not supplied their declaration of competing interest.
Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the indivi... more Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the individuals finding themselves unable to cope and progressing to prolonged grief, risking further mental and physical problems. Objective: The development and implementation of an online grief program, such as LEAVES (optimizing the mentaL hEalth and resilience of older Adults that haVe lost thEir spouSe via blended, online therapy), intends to improve prevention and treatment of prolonged grief, so that elderly mourners can continue to lead an active, meaningful and dignified life. Methods: The LEAVES program, a project under AAL (Active and Assisted Living) 2019 Call for Sustainable Smart Solutions for Ageing Well, is in development by an international consortium and integrates academical, clinical and technical experts. The project will take place between February 2020 and January 2023 and involve real-life evaluation of 315 end-users. The Psychiatric Department at the Health Unit of Baixo Alentejo (ULSBA) will offer the service to its primary users, blending online services with telephone, video calls and face-to-face sessions. Widowed older adults >65 that express the need for help in mourning their spouse will be recruited in the community as well as via the geriatric psychiatry team and primary care. Results: With LEAVES program we aim for older adults to process the loss of a spouse in a blended online/presential environment, detecting olders at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The evaluation will focus on wellbeing and involve several measures to assess grief symptoms, loneliness, hopelessness, satisfaction and quality of life. Conclusions: ULSBA will use LEAVES to improve clinical practice on preventing and managing prolonged grief as well as, after testing and validating it in this project, to save economical costs and improve effectiveness, both to hospital and patients.
Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disc... more Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disconnection in self-harm in older adults Anne Wand Loneliness and feeling disconnected have been identified as important contributing factors to self-harm in late life in epidemiological studies and are key components of Joiner's interpersonal theory of suicide. However, there have been few qualitative studies examining how loneliness (and other underlying constructs) may play a role in self-harm and what happens over time to such perceptions in older people who have self-harmed, as well as their outcomes. Objectives: To qualitatively follow-up a cohort of older people who had self-harmed, their carer and general practitioner one year later to examine their reflections on self-harm, experiences of clinical care and outcomes. Methods: A qualitative study involving in-depth interviews of older individuals (80+) who had recently harmed themselves and their carers was conducted. A narrative inquiry approach was taken. Medical records were also reviewed to evaluate outcomes. Questionnaires were sent to the older person's general practitioner to evaluate their perspectives. Interviews were audio-recorded, transcribed and thematically analysed using NVIVO. Findings: Nineteen patients (63% of the baseline sample), 29 carers (90.6%) and 11 GPs (26.7%) were available at follow-up. Over 50% of patients were living in a nursing home. Themes which emerged from patient interviews included 'more invalidation', 'being heard', 'endless suffering', 'denial and secrets', and 'miserable in care'. Themes from carer responses were 'abandonment by clinicians', 'denial and secrets', 'patient's persistent wish to die', 'unending burden for the carer' and 'distress regarding placement'. By contrast, GP themes were 'the troops have arrived', 'the problem is fixed' and 'I understand'. Conclusions: There was synergy between patient and carer perspectives, with many of the factors contributing to self-harm persisting at one year follow-up. Patients continued to feel rejected by their carers and clinicians alike, resulting in ongoing alienation, which their carers experienced too as abandonment. Suicidal secrets further isolate patients. Moving to a nursing home-which for 1/3 was a consequence of self-harm-was perceived as further invalidation, amplifying feelings of isolation. How the system of the older personcarers, general practitioners, and mental health professionals-responds to self-harm may either reinforce or attenuate underlying reasons for self-harm; with clear implications for intervention Loneliness: a multifaceted phenomenon Gabriela Stoppe Loneliness is the agonizing human experience of separation from other people or communities. Unlike the concept of social integration, loneliness cannot be quantified. Nevertheless, like other psychological phenomena, loneliness can be measured with scales. Loneliness seems to take a two-pronged course with peaks in youth and old age. Women are more often lonely than men. The causes of loneliness are manifold; they can lie in illnesses and disabilities, but also in the personality structure. In recent years, loneliness has been described as a risk factor for increased morbidity and mortality. However, it is becoming more and more apparent that loneliness is less of a cause than the associated depression. Loneliness may also be a risk factor for the development of depression, psychosis and possibly dementia. Loneliness can also have a positive connotation, in the sense of self-chosen and, for example, spiritually understood isolation. In some Western societies, loneliness is seen as a threatening phenomenon, while in some cases programmes and ministries are set up against it. Today's digitalisation is also intended to open up opportunities for participation beyond physical boundaries.
BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clini... more BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.ObjectivesDescribe the main differences between primary insomnia WSM and wSM regarding:– clinical features;– diagnosis;– management;– implications.MethodsWe conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.ResultsThe prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.ConclusionsThe clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.Disclosure of interestThe authors have not supplied their declaration of competing interest.
A young woman with autism spectrum disorder was admitted to the hospital via the emergency care u... more A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
Background: The death of a partner is a critical life event in later life, which requires grief w... more Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention's clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20).
Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased... more Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased HF% power, reflecting decreased parasympathetic input, and an increased VLF/HF-ratio are features of insomnia. These findings are most prominent in early N2 sleep. Sleep stage related HRV analysis delivers more sensitive markers for insomnia than common sleep EEG variables.
Cyclosporine A induced arteriolopathy in a rat model of chronic cyclosporine nephropathy. Chronic... more Cyclosporine A induced arteriolopathy in a rat model of chronic cyclosporine nephropathy. Chronic cyclosporine (CsA) nephrotoxicity is a major complication of heart, bone marrow, and renal transplantation, and is characterized in humans by striped interstitial fibrosis, tubular dilatation and atrophy, and hyalinization of hilar arterioles. This last feature is highly specific for cyclosporine injuiy and has been difficult to reproduce in normotensive animal models. Salt-depletion has been shown to sensitize rodents to the effects of CsA and accelerate the disease process. We conducted sequential studies in chronically salt depleted, pair fed rats treated with CsA (15 mg/kg, s.c.) or an equivalent dose of olive oil vehicle, and found a histologic lesion associated with CsA that consisted of striped cortical interstitial fibrosis, tubular dilatation and atrophy, and hyalinization of many afferent arterioles. The arteriolopathy was first detected at day 10 with progressive hyalinization of arterioles continuing until termination of the study at day 35. The arteriolopathy consisted initially of eosinophilic granular transformation of smooth muscle cells comprising afferent hilar glomerular arterioles, and progressed to foci of smooth muscle cell vacuolization and accumulation of discrete hyaline deposits in vessel walls. Electron microscopy demonstrated marked accumulation of typical renin granules throughout the smooth muscle cell cytoplasm, corresponding to the eosinophilic granular transformation revealed histologically. Immunocytochemistry confirmed the up-regulated production of renin in these vessels. This study documents a rodent model for CsA arteriolopathy and CsA-associated interstitial fibrosis that strikingly reproduces the most characteristic nephropathic effects of cyclosporine found in human patients treated with this agent. This model offers an opportunity to test therapeutic interventions that might block or ameliorate the most serious nephrotoxic effects of this drug. Cyclosporine (CsA) has improved organ transplantation survival markedly since its introduction by Borel et al [1], and cyclosporine-based immunosuppression has been used successfully as therapy for a number of primary renal and non-renal disease states as well. A major complication of long-term therapy is chronic CsA nephropathy, characterized by tubular vacuolization, striped cortical interstitial fibrosis, and a prominent vascular injury manifested by hyalinosis of hilar arterioles, and terminal portions of small muscular (interlobular) arteries [2]. This arteriolopathy is thought to be the most pathognomonic lesion of
Background The death of a partner is a critical life event in later life, which requires grief wo... more Background The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis ...
Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disc... more Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disconnection in self-harm in older adults Anne Wand Loneliness and feeling disconnected have been identified as important contributing factors to self-harm in late life in epidemiological studies and are key components of Joiner's interpersonal theory of suicide. However, there have been few qualitative studies examining how loneliness (and other underlying constructs) may play a role in self-harm and what happens over time to such perceptions in older people who have self-harmed, as well as their outcomes. Objectives: To qualitatively follow-up a cohort of older people who had self-harmed, their carer and general practitioner one year later to examine their reflections on self-harm, experiences of clinical care and outcomes. Methods: A qualitative study involving in-depth interviews of older individuals (80+) who had recently harmed themselves and their carers was conducted. A narrative inquiry approach was taken. Medical records were also reviewed to evaluate outcomes. Questionnaires were sent to the older person's general practitioner to evaluate their perspectives. Interviews were audio-recorded, transcribed and thematically analysed using NVIVO. Findings: Nineteen patients (63% of the baseline sample), 29 carers (90.6%) and 11 GPs (26.7%) were available at follow-up. Over 50% of patients were living in a nursing home. Themes which emerged from patient interviews included 'more invalidation', 'being heard', 'endless suffering', 'denial and secrets', and 'miserable in care'. Themes from carer responses were 'abandonment by clinicians', 'denial and secrets', 'patient's persistent wish to die', 'unending burden for the carer' and 'distress regarding placement'. By contrast, GP themes were 'the troops have arrived', 'the problem is fixed' and 'I understand'. Conclusions: There was synergy between patient and carer perspectives, with many of the factors contributing to self-harm persisting at one year follow-up. Patients continued to feel rejected by their carers and clinicians alike, resulting in ongoing alienation, which their carers experienced too as abandonment. Suicidal secrets further isolate patients. Moving to a nursing home-which for 1/3 was a consequence of self-harm-was perceived as further invalidation, amplifying feelings of isolation. How the system of the older personcarers, general practitioners, and mental health professionals-responds to self-harm may either reinforce or attenuate underlying reasons for self-harm; with clear implications for intervention Loneliness: a multifaceted phenomenon Gabriela Stoppe Loneliness is the agonizing human experience of separation from other people or communities. Unlike the concept of social integration, loneliness cannot be quantified. Nevertheless, like other psychological phenomena, loneliness can be measured with scales. Loneliness seems to take a two-pronged course with peaks in youth and old age. Women are more often lonely than men. The causes of loneliness are manifold; they can lie in illnesses and disabilities, but also in the personality structure. In recent years, loneliness has been described as a risk factor for increased morbidity and mortality. However, it is becoming more and more apparent that loneliness is less of a cause than the associated depression. Loneliness may also be a risk factor for the development of depression, psychosis and possibly dementia. Loneliness can also have a positive connotation, in the sense of self-chosen and, for example, spiritually understood isolation. In some Western societies, loneliness is seen as a threatening phenomenon, while in some cases programmes and ministries are set up against it. Today's digitalisation is also intended to open up opportunities for participation beyond physical boundaries.
A young woman with autism spectrum disorder was admitted to the hospital via the emergency care u... more A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
A young woman with autism spectrum disorder was admitted to the hospital via the emergency care u... more A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased... more Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased HF% power, reflecting decreased parasympathetic input, and an increased VLF/HF-ratio are features of insomnia. These findings are most prominent in early N2 sleep. Sleep stage related HRV analysis delivers more sensitive markers for insomnia than common sleep EEG variables.
Material and methods PAFIP is an early intervention program for early stages of psychosis. One hu... more Material and methods PAFIP is an early intervention program for early stages of psychosis. One hundred and sixty-three were included, followed-up at regular intervals of six months for three years with administration of clinical and functional scales (BPRS, SAPS, SANS, CDRS, GAF and Drake). Patients were divided into three groups: (1) those non-users neither before the onset nor during follow-up (nn) PEP, (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn). Results No statistically significant differences were observed in terms of functionality at three-year follow-up endpoint but a trend to a better-preserved functionality in the sn group. The sn group presented lower scores in scales for positive symptoms with respect to the comparison groups. Conclusions The interruption in cannabis use may have a beneficial effect on short-term clinical prognosis and functionality on long term. Disclosure of interest The authors have not supplied their declaration of competing interest.
Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the indivi... more Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the individuals finding themselves unable to cope and progressing to prolonged grief, risking further mental and physical problems. Objective: The development and implementation of an online grief program, such as LEAVES (optimizing the mentaL hEalth and resilience of older Adults that haVe lost thEir spouSe via blended, online therapy), intends to improve prevention and treatment of prolonged grief, so that elderly mourners can continue to lead an active, meaningful and dignified life. Methods: The LEAVES program, a project under AAL (Active and Assisted Living) 2019 Call for Sustainable Smart Solutions for Ageing Well, is in development by an international consortium and integrates academical, clinical and technical experts. The project will take place between February 2020 and January 2023 and involve real-life evaluation of 315 end-users. The Psychiatric Department at the Health Unit of Baixo Alentejo (ULSBA) will offer the service to its primary users, blending online services with telephone, video calls and face-to-face sessions. Widowed older adults >65 that express the need for help in mourning their spouse will be recruited in the community as well as via the geriatric psychiatry team and primary care. Results: With LEAVES program we aim for older adults to process the loss of a spouse in a blended online/presential environment, detecting olders at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The evaluation will focus on wellbeing and involve several measures to assess grief symptoms, loneliness, hopelessness, satisfaction and quality of life. Conclusions: ULSBA will use LEAVES to improve clinical practice on preventing and managing prolonged grief as well as, after testing and validating it in this project, to save economical costs and improve effectiveness, both to hospital and patients.
Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disc... more Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disconnection in self-harm in older adults Anne Wand Loneliness and feeling disconnected have been identified as important contributing factors to self-harm in late life in epidemiological studies and are key components of Joiner's interpersonal theory of suicide. However, there have been few qualitative studies examining how loneliness (and other underlying constructs) may play a role in self-harm and what happens over time to such perceptions in older people who have self-harmed, as well as their outcomes. Objectives: To qualitatively follow-up a cohort of older people who had self-harmed, their carer and general practitioner one year later to examine their reflections on self-harm, experiences of clinical care and outcomes. Methods: A qualitative study involving in-depth interviews of older individuals (80+) who had recently harmed themselves and their carers was conducted. A narrative inquiry approach was taken. Medical records were also reviewed to evaluate outcomes. Questionnaires were sent to the older person's general practitioner to evaluate their perspectives. Interviews were audio-recorded, transcribed and thematically analysed using NVIVO. Findings: Nineteen patients (63% of the baseline sample), 29 carers (90.6%) and 11 GPs (26.7%) were available at follow-up. Over 50% of patients were living in a nursing home. Themes which emerged from patient interviews included 'more invalidation', 'being heard', 'endless suffering', 'denial and secrets', and 'miserable in care'. Themes from carer responses were 'abandonment by clinicians', 'denial and secrets', 'patient's persistent wish to die', 'unending burden for the carer' and 'distress regarding placement'. By contrast, GP themes were 'the troops have arrived', 'the problem is fixed' and 'I understand'. Conclusions: There was synergy between patient and carer perspectives, with many of the factors contributing to self-harm persisting at one year follow-up. Patients continued to feel rejected by their carers and clinicians alike, resulting in ongoing alienation, which their carers experienced too as abandonment. Suicidal secrets further isolate patients. Moving to a nursing home-which for 1/3 was a consequence of self-harm-was perceived as further invalidation, amplifying feelings of isolation. How the system of the older personcarers, general practitioners, and mental health professionals-responds to self-harm may either reinforce or attenuate underlying reasons for self-harm; with clear implications for intervention Loneliness: a multifaceted phenomenon Gabriela Stoppe Loneliness is the agonizing human experience of separation from other people or communities. Unlike the concept of social integration, loneliness cannot be quantified. Nevertheless, like other psychological phenomena, loneliness can be measured with scales. Loneliness seems to take a two-pronged course with peaks in youth and old age. Women are more often lonely than men. The causes of loneliness are manifold; they can lie in illnesses and disabilities, but also in the personality structure. In recent years, loneliness has been described as a risk factor for increased morbidity and mortality. However, it is becoming more and more apparent that loneliness is less of a cause than the associated depression. Loneliness may also be a risk factor for the development of depression, psychosis and possibly dementia. Loneliness can also have a positive connotation, in the sense of self-chosen and, for example, spiritually understood isolation. In some Western societies, loneliness is seen as a threatening phenomenon, while in some cases programmes and ministries are set up against it. Today's digitalisation is also intended to open up opportunities for participation beyond physical boundaries.
BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clini... more BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.ObjectivesDescribe the main differences between primary insomnia WSM and wSM regarding:– clinical features;– diagnosis;– management;– implications.MethodsWe conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.ResultsThe prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.ConclusionsThe clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.Disclosure of interestThe authors have not supplied their declaration of competing interest.
A young woman with autism spectrum disorder was admitted to the hospital via the emergency care u... more A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
Background: The death of a partner is a critical life event in later life, which requires grief w... more Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention's clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20).
Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased... more Conclusions: Our results are in line with the hypothesis of hyperarousal in insomnia. A decreased HF% power, reflecting decreased parasympathetic input, and an increased VLF/HF-ratio are features of insomnia. These findings are most prominent in early N2 sleep. Sleep stage related HRV analysis delivers more sensitive markers for insomnia than common sleep EEG variables.
Cyclosporine A induced arteriolopathy in a rat model of chronic cyclosporine nephropathy. Chronic... more Cyclosporine A induced arteriolopathy in a rat model of chronic cyclosporine nephropathy. Chronic cyclosporine (CsA) nephrotoxicity is a major complication of heart, bone marrow, and renal transplantation, and is characterized in humans by striped interstitial fibrosis, tubular dilatation and atrophy, and hyalinization of hilar arterioles. This last feature is highly specific for cyclosporine injuiy and has been difficult to reproduce in normotensive animal models. Salt-depletion has been shown to sensitize rodents to the effects of CsA and accelerate the disease process. We conducted sequential studies in chronically salt depleted, pair fed rats treated with CsA (15 mg/kg, s.c.) or an equivalent dose of olive oil vehicle, and found a histologic lesion associated with CsA that consisted of striped cortical interstitial fibrosis, tubular dilatation and atrophy, and hyalinization of many afferent arterioles. The arteriolopathy was first detected at day 10 with progressive hyalinization of arterioles continuing until termination of the study at day 35. The arteriolopathy consisted initially of eosinophilic granular transformation of smooth muscle cells comprising afferent hilar glomerular arterioles, and progressed to foci of smooth muscle cell vacuolization and accumulation of discrete hyaline deposits in vessel walls. Electron microscopy demonstrated marked accumulation of typical renin granules throughout the smooth muscle cell cytoplasm, corresponding to the eosinophilic granular transformation revealed histologically. Immunocytochemistry confirmed the up-regulated production of renin in these vessels. This study documents a rodent model for CsA arteriolopathy and CsA-associated interstitial fibrosis that strikingly reproduces the most characteristic nephropathic effects of cyclosporine found in human patients treated with this agent. This model offers an opportunity to test therapeutic interventions that might block or ameliorate the most serious nephrotoxic effects of this drug. Cyclosporine (CsA) has improved organ transplantation survival markedly since its introduction by Borel et al [1], and cyclosporine-based immunosuppression has been used successfully as therapy for a number of primary renal and non-renal disease states as well. A major complication of long-term therapy is chronic CsA nephropathy, characterized by tubular vacuolization, striped cortical interstitial fibrosis, and a prominent vascular injury manifested by hyalinosis of hilar arterioles, and terminal portions of small muscular (interlobular) arteries [2]. This arteriolopathy is thought to be the most pathognomonic lesion of
Background The death of a partner is a critical life event in later life, which requires grief wo... more Background The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis ...
Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disc... more Symposia S2: Late Life Loneliness: from private condition to social emergency Loneliness and disconnection in self-harm in older adults Anne Wand Loneliness and feeling disconnected have been identified as important contributing factors to self-harm in late life in epidemiological studies and are key components of Joiner's interpersonal theory of suicide. However, there have been few qualitative studies examining how loneliness (and other underlying constructs) may play a role in self-harm and what happens over time to such perceptions in older people who have self-harmed, as well as their outcomes. Objectives: To qualitatively follow-up a cohort of older people who had self-harmed, their carer and general practitioner one year later to examine their reflections on self-harm, experiences of clinical care and outcomes. Methods: A qualitative study involving in-depth interviews of older individuals (80+) who had recently harmed themselves and their carers was conducted. A narrative inquiry approach was taken. Medical records were also reviewed to evaluate outcomes. Questionnaires were sent to the older person's general practitioner to evaluate their perspectives. Interviews were audio-recorded, transcribed and thematically analysed using NVIVO. Findings: Nineteen patients (63% of the baseline sample), 29 carers (90.6%) and 11 GPs (26.7%) were available at follow-up. Over 50% of patients were living in a nursing home. Themes which emerged from patient interviews included 'more invalidation', 'being heard', 'endless suffering', 'denial and secrets', and 'miserable in care'. Themes from carer responses were 'abandonment by clinicians', 'denial and secrets', 'patient's persistent wish to die', 'unending burden for the carer' and 'distress regarding placement'. By contrast, GP themes were 'the troops have arrived', 'the problem is fixed' and 'I understand'. Conclusions: There was synergy between patient and carer perspectives, with many of the factors contributing to self-harm persisting at one year follow-up. Patients continued to feel rejected by their carers and clinicians alike, resulting in ongoing alienation, which their carers experienced too as abandonment. Suicidal secrets further isolate patients. Moving to a nursing home-which for 1/3 was a consequence of self-harm-was perceived as further invalidation, amplifying feelings of isolation. How the system of the older personcarers, general practitioners, and mental health professionals-responds to self-harm may either reinforce or attenuate underlying reasons for self-harm; with clear implications for intervention Loneliness: a multifaceted phenomenon Gabriela Stoppe Loneliness is the agonizing human experience of separation from other people or communities. Unlike the concept of social integration, loneliness cannot be quantified. Nevertheless, like other psychological phenomena, loneliness can be measured with scales. Loneliness seems to take a two-pronged course with peaks in youth and old age. Women are more often lonely than men. The causes of loneliness are manifold; they can lie in illnesses and disabilities, but also in the personality structure. In recent years, loneliness has been described as a risk factor for increased morbidity and mortality. However, it is becoming more and more apparent that loneliness is less of a cause than the associated depression. Loneliness may also be a risk factor for the development of depression, psychosis and possibly dementia. Loneliness can also have a positive connotation, in the sense of self-chosen and, for example, spiritually understood isolation. In some Western societies, loneliness is seen as a threatening phenomenon, while in some cases programmes and ministries are set up against it. Today's digitalisation is also intended to open up opportunities for participation beyond physical boundaries.
A young woman with autism spectrum disorder was admitted to the hospital via the emergency care u... more A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
A young woman with autism spectrum disorder was admitted to the hospital via the emergency care u... more A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
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