Ana Cardoso

Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG) population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site). Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80–10.90) using the 10/66 DRG algorithm and 3.65% (95% CI 2.97–4.97) using DSM-IV criteria. Pure Alzheimer’s disease was the most prevalent dementia subtype (41.9%). The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two approaches remains to be confirmed in the European context. We improved the evidence base to raise awareness and empower advocacy about dementia in Portugal, so that the complex needs of frail older people may be met in better ways.

Introduction: Non-adherence is a problem throughout medicine and there are many strategies that are used to improve antipsychotic adherence. A review of the literature identified 33 commonly cited strategies for enhancing consumer adherence. Three core themes were identified: Information/Education; Behavioural strategies; and Cognitive/Motivational strategies.Aims/objectives: To develop the Portuguese version of the DIAS.Methods: The DIAS was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. The participants were asked to rate how often they had difficulties using each of the 33 strategies with consumers who were non-adherent. A four point Likert scale was used (1 = never; 4 = always) such that higher scores indicated more frequent difficulty using the strategy.Results: A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in DIAS was 85.0 (SD14.6). The value of internal reliability coefficient α was 0.93. The intraclass correlation coefficient of total MABQ score was 0.45. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (84.5 vs.90.5; P = 0.04).Conclusion: Interventions to improve antipsychotic adherence would benefit from further research. However, it is important always to bear in mind that none of these strategies can be a substitute a positive therapeutic alliance. The Portuguese version of DIAS will provide professionals with a new tool to evaluate the frequency how strategies are implemented and the impact of each strategy in treatment adherence.Disclosure of interest: The authors have not supplied their declaration of competing interest.

Introduction: Clinician's attitudes are an important consideration in implementing adherence strategies and that these attitudes can be successfully improved as a result of training. The 22-item Medication Alliance Beliefs Questionnaire (MABQ; Byrne et al.2008) was used to assess clinician attitudes towards non-adherence. The MABQ contains five subscales reflecting the clinician's self-efficacy (adequacy), the satisfaction (work satisfaction); their appraisal of their self-worth (self-esteem), their outcome expectancies (pessimism) in relation to non-adherent patients, and the extent to which they understand the difficulties patients might experience in trying to adhere to treatment (empathy).Aims/objectives: To develop the Portuguese version of the MABQ.Methods: The MABQ was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. After pre-testing, the final version of the Portuguese translation was produced.Results: A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in MABQ was 80.06 (SD 9.5). The value of internal reliability coefficient α was 0.80. The intraclass correlation coefficient of total MABQ score was 0.35. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (80.4 vs.76.2; P = 0.02).Conclusion: The attitudes of mental health professionals may have a predictive relationship with treatment outcomes of patients with mental health disorders. The validation of the Portuguese version of MABQ will provide professionals with a new tool to evaluate crucial issues related to medication beliefs.Disclosure of interest: The authors have not supplied their declaration of competing interest.

Introduction: The therapeutic alliance might be the most important part of beginning clinical relationship and may have an important impact in treatment adherence. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome.Objectives: To assess clinical skills and attitudes in mental health professionals(MHP).Aims: This study explore the impact of clinical skills and socio-demographic factors related MHP may have on treatment adherence of patients with mental health disorders (MHD).Methods: In this cross sectional study, we use a convenience sample of MHP working in the mental health departments of three general hospitals in Lisbon great area. Data is being collected through individual interviews. We used a optimism scale (ETOS), Medication Alliance Beliefs Questionnaire (MABQ), and socio-demographic and clinical questionnaire.Results: A convenience sample composed of sixty-five mental health clinician working in a variety of settings is being collected. We don’t found statistically significant differences between the therapeutic optimism and the socio-demographic and clinical characteristics of MHP. The average values of optimism found in MHP with additional training in skills training it was higher (t test = 1,64). The results demonstrate that the most of clinicians (n = 42; agree 64,6%; strongly agree, n = 19; 29,2%) believe that have the capacity to positively influence outcomes for people with mental disorders.Conclusion: This topic, along with a detailed examination of the relationship between therapeutic alliance and treatment adherence, will be the subject of future research projects.Disclosure of interest: The authors have not supplied their declaration of competing interest.

Introduction: Insight is an important factor associated with non-compliance and poor outcome. Poor level of insight has been described as a characteristic in patients with acute bipolar disorder with more unawareness in social consequences. In contrast, awareness of having a mental disorder, of its symptoms, of its consequences, and/or of the need for treatment is associated with a number of positive prognostic indicators. Insight is also linked, however, to depression and suicidal ideation in bipolar disorder.Objectives: (1) Assess the illness perception. (2) Assess the impact of insight in suicidal tendencies.Aims: Contribute to development measures to improve the insight in bipolar disorders.Methods: In this cross sectional study we use a convenience sample of patients with bipolar disorder attending in the mental health departments of three general hospitals in Lisbon great area. We have applied clinical and socio-demographic questionnaire and additional measures to assess symptom severity, treatment adherence and illness perception.Results: A samples was composed by 64 patients with bipolar disorder (mean age = 38.7; SD ± 10.1). A total of 48.4% patients (n = 31) had made a suicide attempted and 23.4% (n = 15) of this patient done 5 or more attempted suicide. We found a significant correlation with symptoms and insight (r_s = 0.56; P < 0.01).Conclusion: Mental health professionals often utilize insight as an indicator of prognosis, because of its association with treatment adherence. The findings of the current study suggest that having intact or good insight may be an indicator for suicidal ideation among patients with bipolar disorders. A brief psychoeducational approach could potentially be effective. We recommend a combined approach to Improve clinical insight in bipolar disorder.Disclosure of interest: The authors have not supplied their declaration of competing interest.