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Kornblith E, Schweizer S, Abrams G, Gardner R, Barnes D, Yaffe K, Novakovic-Agopian T. Telehealth delivery of group-format cognitive rehabilitation to older veterans with TBI: a mixed-methods pilot study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-13. [PMID: 37044120 DOI: 10.1080/23279095.2023.2199160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist. Goal Oriented Attentional Self-Regulation (GOALS) is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults. Our objectives were to adapt GOALS for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS). Six Veterans 69+, with multiple TBIs completed the 10-session intervention in groups of 2. One participant withdrew, and another completed the remaining sessions alone (total n enrolled = 8). Required adaptations were noted; questionnaire responses were quantified; and feedback was analyzed and coded to identify themes. Quantitative and qualitative methods were used to examine feasibility (i.e., recruitment and retention) and participant-rated acceptability. Minimal adaptations were required for IVT delivery. Key themes emerged: (a) the importance of telehealth logistics, (b) facilitators' roles in prioritizing interpersonal connection, and (c) telehealth's capability to create opportunities for community reintegration. Thematic saturation (the point at which feedback from respondents is consistent and no further adaptations are required) was achieved. Participants stated they would likely recommend TeleGOALS to other Veterans. Although further study with a larger, more diverse sample is required, the adapted TeleGOALS intervention appears highly feasible and acceptable for older Veterans with TBI able and willing to participate in a group-format IVT intervention.
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Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sara Schweizer
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Raquel Gardner
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Deborah Barnes
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Kristine Yaffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Tatjana Novakovic-Agopian
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
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2
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Sacks-Zimmerman A, Bergquist TF, Farr EM, Cornwell MA, Kanellopoulos D. Rehabilitation of Neuropsychiatric Symptoms in Patients With Long COVID: Position Statement. Arch Phys Med Rehabil 2023; 104:350-354. [PMID: 36272444 PMCID: PMC9581644 DOI: 10.1016/j.apmr.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 02/07/2023]
Abstract
Long COVID, a term used to describe ongoing symptoms after COVID-19 infection, parallels the course of other postviral syndromes. Neuropsychiatric symptoms of long COVID can be persistent and interfere with quality of life and functioning. Within the biopsychosocial framework of chronic illness, rehabilitation professionals can address the neuropsychiatric sequelae of long COVID. However, current practice models are not designed to address concurrent psychiatric and cognitive symptoms in adults living with long COVID. Thus, we present a biopsychosocial framework for long COVID and provide treatment strategies based on evidence from current literature of postviral chronic illness. These recommendations will guide rehabilitation professionals in identifying common neuropsychiatric symptoms in long COVID that can be targeted for intervention and addressing these symptoms via integrative interventions taking into account the biopsychosocial presentation of long COVID symptoms.
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Affiliation(s)
- Amanda Sacks-Zimmerman
- Weill Cornell Medicine, Brain & Spine Center, Department of Neurological Surgery, New York, NY.
| | - Thomas F Bergquist
- Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN; Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Ellen M Farr
- Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN
| | - Melinda A Cornwell
- Weill Cornell Medicine, Brain & Spine Center, Department of Neurological Surgery, New York, NY
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Siqueira ASS, Biella MM, Borges MK, Mauer S, Apolinario D, Alves TCDTF, Jacob-Filho W, Oude Voshaar RC, Aprahamian I. Decision-making executive function profile and performance in older adults with major depression: a case-control study. Aging Ment Health 2022; 26:1551-1557. [PMID: 34263687 DOI: 10.1080/13607863.2021.1950617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.
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Affiliation(s)
| | - Marina Maria Biella
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sivan Mauer
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Apolinario
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
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4
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Kassel MT, Rhodes E, Insel PS, Woodworth K, Garrison-Diehn C, Satre DD, Nelson JC, Tosun D, Mackin RS. Cognitive outcomes are differentially associated with depression severity trajectories during psychotherapy treatment for late life major depressive disorder. Int J Geriatr Psychiatry 2022; 37. [PMID: 35822633 PMCID: PMC10162695 DOI: 10.1002/gps.5779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Late Life Depression (LLD) is associated with persistent cognitive dysfunction even after depression symptoms improve. The present study was designed to examine cognitive outcomes associated with the pattern of depression severity change during psychotherapy intervention for LLD. METHODS 96 community-dwelling adults ages 65-91 with major depressive disorder completed 12 sessions of Problem-Solving Therapy at the University of California, San Francisco. Nonlinear trajectories of depression severity ratings using the Hamilton Depression Rating Scale were computed from multiple time points collected throughout the weekly psychotherapy intervention. Performance on measures of cognition (information processing speed, executive functioning, verbal learning, memory) was assessed at baseline and post-treatment. Linear mixed-effects models examined associations between nonlinear depression severity trajectories and post-treatment change in cognitive performance. RESULTS Broadly, different patterns of depression change during treatment were associated with improved cognition post-treatment. Greater and more consistent interval improvements in depression ratings were differentially associated with improvements in aspects of verbal learning, memory, and executive function post-treatment, while no associations were found with information processing speed. CONCLUSIONS The heterogeneity of depression trajectories associated with improved cognitive outcomes suggests that the temporal pattern of depression response may impact specific cognitive processes distinctly. Results suggest that use of nonlinear depression severity trajectories may help to elucidate complex associations between the time course of depression response and cognitive outcomes of psychotherapy in LLD. These findings have important implications for identifying treatment targets to enhance clinical and cognitive outcomes of psychotherapy in LLD.
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Affiliation(s)
- Michelle T Kassel
- Mental Illness Research, Education, and Clinical Centers, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Emma Rhodes
- Mental Illness Research, Education, and Clinical Centers, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kai Woodworth
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Christina Garrison-Diehn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - J Craig Nelson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - R Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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5
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Husain-Krautter S, Ellison JM. Late Life Depression: The Essentials and the Essential Distinctions. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:282-293. [PMID: 34690594 DOI: 10.1176/appi.focus.20210006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Late life depression (LLD), a familiar syndrome, is not differentiated in the DSM-5. LLD can resemble depressive syndromes in younger adults but it differs in demographic characteristics, phenomenology, prognosis, treatment, suicide risk, relationship to other disorders, and etiology. Older depressed adults often present with fewer major depressive symptoms, less emphasis on mood disturbance, greater preoccupation with somatic or psychotic symptoms, and misleading cognitive deficits. LLD's relationships with medical and neurocognitive symptoms and with inflammatory and immune factors are complex. Formal screening tools and biopsychosocial assessment informs diagnosis and treatment. Evidence supports the effectiveness of lifestyle interventions, several psychotherapies, and a variety of somatic treatment approaches. Comorbid medical disorders must be taken into account when planning treatment. In this article, the authors describe the characteristics of LLD, present an approach to assessment and management, and recommend that future DSM editions include a new specifier to differentiate LLD from other depressive syndromes.
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Affiliation(s)
- Sehba Husain-Krautter
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
| | - James M Ellison
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
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6
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Szanto K, Gujral S. Problem-Solving Therapy Effects on Suicidal Ideation: The Role of Reduction in Functional Disability. Am J Geriatr Psychiatry 2021; 29:562-564. [PMID: 33183949 PMCID: PMC8922310 DOI: 10.1016/j.jagp.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Katalin Szanto
- Department of Psychiatry (KS), University of Pittsburgh, Pittsburgh, PA.
| | - Swathi Gujral
- VA VISN 4 Mental Illness Research, Education, and Clinical Center of Excellence (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA
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Oh DJ, Han JW, Bae JB, Kim TH, Kwak KP, Kim BJ, Kim SG, Kim JL, Moon SW, Park JH, Ryu SH, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Executive dysfunction and risk of suicide in older adults: a population-based prospective cohort study. J Neurol Neurosurg Psychiatry 2021; 92:528-533. [PMID: 33563806 DOI: 10.1136/jnnp-2020-324390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/27/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE It is uncertain what factors increases the risk of suicide in older adults without depression, and it is unknown whether executive dysfunction (ED) is one of those factors. We aimed to examine the effect of ED on the risk of suicide in non-demented older adults without depression. METHODS In an ongoing population-based prospective cohort of Korean older adults, we identified suicide using the National Mortality Database and suicidal ideation or attempt (SIA) based on the Korean version of the Mini International Neuropsychiatric Interview. We defined ED as performing below -1.5 SD of age-adjusted, gender-adjusted and education-adjusted norms in any of following tests: Frontal Assessment Battery, Trail Making Test A, Digit Span Test or Verbal Fluency Test. RESULTS The mean age of the 4791 participants at baseline was 69.7 (SD 6.4) years, and 57.1% of them were women (mean follow-up duration=4.9 years). ED at baseline increased the risk of suicide by about seven times (HR 7.20, 95% CI 1.84 to 28.12, p=0.005) but did not change the risk of SIA. However, cognitive impairment without ED did not change the risks of suicide and SIA. In participants with ED, being aged 75 years or above, living alone, and having a low socioeconomic status were associated with the risk of suicide. CONCLUSION ED is a strong risk factor of late life suicide independent from depression, particularly in very old adults living in disadvantaged environments.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea (the Republic of)
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea (the Republic of)
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea (the Republic of)
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea (the Republic of)
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (the Republic of)
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea (the Republic of)
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea (the Republic of)
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea (the Republic of)
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea (the Republic of)
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea (the Republic of)
| | - Dong Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea (the Republic of)
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea (the Republic of)
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea (the Republic of)
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University, School of Medicine, Chuncheon, Korea (the Republic of)
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of) .,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of).,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea (the Republic of)
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Xu H, Koszycki D. Interpersonal Psychotherapy for Late-life Depression and its Potential Application in China. Neuropsychiatr Dis Treat 2020; 16:1919-1928. [PMID: 32821108 PMCID: PMC7423351 DOI: 10.2147/ndt.s248027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
Interpersonal psychotherapy (IPT) is a time-limited, structured, interpersonally oriented psychotherapy, with demonstrated efficacy for the treatment of major depression across the lifespan. IPT uses a medical model of illness and links depressed mood to four research-informed interpersonal problem areas: complicated grief, role transitions, role disputes, and interpersonal deficits/sensitivity. The IPT model of vulnerability to depression nicely dovetails with interpersonal issues that are faced by older adults, and this article focuses on the application of IPT for late-life depression in China. The group format of IPT may be a practical and efficient method of improving access to an established depression-focused treatment for China's rapidly aging population and has the advantage of providing important social support for patients who feel lonely, isolated, and stigmatized. Short-term interventions like IPT are more cost-effective from a public health perspective and can easily be delivered in primary care facilities, where many elderly patients receive care. IPT is effective in different cultures, and possible cultural adaptations of IPT for older adults in China are discussed herein.
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Affiliation(s)
- Hua Xu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Faculty of Education and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Koszycki
- Faculty of Education and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada
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Psychological Treatment for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:233-265. [PMID: 31784967 DOI: 10.1007/978-981-32-9271-0_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.
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Abstract
BACKGROUND Anxiety possibly interferes with executive functioning, although most studies rely on anxiety symptoms or lack control for comorbid depression. The objective of the present study is to examine the association between executive functioning and (individual) anxiety disorders with ak,ld without controlling for depression. METHOD Generalized anxiety disorder (GAD), panic disorder with and without agoraphobia, agoraphobia, social phobia, as well as depressive disorder according to DSM-IV criteria were assessed with the Mini International Neuropsychiatric Interview in 82,360 community-dwelling people participating in the Lifelines cohort. Figural fluency as a measure of executive functioning was assessed with the Ruff Figural Fluency Test (RFTT). Linear regression analyses with the RFFT score as the dependent variable and psychiatric diagnosis as independent variables (dummies) were performed, adjusted for potential confounders. Multivariate results are presented with and without adjustment for depression. RESULTS Presence of any anxiety disorder was associated with worse performance on the RFFT (B = - 0.78, SE = 0.32, p = .015), independent of depression. No dose-response relationship with the number of anxiety disorders was found. Only agoraphobia and generalized anxiety disorder were significantly associated with the RFFT score in the multivariate models. Agoraphobia remained significant when further adjusted for depressive disorder (B = - 1.14, SE = 0.41, p < .01), while GAD did not (B = 0.013, SE = 0.431, p = .975). LIMITATIONS Executive function was tested by only one measure, namely figural fluency. CONCLUSION Agoraphobia is associated with worse executive functioning. Treatment of agoraphobia could be influenced by the executive dysfunction which clinicians should be aware of when regular treatment fails.
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Abstract
UNLABELLED This paper reviews recent research on late-life depression (LLD) pharmacotherapy, focusing on updated information for monotherapy and augmentation treatments. We then review new research on moderators of clinical response and how to use the information for improved efficacy. RECENT FINDINGS A recent review shows that sertraline, paroxetine, and duloxetine were superior to placebo for the treatment of LLD. There is concern that paroxetine could have adverse outcomes in the geriatric population due to anticholinergic properties; however, studies show no increases in mortality, dementia risk, or cognitive measures. Among newer antidepressants, vortioxetine has demonstrated efficacy in LLD, quetiapine has demonstrated efficacy especially for patients with sleep disturbances, and aripiprazole augmentation for treatment resistance in LLD was found to be safe and effective. Researchers have also been identifying moderators of LLD that can guide treatment. Researchers are learning how to associate moderators, neuroanatomical models, and antidepressant response. SSRI/SNRIs remain first-line treatment for LLD. Aripiprazole is an effective and safe augmentation for treatment resistance. Studies are identifying actionable moderators that can increase treatment response.
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12
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Anguera JA, Gunning FM, Areán PA. Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial. Depress Anxiety 2017; 34:508-517. [PMID: 28052513 PMCID: PMC6093618 DOI: 10.1002/da.22588] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/14/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. METHODS In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. RESULTS EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. CONCLUSIONS This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.
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Affiliation(s)
- Joaquin A. Anguera
- Department of Neurology, University of California, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Faith M. Gunning
- Department of Psychiatry, Weil Cornell Medicine, New York, NY, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington
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13
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Diagnostik und multimodale Therapie der Altersdepression. Z Gerontol Geriatr 2017; 50:99-105. [DOI: 10.1007/s00391-016-1174-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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14
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MRI-defined versus clinically-defined vascular depression; comparison of prediction of functional disability in the elderly. Arch Gerontol Geriatr 2016; 66:7-12. [DOI: 10.1016/j.archger.2016.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 02/07/2023]
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15
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Gildengers AG, Butters MA, Albert SM, Anderson SJ, Dew MA, Erickson K, Garand L, Karp JF, Lockovich MH, Morse J, Reynolds CF. Design and Implementation of an Intervention Development Study: Retaining Cognition While Avoiding Late-Life Depression (ReCALL). Am J Geriatr Psychiatry 2016; 24:444-54. [PMID: 27066730 PMCID: PMC4871778 DOI: 10.1016/j.jagp.2015.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To discuss the design, rationale, and implementation of an intervention development study addressing indicated and selective prevention of depression and anxiety in individuals 60 years and older with mild cognitive impairment (MCI) and in their caregivers. METHODS In Phase I, now completed, we developed and standardized problem-solving therapy (PST) and the combined PST + moderate-intensity physical exercise (PE) intervention to be administered to participants with MCI and their caregivers together, dyadically, with both participants working with the same interventionist in the same therapy sessions. In Phase II we have been testing the interventions against enhanced usual care (EUC) and have addressed challenges to recruitment. Randomization was to one of three cells: PST + PE, PST, or EUC. RESULTS Although we set out to intervene dyadically, many individuals with MCI lived alone or did not have a support person who could participate in the study with them. Consequently, we modified the study to include MCI participants with and without support persons. Ninety-four participants were enrolled: 20 with MCI together with their support persons (N = 20 dyads) and 54 MCI participants without accompanying support persons. Most participants have been satisfied with the usefulness of the interventions in managing stress and cognitive problems. CONCLUSION PST and moderate-intensity PE are acceptable interventions for depression and anxiety prevention in older adults with MCI and their available caregivers.
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Affiliation(s)
- Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Stewart J Anderson
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kirk Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Linda Garand
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael H Lockovich
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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16
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Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. Int J Geriatr Psychiatry 2016; 31:526-35. [PMID: 26437368 DOI: 10.1002/gps.4358] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) affects many older adults and is associated with poor medical and mental health outcomes. Problem Solving Therapy (PST) has emerged as a promising psychotherapy for MDD in older adults, although the efficacy of PST in this population has not been well described. We examined the effectiveness of PST for the treatment of MDD in older adults in a systematic review and meta-analysis. METHODS We searched electronic databases to identify randomized controlled trials comparing PST to a control condition or other treatment for MDD in adults with an average age of 60 years or older. We used meta-analysis to arrive at pooled summary measures of the efficacy of PST when compared to control conditions on the change in depressive symptoms and other outcomes. RESULTS Nine studies with a total of 569 participants (290 PST, 279 control) met inclusion criteria. Most studies administered PST in person and were between 6 and 12 weeks in duration. Meta-analysis of six studies evaluating the effect of PST on depression using the Hamilton Rating Scale for Depression identified a significant reduction in depression associated with PST (pooled mean difference = -6.94, 95%CI -10.91 to -2.97, d = 1.15, P = 0.0006). PST was also effective in reducing disability in studies reporting this outcome. CONCLUSIONS Our review supports the existing research literature on PST suggesting that it is an effective treatment for older people with MDD. Further study is required to understand long-term outcomes associated with PST and its efficacy when compared to other treatments.
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Affiliation(s)
- Julia G Kirkham
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
| | - Namkee Choi
- School of Social Work, University of Texas at Austin, TX, USA
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
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17
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Johnco C, Wuthrich VM, Rapee RM. THE IMPACT OF LATE-LIFE ANXIETY AND DEPRESSION ON COGNITIVE FLEXIBILITY AND COGNITIVE RESTRUCTURING SKILL ACQUISITION. Depress Anxiety 2015; 32:754-62. [PMID: 26014612 DOI: 10.1002/da.22375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Studies examining treatment moderators and mediators in late-life anxiety and depression are sparse. Executive functioning skills decrease with age, and are poorer in the context of anxiety and depression. One of the key cognitive behavioral therapy techniques for anxiety and depression is cognitive restructuring (CR), which teaches people to identify and dispute maladaptive thoughts. There is evidence that cognitive flexibility (CF), one aspect of executive functioning, has a negative impact on CR skill acquisition in nonclinical older adults, and this warrants extension in a clinical sample. METHOD This study assessed CR skill acquisition in a clinical sample of 47 older adults with anxiety and depression and 53 nonclinical controls during an experimental paradigm, and investigated the influence of CF on this relationship. A battery of neuropsychological tests assessing CF were administered and CR was learned during a brief intervention. RESULTS The clinical sample showed poorer CF on some measures, as well as poorer CR quality and efficacy (reduction in subjective distress). CF partially mediated the relationship between clinical status and CR quality, and between clinical status and CR efficacy. CONCLUSION These results provide preliminary evidence that older adults with anxiety and depression are worse at learning and benefiting from CR with a brief intervention and this is partially due to having poorer CF skills. These findings warrant further examination in a treatment context to assess whether CR skill acquisition improves over treatment.
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Affiliation(s)
- Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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18
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Simon SS, Cordás TA, Bottino CMC. Cognitive Behavioral Therapies in older adults with depression and cognitive deficits: a systematic review. Int J Geriatr Psychiatry 2015; 30:223-33. [PMID: 25521935 DOI: 10.1002/gps.4239] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/28/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the effectiveness of cognitive behavioral therapies (CBTs) in improving depressive symptoms, disability, and cognition in older adults with depression and cognitive deficits. DESIGN It was performed a systematic search for articles published between 1994 and February 2014 in the MEDLINE/Pubmed, PsycINFO, and SCIELO. The studies should have provided information about benefits after CBTs to older adults with depression and cognitive deficits. RESULTS Cognitive behavioral therapy focused on problem solving is the main approach studied, having better effectiveness than supportive therapy in randomized clinical trials. Significant improvements in mood and disability were consistent, although evidence of changes in cognitive measures is controversial, less studied, and limited. Nevertheless, improvements in executive functions, processing speed, and changes in patients' perspectives of problem solving skills, such as generating alternatives and decision-making, were described. Also, it would be necessary that future studies more often evaluate cognitive status of depressed elders, as well as cognitive changes after psychotherapy. It should be emphasized that there is a lack of studies in this field, and more approaches in CBTs need to be investigated to this population. CONCLUSION Older adults with depression and cognitive deficits can benefit from CBTs. Improvements in mood and disability are more consistent than changes in cognition, which are little studied after CBTs. It is necessary more studies in the field, as well as, to investigate more approaches in CBTs to older adults with depression and cognitive deficits.
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Affiliation(s)
- Sharon Sanz Simon
- Old Age Research Group (PROTER), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil
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19
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Morimoto SS, Kanellopoulos D, Manning KJ, Alexopoulos GS. Diagnosis and treatment of depression and cognitive impairment in late life. Ann N Y Acad Sci 2015; 1345:36-46. [PMID: 25655026 DOI: 10.1111/nyas.12669] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cognitive impairment in late-life depression is prevalent, disabling, and heterogeneous. Although mild cognitive impairment in depression does not usually progress to dementia, accurate assessment of cognition is vital to prognosis and treatment planning. For example, executive dysfunction often accompanies late-life depression, influences performance across cognitive domains, and is associated with poor antidepressant treatment outcomes. Here, we review how assessment can capture dysfunction across cognitive domains and discuss cognitive trajectories frequently observed in late-life depression in the context of the neurobiology of this disorder. We also review the efficacy of a sample of interventions tailored to specific cognitive profiles.
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Affiliation(s)
- Sarah Shizuko Morimoto
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Dora Kanellopoulos
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Kevin J Manning
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut
| | - George S Alexopoulos
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
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20
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Does cognition predict treatment response and remission in psychotherapy for late-life depression? Am J Geriatr Psychiatry 2015; 23:215-9. [PMID: 25441055 PMCID: PMC4289644 DOI: 10.1016/j.jagp.2014.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify cognitive predictors of geriatric depression treatment outcome. METHOD Older participants completed baseline measures of memory and executive function, health, and baseline and post-treatment Hamilton Depression Scales (HAM-D) in a 12-week trial comparing psychotherapies (problem-solving vs. supportive; N = 46). We examined cognitive predictors to identify treatment responders (i.e., HAM-D scores reduced by ≥50%) and remitters (i.e., post-treatment HAM-D score ≤10). RESULTS Empirically derived decision trees identified poorer performance on switching (i.e., Trails B), with a cut-score of ≥82 predicting psychotherapy responders. No other cognitive or health variables predicted psychotherapy outcomes in the decision trees. CONCLUSIONS Psychotherapies that support or improve the executive skill of switching may augment treatment response for older patients exhibiting executive dysfunction in depression. If replicated, Trails B has potential as a brief cognitive tool for clinical decision-making in geriatric depression.
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21
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Recent Advances in Late-Life Mood Disorders. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Mackin RS, Nelson JC, Delucchi KL, Raue PJ, Satre DD, Kiosses DN, Alexopoulos GS, Arean PA. Association of age at depression onset with cognitive functioning in individuals with late-life depression and executive dysfunction. Am J Geriatr Psychiatry 2014; 22:1633-41. [PMID: 24680502 PMCID: PMC4145037 DOI: 10.1016/j.jagp.2014.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To compare patterns of cognitive performance in older adults with late-onset depression (LOD; ≥65 years of age) with that of older adults with early-onset depression (EOD; <65 years). METHODS Participants were 171 adults aged 60 years or older with major depression and executive dysfunction who were participating in a randomized psychotherapy trial. Participants included 72 LOD and 99 EOD individuals. Cognitive performance on measures of verbal learning, memory, and executive functioning were evaluated. Demographic and clinical characteristics, severity of cerebrovascular risk factors, and disability ratings were also compared between groups. RESULTS The LOD group was older and had fewer previous episodes of depression and lower severity of depression compared with EOD participants. The LOD group demonstrated poorer performance on measures of verbal learning (F(1,161) = 4.28, p = 0.04) and memory (F(1,160) = 4.65, p = 0.03) than the EOD group. Linear regression analysis demonstrated that LOD and fewer years of education were significant predictors of poorer verbal learning (F(7,114) = 6.25, p <0.001) and memory (F(7,113)=7.24, p <0.001). Performance on measures of executive functioning, severity of vascular risk factors, and disability ratings did not differ between the two groups. CONCLUSION In older adults with depression and executive dysfunction, LOD was associated with poorer performance on measures of verbal learning and memory. Aging-related brain changes associated with LOD may play a more important role, leading to dysfunction in these cognitive domains than a history of recurrent depressive episodes in older adults with a dysexecutive syndrome.
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Affiliation(s)
- R. Scott Mackin
- University of California, San Francisco, Department of Psychiatry,Center for Imaging of Neurodegenerative Disease, Veterans Administration Medical Center, San Francisco, CA, USA
| | - J. Craig Nelson
- University of California, San Francisco, Department of Psychiatry
| | - Kevin L Delucchi
- University of California, San Francisco, Department of Psychiatry
| | | | - Derek D Satre
- University of California, San Francisco, Department of Psychiatry,Weill Cornell Medical College, Department of Psychiatry
| | | | | | - Patricia A Arean
- University of California, San Francisco, Department of Psychiatry
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23
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Mackin RS, Nelson JC, Delucchi K, Raue P, Byers A, Barnes D, Satre DD, Yaffe K, Alexopoulos GS, Arean PA. Cognitive outcomes after psychotherapeutic interventions for major depression in older adults with executive dysfunction. Am J Geriatr Psychiatry 2014; 22:1496-503. [PMID: 24378255 PMCID: PMC4108572 DOI: 10.1016/j.jagp.2013.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 11/08/2013] [Accepted: 11/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the impact of psychotherapy on cognitive functioning in older adults with late-life depression (LLD) and executive dysfunction. METHODS Two hundred twenty-one adults aged 60 years and older participated in a randomized clinical trial comparing the efficacy of Problem Solving Therapy (PST) and Supportive Therapy (ST) for LLD. Cognitive performance on seven tests of executive functioning, verbal learning, and memory was evaluated at baseline, after 12 weeks of treatment, and at 24 weeks after the completion of treatment. RESULTS Performance on a measure of executive functioning with a significant information processing speed component (Stroop Color and Word Test) improved after treatment, F (1, 312) = 8.50, p = 0.002, and improved performance was associated with a reduction in depressive symptoms but not treatment type. Performance on other measures of executive functioning, verbal learning, and memory did not change significantly after 12 weeks of psychotherapy treatment. CONCLUSION Our results suggest that improvements in cognitive functioning after psychotherapy treatment for depression in older adults with executive dysfunction are likely focal and not distributed across all cognitive domains. Although previous analyses reported that PST was superior to ST in the treatment of depression, this analysis indicated no difference between the two treatments with regard to improvements in cognitive functioning.
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Affiliation(s)
- R. Scott Mackin
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA,Center for Imaging of Neurodegenerative Disease, Veterans Administration Medical Center, San Francisco, CA
| | - J. Craig Nelson
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA
| | - Kevin Delucchi
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA
| | - Patrick Raue
- Weill Cornell Medical College, Department of Psychiatry, New York, NY
| | - Amy Byers
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA,Veterans Administration Medical Center, San Francisco, CA
| | - Deborah Barnes
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA,Veterans Administration Medical Center, San Francisco, CA
| | - Derek D. Satre
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA,Kaiser Permanente Division of Research, Oakland, CA
| | - Kristine Yaffe
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA,Veterans Administration Medical Center, San Francisco, CA
| | | | - Patricia A. Arean
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA
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24
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Parisi JM, Franchetti MK, Rebok GW, Spira AP, Carlson MC, Willis SL, Gross AL. Depressive symptoms and inductive reasoning performance: findings from the ACTIVE reasoning training intervention. Psychol Aging 2014; 29:843-51. [PMID: 25244465 DOI: 10.1037/a0037670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Within the context of the Advanced Cognitive Training for Independent and Vital Elderly study (ACTIVE; Ball et al., 2002; Jobe et al., 2001; Willis et al., 2006), we examined the longitudinal association of baseline depressive symptoms on inductive reasoning performance over a 10-year period between the reasoning training and control conditions (N = 1,375). At baseline, 322 participants (23%) reported elevated depressive symptoms, defined by a score ≥9 on the 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D; Mirowsky & Ross, 2003; Radloff, 1977). Differences in baseline depressive status were not associated with immediate posttraining gains or with subsequent annual change in reasoning performance, suggesting that the presence of elevated baseline depressive symptoms does not impact the ability to benefit from reasoning training.
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Affiliation(s)
- Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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25
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Wang LY, Borisovskaya A, Maxwell AL, Pascualy M. Common psychiatric problems in cognitively impaired older patients: causes and management. Clin Geriatr Med 2014; 30:443-67. [PMID: 25037290 DOI: 10.1016/j.cger.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Although dementias are defined by their cognitive and functional deficits, psychiatric problems are common, contribute to patient distress and caregiver burden, and precipitate institutionalization. Successful treatment involves understanding that physiologic, psychological, and environmental factors can contribute to the development of these symptoms. By carefully assessing each of these factors, clinicians can individualize treatment and flexibly use nonpharmacologic and pharmacologic approaches tailored to patients and the context of care. Although there exist limitations to many treatment options, clinicians can still adapt current knowledge to develop a multifaceted treatment approach that improves the quality of life for patients and their caregivers.
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Affiliation(s)
- Lucy Y Wang
- Mental Health Service, VA Puget Sound Healthcare System, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98108, USA.
| | - Anna Borisovskaya
- Mental Health Service, VA Puget Sound Healthcare System, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98108, USA
| | - Andrea L Maxwell
- Mental Health Service, VA Puget Sound Healthcare System, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98108, USA
| | - Marcella Pascualy
- Mental Health Service, VA Puget Sound Healthcare System, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98108, USA
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26
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Arean PA, Niu G. Choosing treatment for depression in older adults and evaluating response. Clin Geriatr Med 2014; 30:535-51. [PMID: 25037294 DOI: 10.1016/j.cger.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An update is provided on the current information regarding late life depression with regard to assessment, clinical implications, and treatment recommendations. Several treatments are considered evidence-based, but when deployed into field trials, the efficacy of these treatments falls short. It is thought that the lower impact in community trials is due in large part to patient, clinical, environmental, socio-economic, and cognitive correlates that influence treatment response. The aim is to assist providers in making decisions about what type of treatment to recommend based on a sound assessment of these clinical correlates.
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Affiliation(s)
- Patricia A Arean
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Grace Niu
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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Abstract
This brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient's symptoms.
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28
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Bamonti PM, Price EC, Fiske A. Depressive symptoms and suicide risk in older adults: value placed on autonomy as a moderator for men but not women. Suicide Life Threat Behav 2014; 44:188-99. [PMID: 24851257 DOI: 10.1111/sltb.12062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Risk for suicide is elevated among older men. We examined whether value placed on autonomy amplifies the relation between depressive symptoms and suicide risk differently for older men and women. Participants were 98 community-dwelling older adults, M age 73.6 (SD = 8.6), 65.1% female, 93.1% White. Questionnaires measured suicide risk (SBQ-R), depressive symptoms (CESD), and value placed on autonomy (PSI-II autonomy). Among men, depressive symptoms were associated with suicide risk only when PSI-II autonomy was elevated. Among women, greater depressive symptoms were associated with suicide risk at all levels of PSI-II autonomy. Further research on attitudes toward autonomy is warranted.
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Affiliation(s)
| | | | - Amy Fiske
- Department of Psychology; West Virginia University; Morgantown WV USA
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29
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Morimoto SS, Kanellopoulos D, Alexopoulos GS. Cognitive Impairment in Depressed Older Adults: Implications for Prognosis and Treatment. Psychiatr Ann 2014; 44:138-142. [PMID: 25821256 DOI: 10.3928/00485713-20140306-05] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Vu LN, Dean MJ, Mwamburi M, Au R, Qiu WQ. Executive function and mortality in homebound elderly adults. J Am Geriatr Soc 2014; 61:2128-2134. [PMID: 24479144 DOI: 10.1111/jgs.12545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the association between executive function and mortality in homebound elderly adults. DESIGN Longitudinal study. SETTING Four home care agencies in the Boston area. PARTICIPANTS Homebound adults aged 60 and older with 8-year follow-up for mortality (N=1,172). MEASUREMENTS Cognitive domains including executive, memory, and language functions were evaluated at baseline. Executive function was measured using the Trail-Making Test Part B (TMT B), and subjects were divided into four subgroups from lowest to highest TMT B score. The second cross-group analyses were used to compare those who were alive and those who had died. Multivariate logistic regression analysis was used to determine whether there was an association between TMT B scores and mortality. RESULTS At baseline, 436 (37.2%) homebound elderly adults had the highest TMT B scores (≥300), which indicated the slowest performance. At 8-year follow-up, 381 (32.5%) participants had died. Participants with the highest TMT B scores were more than twice as likely to have died as those with the lowest scores (0–99) (odds ratio=2.39, 95% confidence interval=1.27–4.52, P=.003) after adjusting for confounders including medical comorbidities related to death. The other cognitive domains, including memory and language, were not associated with mortality in the same model. CONCLUSION Many homebound elderly adults have multiple medical conditions, and executive function may be critical in their ability to manage their medical conditions and may affect the outcome of death.
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Affiliation(s)
- Linh N Vu
- Department of Pharmacology, Experimental Therapeutics, Boston University Medical Campus, Boston, Massachusetts
| | - Michael J Dean
- Department of Pharmacology, Experimental Therapeutics, Boston University Medical Campus, Boston, Massachusetts
| | - Mkaya Mwamburi
- Department of Public Health and Family Medicine, School of Medicine, Tufts University, Boston, Massachusetts
| | - Rhoda Au
- Department of Neurology, Boston University Medical Campus, Boston, Massachusetts
| | - Wei Qiao Qiu
- Department of Pharmacology, Experimental Therapeutics, Boston University Medical Campus, Boston, Massachusetts.,Department of Psychiatry, Boston University Medical Campus, Boston, Massachusetts.,Alzheimer's Disease Center, Boston University Medical Campus, Boston, Massachusetts
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31
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Naarding P, Beekman ATF. Vascular depression: where do we go from here? Expert Rev Neurother 2014; 11:77-83. [DOI: 10.1586/ern.10.92] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Abstract
Late life depression (LLD) frequently presents with cognitive impairment, and growing evidence suggests that these disease processes are "linked" in multiple ways. For some individuals, LLD may be a recurrence of a long-standing depressive illness, while for others it may be the leading symptom of a developing neuropathological disorder. Overall, studies investigating the relationship between treatment of LLD and improvement in cognitive functioning have yielded mixed results. Research suggests that a subset of individuals with LLD and cognitive dysfunction will experience an improvement in cognitive function after antidepressant treatment, though a significant proportion will continue to exhibit cognitive impairment following resolution of their depressive symptoms. From a treatment standpoint, it is critical to ensure that an individual's depressive symptoms have been treated to remission, measured by a standardized rating scale such as the Geriatric Depression Scale (GDS). SSRI or SNRI monotherapy is often effective, and may be enhanced by employing an evidence-based psychotherapy such as Problem Solving Therapy (PST) or Interpersonal Therapy (IPT), modified to accommodate cognitive impairments that may be present. With respect to specific treatment of cognitive dysfunction, cognitive augmentation or training strategies can be helpful for some patients, and may be explored in combination with treatment of the primary depressive episode. While the introduction of a cholinesterase inhibitor (e.g. donepezil) may be considered, the potential benefit (modest improvement in cognition and functioning) must be weighed against an increased risk for worsening or recurrent depression. Finally, lifestyle factors-such as aerobic exercise, follow-up with a primary care physician for management of co-morbid medical illnesses, and regular participation in stimulating activities (such as through a senior center)-are important and should be included as part of the overall treatment plan.
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Affiliation(s)
- Aaron M Koenig
- Department of Psychiatry, University of Pittsburgh School of Medicine (Pittsburgh, PA, USA)
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine (Pittsburgh, PA, USA)
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Ayers CR, Wetherell JL, Schiehser D, Almklov E, Golshan S, Saxena S. Executive functioning in older adults with hoarding disorder. Int J Geriatr Psychiatry 2013; 28:1175-81. [PMID: 23440720 PMCID: PMC4037916 DOI: 10.1002/gps.3940] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/22/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hoarding disorder (HD) is a chronic and debilitating psychiatric condition. Midlife HD patients have been found to have neurocognitive impairment, particularly in areas of executive functioning, but the extent to which this is due to comorbid psychiatric disorders has not been clear. AIMS/METHOD The purpose of the present investigation was to examine executive functioning in geriatric HD patients without any comorbid Axis I disorders (n = 42) compared with a healthy older adult comparison group (n = 25). We hypothesized that older adults with HD would perform significantly worse on measures of executive functioning (Wisconsin Card Sort Task [Psychological Assessment Resources, Lutz, Florida, USA] ( Psychological Assessment Resources, 2003) and the Wechsler Adult Intelligence Scale-IV digit span and letter-number sequencing tests [Pearson, San Antonio, TX, USA]). RESULTS Older adults with HD showed significant differences from healthy older controls in multiple aspects of executive functioning. Compared with healthy controls, older adults with HD committed significantly more total, non-perseverative errors and conceptual level responses on the Wisconsin Card Sort Task and had significantly worse performance on the Wechsler Adult Intelligence Scale-IV digit span and letter-number sequencing tests. Hoarding symptom severity was strongly correlated with executive dysfunction in the HD group. CONCLUSIONS Compared with demographically-matched controls, older adults with HD have dysfunction in several domains of executive functioning including mental control, working memory, inhibition, and set shifting. Executive dysfunction is strongly correlated with hoarding severity and is not because of comorbid psychiatric disorders in HD patients. These results have broad clinical implications suggesting that executive functioning should be assessed and taken into consideration when developing intervention strategies for older adults with HD.
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Affiliation(s)
- Catherine R. Ayers
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
,Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Julie Loebach Wetherell
- Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dawn Schiehser
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
,Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
,Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Shahrokh Golshan
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Sanjaya Saxena
- Department of Psychiatry, University of California, San Diego, CA, USA
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Stein-Shvachman I, Karpas DS, Werner P. Depression Treatment Non-adherence and its Psychosocial Predictors: Differences between Young and Older Adults? Aging Dis 2013; 4:329-36. [PMID: 24307966 DOI: 10.14336/ad.2013.0400329] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 11/01/2022] Open
Abstract
Depression is a common disease among young and older adults. Although it can be treated, non-adherence is very common among individuals of different ages. The aim of the present paper is to review and summarize research findings regarding depression among young and older adults, with a special focus on the phenomenon of treatment non-adherence among young and older adults with depression. The first section of the review focuses on describing the characteristics of depression in young and older adults. The second section focuses on treatment non-adherence of young and older adults, the prevalence of this phenomenon, and its consequences. The third section focuses on several factors (illness beliefs, treatment beliefs, self-stigma, and self-esteem) that were identified as having a significant association with treatment non-adherence of individuals with depression, with special attention focused on age differences. Results of the review of the literature reveal that research in the area of depression treatment non-adherence and its predictors among young and older adults has received, to date, very minor and limited attention. Thus, there is a need to expand the current body of knowledge and promote future interventions geared towards the unique characteristics of depression among young and older adults, in order to increase their treatment adherence.
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Affiliation(s)
- Ifat Stein-Shvachman
- Department of Gerontology, University of Haifa, IsraelMt. Carmel, Haifa 31905, Israel
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35
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Wilkinson P. Cognitive behavioural therapy with older people. Maturitas 2013; 76:5-9. [DOI: 10.1016/j.maturitas.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/16/2013] [Indexed: 11/27/2022]
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Lee TW, Liu HL, Wai YY, Ko HJ, Lee SH. Abnormal neural activity in partially remitted late-onset depression: an fMRI study of one-back working memory task. Psychiatry Res 2013; 213:133-41. [PMID: 23154094 DOI: 10.1016/j.pscychresns.2012.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 11/29/2011] [Accepted: 04/22/2012] [Indexed: 01/10/2023]
Abstract
Only half of the geriatric patients with major depressive disorder (MDD) can reach full remission after treatment of half a year. This study was designed to examine the neural responses in the partial responders of late-onset MDD. We used 3-Tesla functional magnetic resonance imaging to assess the patterns of cerebral activation/deactivation in the performance of a one-back version of the n-back working memory task. We recruited 14 major depressive patients who reached partial remission after at least half a year of pharmacological intervention, compared with 14 non-depressive controls. There were no significant between-group differences in the demographical profiles and working memory performance, which was true for both accuracy and reaction time. Brain masks encompassing the neural responses of activation/deactivation were constructed from the non-depressive controls. The depressive group shows enhanced activities at left middle frontal and left parietal regions, and reduced deactivation at several temporal regions and left amygdala within the masks. Besides, the depressive group activates extra neural nodes at middle frontal and middle temporal regions outside the masks. The neural responses in the left amygdala are significantly correlated with the severity of depression and comorbid anxiety. The loss of deactivation in the left amygdala and the temporal areas in cognitive endeavor may be related to the refractoriness to treatment.
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Affiliation(s)
- Tien-Wen Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan County, Taiwan, ROC
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37
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Mackin RS, Tosun D, Mueller SG, Lee JY, Insel P, Schuff N, Truran-Sacrey D, Arean P, Nelson JC, Weiner MW. Patterns of reduced cortical thickness in late-life depression and relationship to psychotherapeutic response. Am J Geriatr Psychiatry 2013; 21:794-802. [PMID: 23567394 PMCID: PMC3732520 DOI: 10.1016/j.jagp.2013.01.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 12/23/2011] [Accepted: 02/01/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cortical atrophy has been associated with late-life depression (LLD) and recent findings suggest that reduced right hemisphere cortical thickness is associated with familial risk for major depressive disorder, but cortical thickness abnormalities in LLD have not been explored. Furthermore, cortical atrophy has been posited as a contributor to poor antidepressant treatment response in LLD, but the impact of cortical thickness on psychotherapy response is unknown. This study was conducted to evaluate patterns of cortical thickness in LLD and in relation to psychotherapy treatment outcomes. METHODS Participants included 22 individuals with LLD and 12 age-matched comparison subjects. LLD participants completed 12 weeks of psychotherapy and treatment response was defined as a 50% reduction in depressive symptoms. All participants underwent magnetic resonance imaging of the brain, and cortical mapping of gray matter tissue thickness was calculated. RESULTS LLD individuals demonstrated thinner cortex than controls prominently in the right frontal, parietal, and temporal brain regions. Eleven participants (50%) exhibited positive psychotherapy response after 12 weeks of treatment. Psychotherapy nonresponders demonstrated thinner cortex in bilateral posterior cingulate and parahippocampal cortices, left paracentral, precuneus, cuneus, and insular cortices, and the right medial orbitofrontal and lateral occipital cortices relative to treatment responders. CONCLUSIONS Our findings suggest more distributed right hemisphere cortical abnormalities in LLD than have been previously reported. In addition, our findings suggest that reduced bilateral cortical thickness may be an important phenotypic marker of individuals at higher risk for poor response to psychotherapy.
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Affiliation(s)
- R. Scott Mackin
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Duygu Tosun
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Susanne G. Mueller
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Jun-Young Lee
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA
| | - Philip Insel
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA
| | - Norbert Schuff
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Diana Truran-Sacrey
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA
| | - Patricia Arean
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - J. Craig Nelson
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA,Department of Medicine, University of California, San Francisco, CA, USA
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Sharpe L, Gittins CB, Correia HM, Meade T, Nicholas MK, Raue PJ, McDonald S, Areán PA. Problem-solving versus cognitive restructuring of medically ill seniors with depression (PROMISE-D trial): study protocol and design. BMC Psychiatry 2012; 12:207. [PMID: 23173830 PMCID: PMC3561282 DOI: 10.1186/1471-244x-12-207] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 11/07/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With an ageing population in most Western countries, people are living longer but often with one or more chronic physical health problems. Older people in physically poor health are at greater risk of developing clinical depression. Cognitive Behavioural Therapy (CBT) and Problem Solving Therapy (PST) have both been found to be efficacious in treating late-life depression, however patients with "multi-morbidity" (i.e. more than one chronic condition) are often excluded from these trials. The aim of this study is to compare the efficacy of CBT and PST in treating older adults who have one or more chronic physical health conditions and a diagnosable depressive disorder. This study will be the first to explicitly target the treatment of depression in older people in primary care settings presenting with a range of health problems using behavioural interventions. METHODS/DESIGN The PROMISE-D study is a randomised controlled trial of two evidence-based treatments for late-life major or minor depression for patients who also have at least one co-morbid chronic health problem. Participants will be randomised to two active interventions (PST or CBT) or enhanced treatment-as-usual (E-TAU). Primary outcomes will be depression diagnostic status and severity of depression (according to the Hamilton Depression Rating Scale and the Geriatric Depression Scale). Secondary outcomes will be anxiety severity, quality of life and health care utilisation. Assessments will be conducted by a researcher who remains blind to the patient's treatment allocation and will be conducted pre and post-treatment and at six and 12 months follow-up. Health care utilisation will be assessed throughout a two year period following entry to the trial. Executive function, rumination and emotion regulation will also be measured to determine the impact of these factors on treatment response in two treatment groups. DISCUSSION Multi-morbidity, the experience of two or more chronic health problems, is becoming an increasing problem internationally, particularly amongst the elderly. Evidence-based psychological treatments exist for late-life depression and these have been shown to be effective for participants with individual health problems and depression. However, there are no studies that have compared the two leading psychotherapies shown to be effective in the treatment of late-life depression. In addition, many trials of psychotherapy with older adults exclude those with multi-morbidity. Hence, this trial will confirm whether CBT and PST are efficacious in the treatment of depression in the context of complex medical needs and determine which of these two interventions is most efficacious. TRIAL REGISTRATION ACTRN12612000854831.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | | | | | - Tanya Meade
- School of Psychology, University of Western Sydney, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - Patrick J Raue
- Weill Medical College, Cornell University, New York, USA
| | - Sarah McDonald
- School of Psychology, University of Sydney, Sydney, Australia
| | - Patricia A Areán
- Department of Psychiatry, University of California, San Francisco, USA
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40
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Abstract
Late life depression (LLD) is a heterogeneous illness with high rates of treatment resistance. Cognitive impairment is common in the context of LLD, and LLD may be a prodromal symptom and/or potentially a risk factor for dementia. This manuscript reviews the most recent research into the cognitive deficits associated with LLD and risk of conversion to dementia in the context of LLD. We discuss potential moderators and mediators of cognitive deficits in LLD, including demographic and clinical variables, in addition to brain structure and function. Potential interventions for cognitive symptoms of LLD are reviewed. We conclude with a discussion of the broader implications of what is now known about LLD, and how this might be applied toward improved prognosis and models for effective treatment.
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Affiliation(s)
- Sara L Weisenbach
- Department of Psychiatry, University of Michigan Medical School, 2101 Commonwealth Boulevard, Suite C, Ann Arbor, MI 48105, USA.
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Andreescu C, Reynolds CF. Late-life depression: evidence-based treatment and promising new directions for research and clinical practice. Psychiatr Clin North Am 2011; 34:335-55, vii-iii. [PMID: 21536162 PMCID: PMC8442985 DOI: 10.1016/j.psc.2011.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the population ages, successive cohorts of older adults will experience depressive disorders. Late-life depression (LLD) carries additional risk for suicide, medical comorbidity, disability, and family caregiving burden. Although response and remission rates to pharmacotherapy and electroconvulsive therapy are comparable with those in midlife depression, relapse rates are higher, underscoring the challenge to achieve and maintain wellness. This article reviews the evidence base for LLD treatment options and provides an analysis of treatment options for difficult-to-treat LLD variants (eg, psychotic depression, vascular depression). Treatment algorithms are also reviewed based on predictors of response and promising novel treatment options.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, 247 Sterling Plaza, Pittsburgh, PA 15213, USA
| | - Charles F. Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, 758 Bellefield Towers, Pittsburgh, PA 15213, USA,Corresponding author.
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Alexopoulos GS, Raue PJ, Kiosses DN, Mackin RS, Kanellopoulos D, McCulloch C, Areán PA. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. ACTA ACUST UNITED AC 2011; 68:33-41. [PMID: 21199963 DOI: 10.1001/archgenpsychiatry.2010.177] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Older patients with depression and executive dysfunction represent a population with significant disability and a high likelihood of failing pharmacotherapy. OBJECTIVES To examine whether problem-solving therapy (PST) reduces disability more than does supportive therapy (ST) in older patients with depression and executive dysfunction and whether this effect is mediated by improvement in depressive symptoms. DESIGN Randomized controlled trial. SETTING Weill Cornell Medical College and University of California at San Francisco. PARTICIPANTS Adults (aged >59 years) with major depression and executive dysfunction recruited between December 2002 and November 2007 and followed up for 36 weeks. Intervention Twelve sessions of PST modified for older depressed adults with executive impairment or ST. Main Outcome Measure Disability as quantified using the 12-item World Health Organization Disability Assessment Schedule II. RESULTS Of 653 individuals referred to this study, 221 met the inclusion criteria and were randomized to receive PST or ST. Both PST and ST led to comparable improvement in disability in the first 6 weeks of treatment, but a more prominent reduction was noted in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and more previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was, in part, due to greater reduction in disability by PST. Although disability increased during the 24 weeks after the end of treatment, the advantage of PST over ST was retained. CONCLUSIONS These results suggest that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00052091.
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Affiliation(s)
- George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA.
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Areán PA, Raue P, Mackin RS, Kanellopoulos D, McCulloch C, Alexopoulos GS. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry 2010; 167:1391-8. [PMID: 20516155 PMCID: PMC2998516 DOI: 10.1176/appi.ajp.2010.09091327] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether problem-solving therapy is an effective treatment in older patients with depression and executive dysfunction, a population likely to be resistant to antidepressant drugs. METHOD Participants were adults age 60 and older with major depression and executive dysfunction. Problem-solving therapy was modified to be accessible to this population. Participants were randomly assigned to 12 weekly sessions of problem-solving therapy or supportive therapy and assessed at weeks 3, 6, 9, and 12. RESULTS Of the 653 individuals referred for this study, 221 met selection criteria and were enrolled in the study. Reduction of depressive symptom severity was comparable for the two treatment groups during the first 6 weeks of treatment, but at weeks 9 and 12 the problem-solving therapy group had a greater reduction in symptom severity, a greater response rate, and a greater remission rate than the supportive therapy group (response rates at week 9: 47.1% and 29.3%; at week 12:56.7% and 34.0%; remission rates at week 9: 37.9% and 21.7%; at week 12: 45.6% and 27.8%). Problem-solving therapy yielded one additional response or remission over supportive therapy for every 4.4-5.6 patients by the end of the trial. CONCLUSIONS These results suggest that problem-solving therapy is effective in reducing depressive symptoms and leading to treatment response and remission in a considerable number of older patients with major depression and executive dysfunction. The clinical value of this finding is that problem-solving therapy may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.
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Rosen D, Morse JQ, Reynolds CF. Adapting problem-solving therapy for depressed older adults in methadone maintenance treatment. J Subst Abuse Treat 2010; 40:132-41. [PMID: 21036509 DOI: 10.1016/j.jsat.2010.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 09/02/2010] [Accepted: 09/15/2010] [Indexed: 11/18/2022]
Abstract
Late-life depression is prevalent in older adults who are dependent on opiates. Depressive disorders among opiate abusers have detrimental effects on their well-being and ability to refrain from illegal drugs. There are numerous barriers to the provision of appropriate mental health care to older adults receiving methadone maintenance treatment. This article focuses on problem-solving therapy (PST) and presents evidence that PST may be a promising nonpharmacological treatment for older methadone clients with comorbid depressive disorders that can be applied within the staffing and resource limits of methadone maintenance treatment facilities. The advantages of PST relative to other behavioral therapies for this population are based on evidence that PST is less cognitively demanding for an older adult population with mood and substance use disorders. A properly modified PST for an older adult substance-dependent population with subsyndromal or diagnosed depression may be a viable option for methadone maintenance programs with limited resources.
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Affiliation(s)
- Daniel Rosen
- University of Pittsburgh, Pittsburgh, PA 15260, USA.
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The Relationship of Age-Related Factors to Psychological Functioning Among People With Disabilities. Phys Med Rehabil Clin N Am 2010; 21:281-97. [DOI: 10.1016/j.pmr.2009.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW To identify and discuss recent research studies that propose innovative psychosocial interventions in old age psychiatry. RECENT FINDINGS Studies have shown that cognitive training research for healthy elderly has advanced in several ways, particularly in the refinement of study design and methodology. Studies have included larger samples and longer training protocols. Interestingly, new research has shown changes in biological markers associated with learning and memory after cognitive training. Among mild cognitive impairment patients, results have demonstrated that they benefit from interventions displaying cognitive plasticity.Rehabilitation studies involving dementia patients have suggested the efficacy of combined treatment approaches, and light and music therapies have shown promising effects. For psychiatric disorders, innovations have included improvements in well known techniques such as cognitive behavior therapy, studies in subpopulations with comorbidities, as well as the use of new computer-aided resources. SUMMARY Research evidence on innovative interventions in old age psychiatry suggests that this exciting field is moving forward by means of methodological refinements and testing of creative new ideas.
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Abstract
Technical advances have facilitated the exploration of factors related to geriatric depression and have helped generate novel biological and psychosocial treatment approaches. This review summarizes the main advancements in epidemiology, clinical presentation and course, genetics, and other areas of biological research. Treatment interventions outlined in this paper include electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation, deep brain stimulatn, depression prophylaxis, multidisciplinary approaches to depression treatment, and psychotherapy. Forms of psychotherapy for geriatric depression summarized include interpersonal psychotherapy, supportive psychotherapy, cognitive-behavioral therapy, problem-solving therapy, and ecosystem-focused therapy. Neuroimaging techniques based on magnetic resonance imaging are discussed briefly, including volumetric brain studies, diffusion tensor imaging, fractional anisotropy, fiber tractography, magnetization transfer imaging, and blood-oxygenation-level-dependent functional magnetic resonance imaging. Finally, treatment effectiveness is addressed in a discussion of new models to improve access to and quality of care offered in the community.
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Affiliation(s)
- GEORGE S. ALEXOPOULOS
- Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - ROBERT E. KELLY JR.
- Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Pillay AL, Kometsi MJ, Siyothula ETB. A Profile of Patients Seen by Fly-in Clinical Psychologists at a Non-Urban Facility and Implications for Training and Future Services. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2009. [DOI: 10.1177/008124630903900304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With the serious mental health services deficits in non-urban communities, there is a need to evolve alternative approaches to facilitate access to care. Considering clinical psychology services are largely concentrated in the metropolitan areas, we describe a relatively unusual approach to providing services in an outlying area. The majority of patients attended to in this service are children and adolescents, and most patients have less than secondary-school education. The commonest diagnoses are mental retardation, mood and anxiety disorders, with the last two conditions mainly found in scholars and the unemployed. Fractured families are almost the norm, with four out of five children living with only one or no parents. Over half the patients are from families receiving a state grant. The majority of patients travel great distances to get to the clinical psychologists. The findings point to the need for clinical psychologists to seriously consider developing newer models for providing care, and the need for working outside of traditional approaches.
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Affiliation(s)
- Anthony L. Pillay
- Department of Behavioural Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal and Fort Napier Hospital, South Africa
| | | | - Evy-Terressah B. Siyothula
- Department of Behavioural Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal and Fort Napier Hospital
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