Caroline A. Fisher

Aggression in Huntington's disease: a systematic review of rates of aggression and treatment methods.

Aggression is commonly reported in individuals with Huntingtons disease (HD). While correlating factors for aggression are often speculated about, features that are associated with, and contribute to, aggression in this population have not been clearly determined. This systematic review investigates rates of aggression and treatment options for aggression in HD. A number of key findings were revealed. Studies reporting on rates of aggression revealed that its prevalence is high, falling between 22 and 66 percent in the majority of studies. Aggression may be more common in males with HD, and is also found in higher rates in individuals who experience frequent falls, have obsessive-compulsive symptoms and suicidal ideation. There is little research investigating antecedents for aggression in HD. A wide variety of psychotropic medications have been reported in the literature to treat individuals with HD and aggressive behaviour. However, due to methodological limitations, no treatment recommendations can be made, based on the current literature. Two non-medication therapies have been investigated, behaviour support and sensory modulation intervention. However, again, due to methodological limitations with these studies, further research is needed before they can be recommended as frontline interventions. This review highlights the need for further methodologically rigorous studies investigating the treatment of aggression in HD.

Back to basics: could behavioural therapy be a good treatment option for youth depression? A critical review

Recent findings from systematic reviews and primary research studies have shown more modest effects of cognitive behavioural therapy (CBT) for youth depression than previously shown, highlighting the need to further enhance the effectiveness of this intervention, or components of this intervention. Therefore, the aim of this review is to summarize the work that has been done to identify the different components of CBT and their varying effectiveness for young people with depression.

Characterizing neurocognitive impairment in young people with major depression: state, trait, or scar?

Major depressive disorder (MDD) affects a quarter of adolescents and young adults and is associated with the greatest global burden of disease in this population. There is a growing literature, mostly in adults, showing that significant neurocognitive impairments are common in MDD. It remains unclear whether these impairments are pre‐existing trait markers of MDD, state‐related impairments that fluctuate with depressive symptoms, or ‘scar’ impairments that worsen with illness progression. The aim of this study is to provide a conceptual framework for understanding MDD and neurocognitive impairment in adolescence and young adulthood (ages 12–25 years).

Integrated (one-stop shop) youth health care: best available evidence and future directions

Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

Neuropsychology and Youth Mental Health in Victoria: The Results of a Clinical Service Audit

Objective The allocation of neuropsychology services in Victorias public youth mental health system is very limited. The objective of this study was to evaluate the utility of a youth mental health neuropsychology service over a 16‐month period, and to evaluate referrer feedback about the service. Methods A 16‐month clinical data audit and referrer survey of the Eastern Health Child and Youth Mental Health Service neuropsychology service. Results A total of 45 clients were seen for assessment during the audit period with an age range of 7–25-years. Neuropsychological involvement identified DSM diagnoses in 42% of clients, as well as findings that were considered to be of neuropsychological importance in a further 51%. Case manager referrer surveys were returned at a rate of 58%, with 100% of responses indicating that the neuropsychological input had assisted with treatment planning, and that 79% of responders had altered their therapeutic approach after receiving the neuropsychological results. Conclusions Neuropsychology input in youth mental health services is useful from both a diagnostic and treatment planning perspective and often results in alterations in the therapeutic approach of case managers.

Optimising occupational performance through sensory modulation interventions: Case reports of two young adults diagnosed with juvenile Huntington's disease

Statement of context People with juvenile Huntingtons disease often experience difficulty engaging in occupations due to neuropsychiatric sequelae, such as impulse control difficulties, agitation and aggression. Occupational therapy using sensory modulation intervention strategies may be utilised to assuage behavioural symptoms in this population. Critical reflection on practice Through case reports, this practice analysis explores changes in occupational performance for two young adults diagnosed with juvenile Huntingtons disease who received sensory modulation treatment. Implications for practice These inspiring reports could encourage occupational therapists to consider sensory modulation intervention to decrease psychiatric disturbance, thus optimising performance capacity among this rare population.

Sensory modulation intervention and behaviour support modification for the treatment of severe aggression in Huntington's disease. A single case experimental design

ABSTRACT Aggression is common in Huntingtons disease. However, at present there are no standard guidelines for managing aggression in Huntingtons sufferers due to a lack of empirical research. This paper presents a case study of the treatment of very high levels of aggression with sensory modulation and behaviour support intervention in a Huntingtons sufferer. The client exhibited a range of aggressive behaviours, including physical aggression to people, furniture and objects, and verbal aggression. Following an eight week baseline phase, five weeks of sensory modulation intervention were employed. A behaviour support plan was then implemented as an adjunct to the sensory intervention, with aggressive behaviour systematically audited for a further 11 weeks. The results indicate a significant reduction in reported levels of aggression during the combined sensory modulation and behaviour support phase, compared to both the baseline and the sensory modulation therapy alone phases. This case study highlights the efficacy non-pharmacological interventions may have for reducing aggression in HD.

Chronic behavior disturbance and neurocognitive deficits in neuro-Behcet’s disease: a case study

ABSTRACT Behcet’s disease is a vasculitis and multisystem inflammatory syndrome. Neurological abnormalities occur in a subset of patients. This report presents a case of neuro-Behcet’s disease characterized by an initial onset of behavior changes prior to diagnosis, which evolved into a chronic behavioral syndrome. Neuroimaging investigations revealed progressive periventricular white matter and brainstem atrophy and lesions in the basal ganglia and deep white matter tracts, while neuropsychological investigations revealed reductions in information processing, executive functioning, and memory. The case indicates that behavior changes may be the first symptoms to emerge in Behcet’s, before other defining features of the disease.

Long-Term use of Modified Diets in Huntington’s Disease: A Descriptive Clinical Practice Analysis on Improving Dietary Enjoyment

Dysphagia is a very common occurrence in Huntingtons disease (HD). As such, many people with HD require texture modified diets. This commentary discusses the implications for individuals living long-term on modified diets, including the loss of sensory stimulation and dietary enjoyment. Clinical practice analyses of two interventions aimed at promoting dietary satisfaction and involvement in food preparation for those with HD are described and parameters for future research are discussed.

Subjective ratings of neurocognitive functioning in depressed young people undergoing treatment: utility of a brief screening tool.

AIMS To determine how young people with depression rate their neurocognitive functioning during treatment, and whether these ratings are affected by depression severity, age, suicidal ideation and antidepressant status. METHODS Fifty young people (12-25 years) engaged in psychological therapy completed the Neuropsychological Symptoms Self-Report rating their neurocognitive functioning in a range of domains. RESULTS In two domains, working memory/multitasking and motivation, more than 40% of the sample rated their functioning as improved, since commencing treatment. Ratings of neurocognitive functioning were affected by depression severity and suicidal ideation, particularly in the areas of wakefulness, attention and concentration, working memory/multitasking, and motivation. However, there were few differences related to age or antidepressant status. CONCLUSIONS The Neuropsychological Symptoms Self-Report - a rapid measure of subjective neurocognitive functioning - can provide a snapshot of subjective changes in neurocognitive functioning during treatment for depression. This information may guide treatment approaches.