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Article: Standards de qualité en psychiatrie de la personne âgée.

Klöppel, Stefan / von Gunten, Armin / Georgescu, Dan

2023 Volume 112, Issue 5-6, Page(s) 1–7

Abstract: Quality Standards in Old Age ... ...

Title translation	Qualitätsstandards in der Alterspsychiatrie.
Abstract	Quality Standards in Old Age Psychiatry
MeSH term(s)	Humans ; Psychotherapy ; Workforce
Language	French
Publishing date	2023-03-31
Publishing country	Switzerland
Document type	English Abstract ; Journal Article
ZDB-ID	209026-0
ISSN	1661-8165 ; 1661-8157 ; 0369-8394
ISSN (online)	1661-8165
ISSN	1661-8157 ; 0369-8394
DOI	10.1024/1661-8157/a004028
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Article: Polysémie de l’agitation chez le sujet dément.

Schuster, Jean-Pierre / Santos, Zita / Von Gunten, Armin

Revue medicale suisse

2023 Volume 19, Issue 816, Page(s) 426–429

Abstract: Agitation is a common feature in people with dementia. Agitation can be the clinical expression of a medical condition comorbid with dementia or a behavioural and psychological symptom of dementia. In both cases, it is a clinical manifestation and not a ... ...

Title translation	Polysemy of agitation in dementia.
Abstract	Agitation is a common feature in people with dementia. Agitation can be the clinical expression of a medical condition comorbid with dementia or a behavioural and psychological symptom of dementia. In both cases, it is a clinical manifestation and not a disease in itself. This polysemy of agitation invites us to think of a global care of the demented subject taking into account the subject in his environment and their history. Reducing the treatment of agitation to sedating it amounts to a reification of the demented subject.
MeSH term(s)	Humans ; Dementia/complications ; Psychomotor Agitation/etiology
Language	French
Publishing date	2023-02-22
Publishing country	Switzerland
Document type	English Abstract ; Journal Article
ZDB-ID	2177010-4
ISSN	1660-9379
ISSN	1660-9379
DOI	10.53738/REVMED.2023.19.816.426
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Article ; Online: The geometric approach to human stress based on stress-related surrogate measures.

Kloucek, Petr / von Gunten, Armin

PloS one

2021 Volume 16, Issue 1, Page(s) e0219414

Abstract: We present a predictive Geometric Stress Index (pGSI) and its relation to behavioural Entropy ([Formula: see text]). [Formula: see text] is a measure of the complexity of an organism's reactivity to stressors yielding patterns based on different ... ...

Abstract	We present a predictive Geometric Stress Index (pGSI) and its relation to behavioural Entropy ([Formula: see text]). [Formula: see text] is a measure of the complexity of an organism's reactivity to stressors yielding patterns based on different behavioural and physiological variables selected as Surrogate Markers of Stress (SMS). We present a relationship between pGSI and [Formula: see text] in terms of a power law model. This nonlinear relationship describes congruences in complexity derived from analyses of observable and measurable SMS based patterns interpreted as stress. The adjective geometric refers to subdivision(s) of the domain derived from two SMS (heart rate variability and steps frequency) with respect to a positive/negative binary perceptron based on a third SMS (blood oxygenation). The presented power law allows for both quantitative and qualitative evaluations of the consequences of stress measured by pGSI. In particular, we show that elevated stress levels in terms of pGSI leads to a decrease of the [Formula: see text] of the blood oxygenation, measured by peripheral blood oxygenation SpO2 as a model of SMS.
MeSH term(s)	Entropy ; Heart Rate/physiology ; Humans ; Oxygen/blood ; Stress, Physiological/physiology
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-01-25
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0219414
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Article: Utilisation de la kétamine en psychiatrie : mise à jour.

Clerc, Marie-Thérèse / Rosenhagen-Lapoirie, Marcus / Von Gunten, Armin

Revue medicale suisse

2022 Volume 18, Issue 793, Page(s) 1626–1629

Abstract: Ketamine has demonstrated at a lower dose a robust and rapid antidepressant effect due to a mechanism of action different from conventional treatments. It is now included in several international recommendations on treatment-resistant depression. ... ...

Title translation	Use of ketamine in psychiatry: an update.
Abstract	Ketamine has demonstrated at a lower dose a robust and rapid antidepressant effect due to a mechanism of action different from conventional treatments. It is now included in several international recommendations on treatment-resistant depression. Ketamine may be used in both out- or in-patient settings, generally by way of intravenous or intranasal formulations provided the fulfillment of safety requirements. There is a growing interest in the use of ketamine for other resistant psychiatric disorders such as anxiety and substance use disorders. Ketamine proves an innovating and promising treatment that extends the range of therapeutic possibilities in psychiatry. We propose here to review its current clinical use.
MeSH term(s)	Administration, Intravenous ; Antidepressive Agents/therapeutic use ; Depressive Disorder, Treatment-Resistant/drug therapy ; Humans ; Ketamine/therapeutic use ; Psychiatry
Chemical Substances	Antidepressive Agents ; Ketamine (690G0D6V8H)
Language	French
Publishing date	2022-09-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2177010-4
ISSN	1660-9379
ISSN	1660-9379
DOI	10.53738/REVMED.2022.18.793.1626
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Article: Relationship Between Depression and Falls Among Nursing Home Residents: Protocol for an Integrative Review.

Matos Queirós, Alcina / von Gunten, Armin / Rosselet Amoussou, Joëlle / Martins, Maria Manuela / Verloo, Henk

JMIR research protocols

2023 Volume 12, Page(s) e46995

Abstract: Background: Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may ...

Abstract	Background: Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may become essential to ensure their continued safety and health. Depression is one of the most common psychiatric disorders among older adults, especially among those who are institutionalized. Depressed NH residents face a high risk of future functional decline and falls, decreasing their quality of life. The relationship between depression and falls is complex and bidirectional. Previous reviews have focused on home-dwelling older adults or explored the relationship between antidepressant drugs and falls. To the best of our knowledge, no integrative literature reviews have explored the relationship between depression and falls among NH residents. Objective: Analyze studies on the relationship between depression and falls among NH residents. Methods: We will conduct an integrative literature review of published articles in relevant scientific journals on the relationship between depression and depressive symptomatology and falls among NH residents. As usually defined, we will consider NH residents to be people aged 65 years and older who can no longer live safely and independently in their homes. We will also consider older adults on short-term stays in an NH for rehabilitation after hospital discharge. Retrieved articles will be screened for eligibility and analyzed following previously reported steps. The most pertinent bibliographical databases will be examined for qualitative, quantitative, and mixed methods studies, from inception until August 31, 2023, thus ensuring that all relevant literature is included. We will also hand-search the bibliographies of all the relevant articles found and search for unpublished studies in any language. If appropriate, we will consider conducting a meta-analysis of the studies retrieved. Results: A first round of data collection was completed in March 2023. We retrieved a total of 2276 references. A supplementary literature search to ensure the most up-to-date evidence is ongoing. We anticipate that the review will be completed in late September 2023, and we expect to publish results at the end of December 2023. Conclusions: This integrative review will increase knowledge and understanding of the complex relationship between depression and falls in NH environments. Its findings will be important for developing integrated, multidisciplinary models and care recommendations, adaptable to each NH resident's situation and health status, and for creating preventive interventions to help them maintain or recover optimal health stability. International registered report identifier (irrid): DERR1-10.2196/46995.
Language	English
Publishing date	2023-10-19
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/46995
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Article ; Online: Home-Dwelling Older Adults' Day-to-Day Community Interactions: A Qualitative Study.

Perruchoud, Elodie / von Gunten, Armin / Ferreira, Tiago / Queirós, Alcina Matos / Verloo, Henk

Geriatrics (Basel, Switzerland)

2022 Volume 7, Issue 4

Abstract: Background: Many home-dwelling older adults present abnormal behaviours related to dementia or to non-dementia cognitive impairment (e.g., agitation, anxiety, apathy, etc.). Because many older adults live at home alone or are able to hide any signs of ... ...

Abstract	Background: Many home-dwelling older adults present abnormal behaviours related to dementia or to non-dementia cognitive impairment (e.g., agitation, anxiety, apathy, etc.). Because many older adults live at home alone or are able to hide any signs of abnormal behaviours from others, the non-healthcare workers who interact with older adults on a daily basis are key actors in detecting those behaviours and orienting older adults towards appropriate support services. To the best of our knowledge, no studies to date have explored the daily interactions experienced between older adults and the various non-healthcare workers whom they regularly encounter in the community. This work aimed to identify the non-healthcare workers who are regularly in direct contact with older adults during their day-to-day activities and then develop specific training for these workers on the subject of abnormal behaviours among the elderly. Methods: This qualitative and ethnographic study asked 21 home-dwelling older adults aged 65 years old or more to answer open-ended questions. Sixteen had no self-reported cognitive impairments, and five had a probable or diagnosed slight cognitive impairment or mild-to-moderate dementia. A thematic analysis of the data was carried out. Results: The non-healthcare workers who spent the most time with older adults with and without reported cognitive impairments were those working in cafés or tea rooms and leisure or activity centres. Conclusions: In view of the significant amounts of contact between home-dwelling older adults and non-healthcare workers, it seems necessary and sensible to increase non-healthcare workers' knowledge about abnormal behaviours, especially by offering them training. The proactive detection and identification of older adults' abnormal behaviours by non-healthcare workers will ensure earlier care and reduce avoidable hospitalisations, institutionalisations and costs linked to geriatric healthcare.
Language	English
Publishing date	2022-08-12
Publishing country	Switzerland
Document type	Journal Article
ISSN	2308-3417
ISSN (online)	2308-3417
DOI	10.3390/geriatrics7040082
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Article ; Online: Plant sterols and cholesterol metabolism are associated with five-year cognitive decline in the elderly population.

Clark, Christopher / Gholam, Mehdi / Zullo, Leonardo / Kerksiek, Anja / Castelao, Enrique / von Gunten, Armin / Preisig, Martin / Lütjohann, Dieter / Popp, Julius

iScience

2023 Volume 26, Issue 6, Page(s) 106740

Abstract: Dysregulations in cholesterol metabolism are associated with neurodegenerative and vascular pathologies, and dementia. Diet-derived plant sterols (phytosterols) have cholesterol-lowering, anti-inflammatory, and antioxidant properties and may interfere ... ...

Abstract	Dysregulations in cholesterol metabolism are associated with neurodegenerative and vascular pathologies, and dementia. Diet-derived plant sterols (phytosterols) have cholesterol-lowering, anti-inflammatory, and antioxidant properties and may interfere with neurodegeneration and cognitive decline. Here we performed multivariate analysis in 720 individuals enrolled in a population-based prospective study to determine whether circulating cholesterol precursors and metabolites, triglycerides, and phytosterols, are associated with cognitive impairment and decline in the older population. We report specific dysregulations of endogenous cholesterol synthesis and metabolism, and diet-derived phytosterols, and their changes over time associated with cognitive impairment, and decline in the general population. These findings suggest circulating sterols levels could be considered in risk evaluation and are relevant for the development of strategies to prevent cognitive decline in older people.
Language	English
Publishing date	2023-04-24
Publishing country	United States
Document type	Journal Article
ISSN	2589-0042
ISSN (online)	2589-0042
DOI	10.1016/j.isci.2023.106740
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Article ; Online: Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study.

Pereira, Filipa / Meyer-Massetti, Carla / Del Río Carral, María / von Gunten, Armin / Wernli, Boris / Verloo, Henk

BMJ open

2023 Volume 13, Issue 9, Page(s) e072738

Abstract: Objective: This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent ...

Abstract	Objective: This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). Design: Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. Setting: Hospital and community healthcare in the French-speaking part of Switzerland. Participants: The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. Results: Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. Conclusion: By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
MeSH term(s)	Humans ; Aged ; Patient Discharge ; Retrospective Studies ; Medication Therapy Management ; Prospective Studies ; Inpatients ; Hospitals
Language	English
Publishing date	2023-09-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-072738
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Article ; Online: Psychiatric disorders, personality traits, and childhood traumatic events predicting incidence and persistence of chronic pain: results from the CoLaus|PsyCoLaus study.

Rouch, Isabelle / Strippoli, Marie-Pierre F / Dorey, Jean-Michel / Ranjbar, Setareh / Laurent, Bernard / von Gunten, Armin / Preisig, Martin

Pain

2023 Volume 164, Issue 9, Page(s) 2084–2092

Abstract: Abstract: Chronic pain (CP) is often accompanied by mental disorders (MDs). However, little is known concerning the long-term effect of MDs, personality traits, and early-life traumatic events (ETEs) on CP course. Accordingly, we aimed to prospectively ... ...

Abstract	Abstract: Chronic pain (CP) is often accompanied by mental disorders (MDs). However, little is known concerning the long-term effect of MDs, personality traits, and early-life traumatic events (ETEs) on CP course. Accordingly, we aimed to prospectively assess the associations of major depressive disorders (MDDs), anxiety disorders, personality traits, and ETEs with the incidence and the persistence of CP in middle-aged and older community dwellers. Data stemmed from the 3 first follow-up evaluations of CoLaus\|PsyCoLaus, a prospective cohort conducted in the general population of Lausanne (Switzerland). Diagnostic criteria for MDs and ETEs were elicited using semistructured interviews. CP and personality traits were assessed by self-rating questionnaires. Follow-up intervals were subdivided into 2 groups: those without (n = 2280) and those with (n = 1841) CP initially. The associations between the psychological variables and the occurrence or persistence of CP 5 years later were assessed using serially adjusted logistic regression models. Higher neuroticism (odds ratio [95% confidence interval] 1.21 [1.08; 1.36]) and extraversion (1.18 [1.06; 1.32]) were associated with higher 5-year CP incidence, whereas current (2.14 [1.34; 3.44]) and remitted MDD (1.29 [1.00; 1.66]) as well as lower extraversion (0.83 [0.74; 0.94]) were associated with persistence of CP. By contrast, ETEs and anxiety disorders were not associated with the incidence or persistence of CP. Our results suggest that personality traits are associated with both CP occurrence and persistence, whereas the MDDs may be more associated with CP persistence. Both personality and MDD are accessible to psychotherapy, and MDD is also accessible to pharmacotherapy. Hence, these therapeutic measures might decrease the risk of CP and its persistence.
MeSH term(s)	Child ; Middle Aged ; Humans ; Aged ; Depressive Disorder, Major/epidemiology ; Incidence ; Chronic Pain/epidemiology ; Prospective Studies ; Mental Disorders/diagnosis ; Personality
Language	English
Publishing date	2023-04-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000002912
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Article ; Online: Is Clozapine-induced Weight Gain Dose-dependent? Results From a Prospective Cohort Study.

Piras, Marianna / Chahma, Jihane / Ranjbar, Setareh / Laaboub, Nermine / Grosu, Claire / Plessen, Kerstin Jessica / von Gunten, Armin / Conus, Philippe / Eap, Chin Bin

Schizophrenia bulletin

2023 Volume 49, Issue 4, Page(s) 944–952

Abstract: Background: Antipsychotic-induced metabolic adverse effects are risk factors for cardiometabolic comorbidities. Whether dose lowering could mitigate such effects remains unclear. The present study aims to investigate the associations between clozapine ... ...

Abstract	Background: Antipsychotic-induced metabolic adverse effects are risk factors for cardiometabolic comorbidities. Whether dose lowering could mitigate such effects remains unclear. The present study aims to investigate the associations between clozapine doses and modifications of weight, blood pressure, blood glucose, and lipid levels. Study design: Linear mixed-effects models of weight changes over 1 year and of variations of other metabolic parameters over 4 months were applied to a prospective cohort of 115 patients. Age- and sex-stratified analyses of weight changes were also performed. Study results: Each 100 mg dose increment of clozapine was associated on average with a +0.48% weight increase (P = .004) over 1 year of treatment. Weight increase was greater for treatment duration ≤3 vs >3 months (+0.84% and +0.47% per month, respectively, P < .001), with a significant association with the dose for durations >3 months (+0.54%, P = .004) and a trend for durations ≤3 months (+0.33%, P = .075). Dose increments of 100 mg were also associated with weight increases of +0.71% among adults (P = .001), +1.91% among the elderly (P < .001) and +1.32% among men (P < .001) with no associations among women (P = .62). Among young adults, weight change was positively associated with doses ≤300 mg/day (+2.19% per 100 mg, P = .001), whereas no association was found with doses >300 mg/day (P = .60). No significant effect of clozapine dose on other metabolic parameters was found. Conclusions: This study reports a modest effect of clozapine dose increases on weight gain over 1 year with differences among age categories and sexes and no dose effect on other metabolic parameters over 4 months.
MeSH term(s)	Male ; Young Adult ; Humans ; Female ; Aged ; Infant ; Clozapine/adverse effects ; Prospective Studies ; Antipsychotic Agents/adverse effects ; Weight Gain ; Risk Factors
Chemical Substances	Clozapine (J60AR2IKIC) ; Antipsychotic Agents
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	439173-1
ISSN	1745-1701 ; 0586-7614
ISSN (online)	1745-1701
ISSN	0586-7614
DOI	10.1093/schbul/sbad009
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