Geoffrey Tremont

Cognitive-behavioral prevention of postconcussion syndrome☆

The symptoms of postconcussion syndrome (PCS) are persistent, and no empirically tested treatment is available. The treatment group (n = 29) in this study received a printed manual and met with a therapist prior to hospital discharge to review the nature and incidence of expected symptoms, the cognitive-behavioral model of symptom maintenance and treatment, techniques for reducing symptoms, and instructions for gradual resumption of premorbid activities. The control group (n = 29) received routine hospital treatment and discharge instructions. Both groups had sustained mild head injuries characterized by Glascow Coma Scale scores of 13-15 on admission without any measurable period of posttraumatic amnesia. Group assignment was random. Groups did not differ significantly on age, Glascow scores, litigation status, gender, or initial number of PCS symptoms. Patients were contacted 6 months following injury by an interviewer who was unaware of group assignment to obtain outcome data. Treated patients reported significantly shorter average symptom duration (33 vs. 51 days) and significantly fewer of the 12 symptoms at followup (1.6 vs. 3.1). Subjects were also asked how often each symptom had occurred in the previous week, and how severe the symptom typically was. The treatment group experienced significantly fewer symptomatic days (.5 vs. 1.3) and lower mean severity levels. Results suggest that brief, early psychological intervention can reduce the incidence of PCS.

Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research.

Background The purpose of this article is to review the evidence for the efficacy of hatha yoga for depression and possible mechanisms by which yoga may have an impact on depression, and to outline directions for future research. Methods Literature review and synthesis. Results and Conclusions A literature search for clinical trials examining yoga for depression uncovered eight trials: 5 including individuals with clinical depression, and 3 for individuals with elevated depression symptoms. Although results from these trials are encouraging, they should be viewed as very preliminary because the trials, as a group, suffered from substantial methodological limitations. We would argue, however, that there are several reasons to consider constructing careful research on yoga for depression. First, current strategies for treating depression are not sufficient for many individuals, and patients have several concerns about existing treatments. Yoga may be an attractive alternative to or a good way to augment current depression treatment strategies. Second, aspects of yoga—including mindfulness promotion and exercise—are thought to be “active ingredients” of other successful treatments for depression. Third, there are plausible biological, psychological, and behavioral mechanisms by which yoga may have an impact on depression. We provide suggestions for the next steps in the study of yoga as a treatment for depression. (Journal of Psychiatric Practice 2010;16:22–33).

Premorbid Relationship Satisfaction and Caregiver Burden in Dementia Caregivers

Dementia caregiver appraisal of the quality of their current and premorbid relationship with the care recipient is associated with caregiving behaviors, caregiver mood, and the decision to end home care. This study examined the contribution of premorbid relationship satisfaction to caregiver burden in dementia caregivers. Live-in dementia caregivers (n = 72) completed several psychosocial measures. Caregiver responses were used to divide them into low premorbid relationship satisfaction group (low) versus high premorbid relationship satisfaction group (high). Results indicate that premorbid relationship satisfaction is negatively associated with caregiver burden and quality of family functioning. Caregivers with high satisfaction demonstrated significantly less burden and less reactivity to memory and behavior problems, and better problem solving skills and more effective communication compared with the low caregivers. Findings are independent of length of caregiving, disease severity, care recipient daily functioning, and relationship type. Relationship satisfaction may be an important contributor to caregiver burden. (J Geriatr Psychiatry Neurol 2007;20:115-119)

High Risk of Reading Disability and Speech Sound Disorder in Rolandic Epilepsy Families: Case–Control Study

Purpose: Associations between rolandic epilepsy (RE) with reading disability (RD) and speech sound disorder (SSD) have not been tested in a controlled study. We conducted a case–control study to determine whether (1) RD and SSD odds are higher in RE probands than controls and (2) an RE proband predicts a family member with RD or SSD, hence suggesting a shared genetic etiology for RE, RD, and SSD.

Differential Impact of Executive Dysfunction on Verbal List Learning and Story Recall

The California Verbal Learning Test (CVLT) and the Logical Memory (LM) subtest from the Wechsler Memory Scale-Revised (WMS-R) are generally thought to be interchangeable measures of verbal memory. However, little is known about the effects of executive dysfunction on these tasks. The present study involved 96 patients referred for neuropsychological evaluation who were classified as having either significant executive dysfunction (SED) or minimal executive dysfunction (MED) based on the number of impaired executive tasks. Results showed that the SED group performed significantly worse on CVLT total words learned and most of the recall conditions compared to the MED patients (p < .01). However, performance on both immediate and delayed LM did not significantly differentiate the groups. CVLT measures of semantic clustering, perseveration, intrusions, and false positive errors did not appear to account for the group differences. The current study strongly suggests that the CVLT and the LM subtest are differentially associated with executive dysfunction, and argues for the inclusion of both types of tasks in a comprehensive neuropsychological evaluation. </.01).>

Psychosocial Predictors of Dementia Caregiver Desire to Institutionalize: Caregiver, Care Recipient, and Family Relationship Factors

Several factors influence dementia caregiver desire to institutionalize; however, little is known about differences in caregivers who desire institutionalization versus those who do not. The current study compares predictors of desire to institutionalize in dementia caregivers. Seventy-two caregivers completed the Desire to Institutionalize Scale (DIS) and several psychosocial measures, including burden, dementia knowledge, self-efficacy, depression, health, care recipient daily functioning and memory/behavior problems, family functioning, and social support. Based on DIS responses, caregivers were divided into No DI versus DI groups. DI caregivers had significantly higher burden, greater dementia knowledge, more family dysfunction, and decreased social support compared with No DI caregivers. Findings emphasize the importance of caregiver and family relationship variables in DIS, suggesting potentially modifiable targets for caregiver interventions. Dementia knowledge was associated with higher DIS, suggesting that educational programs alone may not be helpful to delay institutionalization.

Review of the validation and dissemination of eye-movement desensitization and reprocessing: A scientific and ethical dilemma

Abstract Eye-Movement Desensitization and Reprocessing (EMDR), a technique that combines imaginai exposure with eye movement, recently has been proposed by its originator, F. Shapiro, as a prescriptive treatment for trauma-related anxiety. To date, several uncontrolled case studies have found EMDR to be effective. However, none employed objective or standardized dependent measures of therapeutic improvement and all combined EMDR with other interventions. In contrast to results obtained from case studies, controlled experiments utilizing objective and standardized dependent measures have failed to support the efficacy of the technique beyond that of its imaginal exposure component. Unfortunately, these experiments employed small samples with a limited range of disorders, indicating the need for further evaluation. However, unbiased replication is impeded by Shapiros practice of prohibiting individuals not associated with her EMDR Institute from training others in the technique. We articulate our concern that despite its lack of empirical validation clinical application of the technique by behavior therapists is rapidly increasing.

Burden among spousal and child caregivers of patients with mild cognitive impairment.

Background/Aims: Patients with mild cognitive impairment (MCI) experience cognitive declines and often report significant emotional/behavioral changes. Despite this, few studies have examined the impact of MCI on caregiver burden. The purpose of this study was to confirm the presence of caregiver burden in MCI and examine the relationship between burden and patients’ neuropsychological, behavioral and emotional functioning. Methods: The current study included 51 individuals who had been diagnosed as having MCI using Petersen’s criteria. The patients underwent a thorough neuropsychological evaluation and completed the Beck Depression Inventory and Cognitive Difficulties Scale. The caregivers completed the Zarit Burden Interview and the Revised Memory and Behavior Checklist. Results: More than 30% of the caregivers reported clinically significant burden. Increased caregiver burden was associated with a longer course of cognitive symptoms, patient reports of worse depression and greater cognitive difficulties, and informant reports of patients having more behavior, mood and memory problems. Caregiver burden was not significantly associated with patients’ neuropsychological test performance. Conclusion: The results highlight the importance of addressing patients’ behavioral and emotional difficulties, as well as caregiver burden, as part of the clinical exam in MCI.

Telephone-Delivered Psychosocial Intervention Reduces Burden in Dementia Caregivers

The objective of this study was to examine the preliminary efficacy of Family Intervention: Telephone Tracking — Dementia (FITT-D), a multi-component intervention that is delivered in 23 telephone contacts over 12 months. Thirty-three dementia caregivers were randomly assigned to receive either FITT-D ( n = 16) or standard care (n = 17) using urn randomization to balance the groups on dementia severity, caregiver gender and relationship type (spouse versus other). Inclusion criteria included formal dementia diagnosis, caregiving for at least six months, residing with the care recipient, and providing at least four hours of direct supervision per day. Masters-level therapists contacted caregivers by telephone over 12 months. Each contact followed a standardized treatment manual, involving assessment and individualized application of interventions to address mood, family functioning, social support and health. Outcomes included Zarit Burden Interview, Revised Memory and Behavior Problem Checklist, and the Geriatric Depression Scale at baseline and 12 months (end of treatment). Caregivers receiving FITT-D exhibited significantly lower burden scores and less severe reactions to memory and behavior problems than caregivers in the standard care condition. Findings provide preliminary evidence for the efficacy of FITT-D, a potentially highly accessible, low-cost intervention for dementia caregivers.

The Boston Qualitative Scoring System as a measure of executive functioning in Rey-Osterrieth Complex Figure performance.

The Boston Qualitative Scoring System (BQSS) for the Rey-Osterrieth Complex Figure (ROCF) includes five scores (Planning, Fragmentation, Neatness, Perseveration, and Organization) developed to measure the executive aspects of ROCF productions. To assess the convergent and discriminant validity of the BQSS, these five scores were compared to scores on four traditional tests of executive functioning, as well as to three non-executive measures, in 141 adult patients. BQSS executive variables significantly correlated with the traditional executive measures and were less correlated with discriminant measures. The BQSS Organization summary score also significantly differentiated patients with either no, mild, or severe executive dysfunction. These results support the construct validity of the BQSS and demonstrate that the ROCF may be a useful measure of executive functioning.