Old Age Psychiatry
Objectives
The primary focus of research in this department is the heterogeneity of affective disorders in old age, studied from three perspectives: first, population based epidemiological studies, second, collaborative care studies carried out mostly in primary care and third, studies in clinical populations. The clinical research program on this third topic is closely connected with regular care and treatment programs in the department of old age psychiatry. In addition there is a regular stream of third referral patients with neuropsychiatric disorders and difficult to treat affective disorders with comorbidity. Bipolar disorders and psychosis, being seriously neglected research topics in geriatric psychiatry to date, have more recently become points of interest in specialised patient care and research.
One of the major strengths of this department is a rich variety of educational and training programs in old age psychiatry. There are specialised programs for all disciplines: nurses, (neuro) psychologists, nursing home physicians, general practitioners and residents in psychiatry with comprehensive training programs.
Collaborations
From a perspective of collaborative care there are strong connections with the departments of primary care, nursing home care and clinical psychology. This collaboration has led to multiple intervention programs in the field of anxiety and depression in the elderly. With regard to specialised geriatric psychiatry programs, four departments from institutions for mental health in the elderly in the Netherlands collaborate in depression research (e.g. NESDO) as well as three academic departments (LUMC, UMCN, UMCG). In collaboration with some of these partners specific topics are the subject of research: electroconvulsive therapy (ECT) in depressed elderly and anxiety in old age. On the field of neuropsychiatric disorders there has been close collaboration with the Alzheimer centre and the neurological department of the VUmc since a long period. The same applies for internal medicine in the field of patient care (COGA) and training programs for residents.
The geriatric psychiatry department is the largest one of GGZ iNGeest with about 6500 patients in treatment facilities, a staff of 20 geriatric psychiatrists and 8 residents training in old age psychiatry.
Results
With respect to specialised patient care in old age psychiatry, the rate of third referrals is 15-20 % in appropriate divisions of GGZ InGeest. Several trials of collaborative care and prevention of depression in the elderly were conducted and are currently carried out. Three cohorts of old age patients in specialised care have been gathered during the last years: 81 clinical patients with severe depression and comorbidity treated with ECT (2002-2007), 120 elderly with psychosis (2004-2008) and 120 elderly with bipolar disorder (2002-2006). Follow-up studies are on their way.
Currently all partners in the NESDO study are including eligible patients with depression with an aim of 400 patients included in the next years (see also website NESDO).
Contact information
Max Stek: M.L.Stek@ggzingeest.nl en M.L.Stek@vumc.nl