The treatment of sleep disorders in older people requires knowledge of the changes in sleep in old age. In the case of multimorbid older people, pharmacological aspects such as interactions must also be taken into account. Sleep in old age is characterised by a lower depth of sleep and more frequent awakenings. The duration of sleep corresponds to that in middle adulthood. In multimorbid older people, sleep is often chronically impaired by pain and/or obstructive breathing disorders. Many medications can have a negative effect on sleep. This applies to cortisone, for example. Antipsychotics can also worsen sleep by worsening nocturnal myoclonia. Ideally, sleep disorders should first be addressed non-pharmacologically. For benzodiazepines, preparations with a short half-life should be chosen. An algorithm is presented. References:Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics 2018;18(3):155-165. Samara MT, Huhn M, Chiocchia V, Schneider-Thoma J, Wiegand M, Salanti G, Leucht S. Efficacy, acceptability, and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta-analysis. ActaPsychiatr Scand. 2020;142(1):6-17.DisclosureNo significant relationships.

For many old people with mental health problems, access to psychotherapeutic and psychiatric help is often difficult. This is partly because going to a psychiatrist is still stigmatised, especially among the older generation. On the other hand, therapists with an interest in and competence for older people are often not sufficiently available even in the well-supplied western countries. In this situation, digitalisation offers various opportunities. Basically, the internet is a good way to promote health literacy. Classic psychoeducation can certainly be offered on the internet. And psychotherapy can also be administered with the help of the internet. Especially in the COVID-19 pandemic, the possibilities of internet-based therapies, for example Zoom or other techniques, were practised. This means that people with limited mobility can also receive therapy over long distances. This technology also makes it possible, for example, for the migrant population to receive therapy in their national language. All these possibilities are under development, but may become routine in the future. With the help of the digital possibilities, it is possible to organise helper conference. The professional exchange between relatives, family doctors, psychiatrists and other people in the help system can be easily organised in this way. The method also saves travel time, which is often not reimbursed in the health systems.DisclosureNo significant relationships.

As in other countries, in Switzerland, the rate of suicide is highest in the elderly. Assisted suicide is allowed and mostly exerted by private organizations like EXIT. The number of assisted suicide cases has doubled during the last five years and is expected to increase. It is mainly committed by women. In the age group 80 + y the number is higher than the number of suicides. To reduce the number of suicides by 25% by 2030, the federal authorities have issued a national action plan in November 2016. It includes preventive means like reduction of access to methods (weapons, drugs), construction of bridges and buildings, education of lays and professionals and specific treatment of those who have attempted suicide. There has been a position paper of Swiss public health concerning suicide prevention in the elderly. Both papers will be presented and discussed.Concerning assisted suicide there is a broad discussion on the control of the state and on the role of physicians in the process. A survey of Swiss physicians showed much ambivalence. Position papers of gerontological and geriatric societies focused on the role loneliness and the provision of adequate psychiatric help, e.g. for depression, and the overestimation of autonomy.Disclosure of interestThe author has not supplied his declaration of competing interest.

The early and correct identification and treatment of memory disorders is crucial for the well-being and prognosis of persons with dementia and their families. Family physicians are in the key position, but previous surveys showed, that their competency regarding this task is too low, although they regard dementia diagnosis as part of their job. After a pilot study with personal interviews we designed a web-based survey. It presented case vignettes, case 1 with mild cognitive impairment in a male or female version, case 2 describing a moderate dementia syndrome in a female multimorbid person. Three alternatives described a typical course of vascular dementia, Alzheimer dementia and Lewy Body dementia. One version of case 1 and case 2 each were randomized to the participants. The questionnaire consisted of open questions and those with given answer categories. From 7'603 invitations and additional reminders, we received 709 full answers (9.3%). The physicians were family physicians (50.7%), specialists for internal medicine (23.2%), psychiatrists (21.9%) and neurologists (3.5%). The respondents were representative regarding age and sex distribution for swiss physicians. Regarding diagnosis, a vascular concept of memory disorders is still strong. Alzheimer dementia is still considered by a low number of physicians. For the investigations neuropsychological screening tests were cited frequently, neuroimaging less often. Antidementia drugs were considered in about 60% of case 1 and less frequently in case 2. Non-drug approaches covered a wide range of activities and were mentioned by two thirds of the physicians. Compared to previous surveys using other methods we detect some improvement in guideline adherence. However there still remains much to do to improve medical outpatient care. We thank the Swiss Alzheimer Associaton for funding this study.

Despite evidence for its efficacy, diagnosis-specific psychoeducation is not routinely applied. This exploratory randomized controlled trial analyses the efficacy of an easily implementable bifocal diagnosis-mixed group psychoeducation in the treatment of severe psychiatric disorders regarding readmission, compliance and clinical variables, for example global functioning. Inpatients of the Psychiatric Hospital of the University of Basel (N = 82) were randomly assigned to a diagnosis-mixed psychoeducational (PE) or a non-specific intervention control group. Relatives were invited to join corresponding family groups. Results at baseline, 3- and 12-month follow-ups are presented. Better compliance after 3 months and a lower suicide rate were significant in favour of PE. For most other outcome variables, no significant differences, however advantages, in PE were found. In summary, it can be concluded that diagnosis-mixed group psychoeducation is effective in the treatment of severe psychiatric disorders. The effects can be classified as induced by distinctive psychoeducational elements. Findings similar to those on psychosis-specific programmes justify clinical application and further investigation.

Introduction Filial maturity has been discussed as important part of a successful development. In two studies we investigated, whether it is related to the subjective burden of care for demented parents and whether there are correlations to the early relationship between the caring child and their parents. Method N = 61 adult children, who took care for a demented mother and/or father were recruited fort his study. We used the following scales and tests: The Louvain Filial Maturity Scale, the Freiburger Personlichkeitsinventar for the personality profile, the Symptom Check List (SCL-90) for general psychopathology, the Nurses Observation Geriatric Scale (NOSGER) for the caregiver-rated symptom profile of the demented parent, the Zarit Burden Interview for caregiver burden. The demented parent were investigated by experts using a standardised interview for the diagnosis of dementia (SIDAM) and the MMSE for dementia severity. In the second study we interviewed N = 47 children also N = 27 of their non-caring siblings. In addition to the above mentioned instruments, we applied the Parental Bonding Scale. Results and conclusion Overall filial maturity was not related to the subjective caregiver burden as measured in this study. However, higher “parental consideration” was related to lower burden. And higher “filial obligation” was related to later nursing home admission. In contrast to their non-caring brothers and sisters, the caregivers rated their “early parents” as significantly less controlling and more caring. Both groups differed also with regard to filial maturity. Further research should clarify the role of parental bonding for the development of filial maturity.

Detection of dementia is usually a two-step procedure, consisting of screening and application of diagnostic instruments. Screening has to be done on the background of fears for stigma and loss of autonomy.There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed. We present results of a study in primary care, where we tested which elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…) would be best for this age group. All available screenings showed a good effect size of >0.70.For the application of further diagnostic tools an update of the current guidelines is given and compared to the available evidence regarding guideline implementation. As far as possible, results of an ongoing study in Switzerland will be presented.

BackgroundCognitive deficits in schizophrenia consist of deficits in attention, concentration, fluency, and executive function. Especially the working memory deficits influence everyday function and rehabilitation.ObjectiveThe ame of the study was to investigate a potential of a neurocognitive intervention in schizophrenia (CS) and multiple sclerosis (MS) by application of a computerised working memory training.MethodsSo far, 30 ms patients and 14 cs patients were investigated. Patients are allocated to a treatment group or to a control design. At baseline, all participants underwent a comprehensive neuropsychological examination including memory, working memory, attention, concentration, information processing speed, mental flexibility and intelligence. The treatment group performed a computer program (Brainstim®) four times a week over a period of four weeks. After 16 training sessions all participants were evaluated again neuropsychologically.ResultsIn both patient groups a significant increase in cognitive performance within the training procedure could be shown. This increase was expressed by an initial exponential function with a steep increase and an asymptotic slope. Pre-post-test-comparisons revealed significant improvement for shortterm and working memory on the neuropsychological outcomes. The program was well accepted by the patients.ConclusionThis preliminary results show, that working memory might be trained in schizophrenia and thus it might interfere positively the cognitive und rehabilitative outcome.

Background There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed. Method We condensed a screening battery of all elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…). Nine primary care practices took part in the study. The practice assistants were trained to approach all patients over 75y visiting the practice. Only patients with already diagnosed dementia, severe hearing or vision disability or communication deficits were excluded. After informed consent they applied the screening. Within the next days a second independent neuropsychological examination was arranged in the memory clinic of the University of Goettingen. This included established neuropsychological tests (CERAD-NP, WMS-R, TMT.) and further scales were applied (NPI, CDR..). All patients with CDR=0.5 were approached 1.5y later for a follow-up by phone. Results N=90 patients (25M, 65F) took part in the initial evaluation. From N=54 with CDR=0.5 only N=14 could be reached for follow-up. None of them returned to CDR=0, most progressed up to CDR=4. There were some correlations to education and dementia severity. All available screenings showed a good effect size of >0.70 (MMSE, DEMTECT, TFDD, RDST). Conclusion Elements for an optimal screening of the oldest old are discussed.

IntroductionWhen comparing the efficay of antipsychotics in clinical studies it would be of high practical relevance to know which doses of the respective drugs would result in equivalent blocking of dopamine-D2-receptors. This study aimed to find clinically applicable dose equivalents for haloperidol, risperidone and olanzapine.MethodAs the occurrence of EPS correlates closely with a blockade of about 80% or more of dopamin-D2-receptors the proportion of patients developing EPS in relation to various doses of either Haloperidol (n=5252), risperidone (n=5017) or olanzapine (n =5029) was calculated. This retrospective, observational study included 20.252 inpatients from 20 hospitals with a diagnosis of schizophrenia and related disorders (ICD10 F20-25). The prescription of anticholinergic medication was utilized as surrogate parameter for the occurrence of EPS. OR, RR and NNH under different doses of AP were calculated and data entered into a probit model to predict the risk of EPS over a continuous dose range. For filtering the data ToscanaJ (FBA) was used.Results1.)Same doses of risperidone and haloperidol induced the same proportion of EPS, reflected in a constant dose ratio of both drugs of ∼ 1:1 over the whole dose range.2.)Over the whole dose range there was no linear relation between olanzapine on one hand and haloperidol and risperidone on the other hand.3.)The results were corroborated by the probit analysis.ConclusionsPrevious clinical trials comparing olanzapine, risperidone and haloperidol found higher risks of EPS for Haloperidol. We propose a new model to calculate dose equivalents.

BackgroundSuicide is one of the major health problems today. The few available health economic studies have focussed on suicides. However suicide attempts, which are much more frequent, have been disregarded.MethodsWe made use of available data of the WHO-Euro-Multicentre study. During the year 2003, N=201 persons committing a suicide attempt in Basel could be accessed for health economic investigations. Due to the care structure in our region we started with the direct costs of inpatient treatment at the university (psychiatric) hospitals, which provide a wide majority of care for the people of the area, especially in emergency cases like suicide. Outpatient treatment was only calculated, if it was performed by these hospitals. This analysis included the overhead of the hospitals (staff etc.) was well as the costs provides for special services, consultation and liaison services, transports and emergency actions.ResultsWe assume that the direct costs make up only part of the total costs. For example the loss of working ability, health costs for family members, caregivers and friends affected are not included in our analyses. Against our assumption, we could not find major differences regarding the underling diagnoses. However, elderly suicide attempts were more costly. There were also gender differences. Further details will be discussed.ConclusionThe data show, that suicide attempts are expensive. Health care planers should take these data into account when discussing and deciding investments in suicide preventions.

BackgroundApolipoprotein E allele ɛ4 is a well established risk factor for Alzheimer dementia (AD). Its presence modifies also the influence of other risk factors as well as the conversion rate of mild cognitive impairment (MCI) to overt dementia. In how far it also influences the clinical presentation of AD, is not known yet.MethodPatients of the memory clinic Göttingen were approached if they fulfilled the inclusion criteria: very mild or mild AD according to NINCDS-ADRDA criteria, MMSE 20-30, and at least two of three typical instrumental findings (hippocampal atrophy in MRI, bilateral temporo-parietal hypoperfusion in Neurolite-SPET, low Aβ1-42and increased tau in CSF). They underwent an extensive neuropsychological investigation. A follow-up took place within one year.ResultsN=74 patients (38M, 36F; mean age 68.1y; MMSE 25.9 ± 2.8) and N=28 age- and sex- and education-matched controls could be recruited. N=36 patients had one (N=20) or two (N=16) APOE -ɛ4-alleles. 53 of 57 CSF analyses revealed AD-typical findings, 64 of 74 cranial MRT revealed bilateral hippocampal or global atrophy and 42 of 64 Neurolite-SPETs showed typical findings. Results of non-memory tests - language, visuospatial ability, attention - did not reveal any difference with regard to APOE genotype. Two memory tests and a memory composite score were significantly worse in the APOE -ɛ4-positive group and even worse in the homozygote group.ConclusionAPOE -ɛ4 influences in a dose dependent manner the neuropsychological functioning in mild AD.

Difficulties initiating and maintaining sleep as well as circadian rhythm disorders are very common in schizophrenia. Sleeping disorders occur as early signs of the first manifestation of illness as well as early signs of relapse. They bear a relation to positive symptoms and disorganisation of thought. Polysomnographic investigations with schizophrenic patients typically demonstrate a prolonged sleep-onset latency and a decrease in sleep efficiency and slow wave sleep. In particular, distortions of deep sleep can affect neocortical plasticity and cognition negatively. The considerable sleeping disorders are often not sufficiently taken into account in clinical routine. Particularly older antipsychotic medication like Haloperidol can affect the circadian and sleep-wake rhythms negatively. Therefore, pathophysiological changes of sleep within the scope of schizophrenic disorders and their potential implications are discussed in this outline. Regarding therapy, psychoeducative approaches are discussed as well as the administration of antipsychotic medication in accordance with the recommendations of sleep medicine professionals.

BackgroundAt least at the larger hospitals specialised gero-psychiatric units have been introduced, usually taking care of those at age 65y and higher. The advantages of this approach have been discussed and examined. The patients’ view has only rarely been investigated and mostly only from a single perspective (e.g. patient satisfaction on gero-psychiatric wards).MethodsWe performed semistructured qualitative interviews in our hospital in a balanced sample of (n=14) patients at 18-40y, (n=10) patients at 41-60y, (n=16) patients at 61-75y, (n=8) patients over 75y. There were (n=) 24 male and (n=) 24 female patients. 12 patients hat been treated exclusively in old age psychiatry, and 10 patients had been treated in old age psychiatry after their 65th birthday.ResultsThe majorities of the patients saw advantages in mixed sex and age care for the younger and for the older patients. Disadvantages where not seen for younger patients, however for the elderly the view was ambivalent (26 yes versus 22 no). Female and higher age patients and those with multiple hospitalisations tended to expect more disadvantages. While a mixed ward would be regarded as more (stimulating), disadvantages could be the combination of aggressive young and frail elderly patients as well as the overburdening of the staff.ConclusionThis is the first investigation on patient view on the segregation of old age psychiatric patients. Further studies should lead to a consumer guided care provision allowing specialisation as well as defending ageism.

International studies showed that caregiver interventions are efficacious especially when they provide the possibility to be free from caregiver role for some hours. Up to now there is no research available concerning the impact on the psychological and physical health of the involved persons.In a program developed by the memory clinic of University of Goettingen, Germany, and a diaconic social service provider, 64 lay helpers were trained for their role in a 40-hours-course. after informed consent, at three times (T0, T1 (after 6 months), T2 (after 1 year), lay helpers, caregivers and the demented patients were interviewed and standard scales were used (SCL-90, BDI, MMSE, GDS, BEHAVE-AD, NOSGER, IADL, RuD, Adult Attachment Scale etc.).31 demented patients were included, however from only 16 results at T2 could be obtained. Most patients werde moderately to severely impaired. However, during the study, their mood, mobility and circadian stability improved. the situation of the caregivers remained stable, the lay helpers showed no “negative” trends except for the result that their attitude to ageing significantly deteriorated.The data should be interpreted with caution because of the low number of persons included and the lack of a control group. in addition lay help is typically variable and other external factors might influence the results. However, because of the broad range of parameters investigated, interesting results are nevertheless worth discussion.

Germany and Switzerland are neighbour countries and have a long history of exchanging cultural and scientific issues especially - because of the common language - with the German speaking part of Switzerland (about 66% of the population). Both are federal states and laws for psychiatric patients are mainly task of the member cantons / states. However, large differences regarding the “liberal” history between both countries may be the reason for differing attitudes and regulations to involuntary admissions and guardianships. Examples will be given, especially concerning demented patients.