2019年10月13日(日) 14:50 〜 16:30 第6会場 (401+402)

Organizer / Chair: Shang-ying TSAI (Department of Psychiatry, Taipei Medical University and Hospital, Taiwan), Co-chair: Tomohisa MORI (Department of Pharmacology, Hoshi University, Tokyo, Japan), Discussants: ‌Roger HO (Department of Psychological Medicine, National University of Singapore, Singapore), Jin NARUMOTO (Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan)

Background: Patients with severe mental illness (SMI) such as schizophrenia (SCZ) and bipolar disorder (BPD) are vulnerable to developing risk factors for cardiovascular diseases (CVDs), including obesity, smoking habit, hypertension, dyslipidemia, and type 2 diabetes mellitus, but they tend to receive low-quality medical care. Therefore, patients with SMI mainly die from CVDs and lose 1-2 decades of life compared to the general population. However, life expectancy has steadily increased globally; consequently, the numbers of older SMI patients in the general population are expected to increase. Thus, older patients with SMI, particularly those with illness onset at young age, constitute a survivor cohort with unique care needs. Aging is a progressively degenerative process tightly integrated with inflammation. Systemic inflammation probably plays an important role in the development of CVDs and pathophysiology of SCZ and BPD. Therefore, combination of aging and pathophysiology of SMI may accelerate the vascular atherosclerosis and brain alternation underlined by inflammatory mechanism in people with SMI after midlife. Medical burden may exert direct effect on cognition and indirect effects on social functioning. Because social functioning in older SMI patients is affected by symptom severity, cognitive impairment, and perceived physical health, patients with SMI after midlife may be considered as a more complex population than those in early life. Long-term care of older SMI patients becomes a new challenge to the mental health system. Planning for medical care that meets the health needs of this growing population of older SMI adults is critical. More than 80% of older SMI patients are community dwellers. Nonetheless, information of community-dwelling patients with SMI on the cognition, medical burden, and social functioning is scant. Therefore, the symposium will focus on these issues of community-dwelling older patients with SMI.
Objectives
The understanding of the aging effects on brain, cardiovascular system, medical burden, and overall outcome of patients with SMI is an indispensable step in building a long-term care models across the lifespan. Although there is still a significant deficit in data, the present symposium will bring some answers, innovative questions, and novel perspectives. There are four presentations in this symposium. The first presentation will discuss the aging effect on physical and cognitive function of the community-dwelling patients with SMI (SCZ and BPD). The second one will present the outcomes after 15-year community living following long-term hospitalization and the trajectory of cognitive function in older SCZ patients. The third one will focus on the cardiovascular system of SCZ in the aging process. To our knowledge, this presentation will be the first time to report the data about cardiac sonography of the geriatric patients with SCZ. The last presentation will focus on the clinical factors and inflammatory markers associated with brain change (including cortical volume reduction and stroke) of older BPD patients. At the conclusion of these presentations, participants will (1) understand better the interaction of aging process and bio-psycho-social functioning in SCZ and BPD; and (2) increase awareness of improving the general health of older patients with SMI.