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Langballe E.M.,Norwegian Institute of Public Health | Engdahl B.,Norwegian Institute of Public Health | Selbaek G.,Research Center for Old Age Psychiatric Research | Selbaek G.,Ullevaal University Hospital | And 2 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2011

Purpose: Concomitant use of anti-dementia drugs with psychotropic drugs is potentially problematic in patients with dementia. The aim of this study was to investigate how frequently patients in Norway use anti-dementia drugs concomitantly with psychotropic drugs. Methods: Analyses are based on data from the Norwegian Prescription Database. All patients who had an anti-dementia drug (ATC-code N06D) dispensed from a Norwegian pharmacy between January 2004 and July 2009 were included. Results: A total of 33816 individuals received anti-dementia drugs at some time during this period. The total concomitant use of anti-dementia drugs with psychotropic drugs was 57.4% in men and 65.8% in women. Compared with men, a significantly higher percentage of women used antidepressants (35.8% versus 27.2%), mild hypnotics (28.8% versus 23.6%), benzodiazepines (25.4% versus 20.8%) and opioids (22.8% versus 17.4%) concomitantly with anti-dementia drugs. Concomitant use of antipsychotics with anti-dementia drugs was about 16% for both male and female patients. Of the total sample, 11.9% of the women and 11.7% of the men used acetylcholinesterase inhibitor (AChEI) anti-dementia drugs concomitantly with an interacting psychotropic drug. Conclusion: The concomitant use of psychotropic drugs with anti-dementia drugs was extensive, especially among women. Co-medication with potentially interacting drugs occurred at a rate of one in 10. The concomitant use of anti-dementia drugs with psychotropic drugs identified in this study may inform the ongoing clinical debate about drug use in this patient group. © 2011 John Wiley & Sons, Ltd.

Helvik A.-S.,Norwegian University of Science and Technology | Skancke R.H.,Innlandet Hospital Trust | Selbaek G.,Research Center for Old Age Psychiatric Research | Selbaek G.,University of Oslo
International Journal of Geriatric Psychiatry | Year: 2010

Aim: The present investigation screened for depression in order to assess the prevalence of depression and to study the associated factors with depression in elderly medically hospitalised patients from a rural area in Norway. Methods: A cross-sectional study evaluated 484 (243 women) elderly medical inpatients with age range 65-101 (mean 80.7) years between September 2006 and August 2008 and used the Hospital Anxiety and Depression scale (HAD), Montgomery and Asberg Depression Rating Scale, the Mini-Mental State Examination, Lawton and Brody's scale for self-maintaining and instrumental activities of daily living. Results: The prevalence of current depression, depression score ≥8 at HAD, was for the total sample 10% of whom 78% was previously not diagnosed as having depression. The odds for depression were decreased for women aged 80 years or more while for men at the same age strata it was increased threefold. Age adjusted logistic regression analyses demonstrated an increased odds for depression for those who were in need of nursing assistance before hospitalisation, had lower level of physical functioning, had clinical anxiety symptoms and had higher number of medicaments at inclusion time. Conclusion: The prevalence of depression in medical hospitalised elderly from rural areas was lower than in most other hospital studies. However, most patients with depression were not previously recognised as being depressed. Copyright © 2009 John Wiley & Sons, Ltd.

Helvik A.-S.,Norwegian University of Science and Technology | Engedal K.,Research Center for Old Age Psychiatric Research | Engedal K.,University of Oslo | Skancke R.H.,Norwegian University of Science and Technology | And 2 more authors.
Nordic Journal of Psychiatry | Year: 2011

Background: Few psychometric studies of the Hospital Anxiety and Depression Scale (HADS) scale have been performed with clinical samples of elderly individuals. Methods: The participants were 484 elderly (65101 years, 241 men) patients in an acute medical unit. The HADS, the MontgomeryAasberg Depression Rating Scale (MADRS) and questionnaires assessing quality of life, functional impairment, and cognitive function were used. The psychometric evaluation of the HADS included the following analyses: 1) the internal construct validity by means of principal component analysis followed by an oblique rotation and corrected itemtotal correlation; 2) the internal consistency reliability by means of the alpha coefficient (Cronbach's) and 3) concurrent validity by means of Spearman's rho. Results: We found a two-factor solution explaining 45% of the variance. Six of seven items loaded adequately (≥0.40) on the HADS-A subscale (item 7 did not) and five of seven items loaded adequately on the HADS-D subscale (items 8 and 10 did not). Cronbach's alpha for the HADS-A and HADS-D subscale was 0.78 and 0.71, respectively. The correlation between HADS-D and the MADRS, a measure of the concurrent validity, was 0.51. Conclusion: The HADS appears to differentiate well between depression and anxiety. The internal consistency of the HADS in a sample of elderly persons was as satisfactory as it is in samples with younger persons. In contrast to younger samples, item 8 ("I feel as if I have slowed down") did not load adequately on the HADS-D subscale. This may be attributed to the way elderly people experience and describe their symptoms. © 2011 Informa Healthcare.

Ruths S.,University of Bergen | Sorensen P.H.,Stavanger Hospital Trust | Kirkevold O.,Norwegian Center for Dementia Research | Kirkevold O.,Research Center for Old Age Psychiatric Research | And 7 more authors.
International Journal of Geriatric Psychiatry | Year: 2013

Background Psychotropic drugs are extensively prescribed for the treatment of neuropsychiatric symptoms, despite modest efficacy and severe side effects. Aims We examined trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009, in order to gain insight in practice development. Methods The study is a secondary data analysis of six cross-sectional nursing home studies conducted between 1997 and 2009. Patients aged >65 years were included. We compared the prevalence of psychotropic drugs (antipsychotics, anxiolytics, hypnotics, and antidepressants). Associations between prescription of psychotropics, and patients' age, gender, type of ward, and year of data collection were examined by univariate analysis and logistic regression. Results Altogether, 7 661 patients (mean age 85.2 years, 72.6% women) were included. Prevalence of all psychotropic drugs combined increased from 57.6% to 70.5%, anxiolytics from 14.9% to 21.9%, hypnotics from 14.5% to 22.9%, and antidepressants from 31.5% to 50.9%. Prevalence of antipsychotics varied between extremes 21.1% and 25.6%. Less prescribing of older drugs was exceeded by an increase in newer drug types. Concomitant prescribing of two or more psychotropic drugs increased from 21% to 33%. Predictors of psychotropic drugs were female gender (except antipsychotics), as well as age <80 years, and residency in special care units (except hypnotics). Conclusions Prescribing of psychotropic drugs in nursing homes has increased considerably, especially regarding antidepressants. Explanations for this trend need to be further explored. Copyright © 2012 John Wiley & Sons, Ltd. Copyright © 2012 John Wiley & Sons, Ltd.

Barca M.L.,University of Oslo | Barca M.L.,Federal University of Rio de Janeiro | Engedal K.,University of Oslo | Engedal K.,Research Center for Old Age Psychiatric Research | And 2 more authors.
Dementia and Geriatric Cognitive Disorders | Year: 2010

Background: The validity of the Cornell Scale for Depression in Dementia is seldom studied in institutions. Method: Two reliability studies, with 103 and 32 patients, and a validity study with 231 patients in nursing homes and in hospital were performed. They were assessed by the Cornell Scale, Clinical Dementia Rating scale and Self-Maintenance scale. A psychiatrist 'blind' to the Cornell assessment diagnosed depression according to the ICD-10, DSM-IV-TR and the Provisional Criteria for Depression in Alzheimer's Disease (PCD-dAD). Results: Cronbach's α values were 0.81 and 0.95, and the mean κ for the Cornell items were 0.91 and 0.57, respectively. In the validity study, 164 subjects had dementia; 105 (45.5%) had depression according to the ICD-10, 68 (29.9%) according to the DSM-IV-TR and 88 (53.3%) of the demented patients had depression according to the PCD-dAD. In the receiver operating characteristic analysis, the DSM-IV-TR criteria produced the highest area under the curve, i.e. 0.81 (95% CI: 0.75-0.87). A range of cutoff points for a depressive disorder was found for the various clinical criteria. Conclusion: The Cornell Scale is reliable and a range of cutoff points should be used for various clinical criteria of depression. © 2010 S. Karger AG, Basel.

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