Robert J. Westlake

MRI and neuropsychological differences in early- and late-life-onset geriatric depression

We sought to determine whether geriatric patients with late-life-onset major depression have more subcortical hyperintensities on MRI and greater cognitive impairment than age-matched geriatric patients with early-life-onset major depression, suggesting that subcortical disease may be etiologic in late-life depression. Most negative studies of the clinical significance of subcortical hyperintensities on MRI in geriatric patients have sampled from a restricted range of subjects, have employed limited batteries of neuropsychological tests, or have not quantified MRI changes; the present study attempted to address these limitations. Thirty subjects from a geriatric psychiatry inpatient service who were over 60 years of age and presented with major depression were divided into groups with onset of first depression after age 60 (mean = 72.4 years, 15 women, 0 men), and onset of first depression before age 60 (mean = 35.8 years, 12 women, 3 men). Quantitative analysis of MRI yielded the volume of: periventricular hyperintensities (PVH) and deep white-matter hyperintensities (DWMH). Subjects were administered a neuropsychological battery and measures of depression by raters blind to age of onset. The late-onset group had significantly more PVH and DWMH. They were also more impaired on executive and verbal and nonverbal memory tasks. Discriminant function analysis using the severity of subcortical signal hyperintensities on MRI, cognitive index, and depression scores correctly predicted late versus early onset of depression in 87% of the early-onset group and 80% of the late-onset group. These findings suggest that late-life-onset depression may be associated with an increased severity of subcortical vascular disease and greater impairment of cognitive performance. NEUROLOGY 1996;46: 1567-1574

The effect of couples training and partner co-operativeness in the behavioral treatment of obesity

Abstract To evaluate the influence of spouse co-operativeness and couples training in the treatment of obesity, 29 obese men and women were assigned to three experimental conditions: (1) Co-operative spouse-couples training: subjects attended all meetings with spouses. Spouses were trained in modeling, monitoring, and reinforcement techniques; (2) Co-operative spouse-subject alone: subjects attended meetings alone even though their partners had agreed to become involved in treatment; (3) Non-cooperative spouse: subjects had spouses refusing to participate in the program, and attended sessions alone. At the 3-month and 6-month maintenance assessments. subjects in the spouse training condition lost significantly more weight than subjects in the other two conditions. Weight losses compared favorably to those of any controlled study with subjects in the couples training group averaging nearly 30 lbs lost after 8 1 2 months of treatment. In the absence of spouse training, subjects with co-operative spouses did no better than subjects with non-co-operative spouses. The findings suggest that spouse training may have a potent facilitative effect in weight reduction, and that this effect may promote long-term maintenance of weight loss.

The behavioral control of obesity: A descriptive analysis of a large-scale program

Evaluated a behavoiral treatment program for 147 obese patients in a Weight Control Clinic. Weight losses during treatment averaged 11.01 pounds with large inter-S variability. Unlike past studies, patients continued to lose weight during a 6-month follow-up period. Weight loss was associated with age and initial degree of obesity, but other demographic and psychological variables failed to predict success in treatment. A critical examination of the attrition problem was carried out to determine the relationship between patient variables and the propensity to terminate treatment prematurely. Results demonstrate the utility of bahvioral treatment procedures for obesity, yet further research is needed to reduce attrition and to facilitate long-term maintenance of weight loss.

Memory processes in depressed geriatric patients with and without subcortical hyperintensities on MRI.

In this study, 12 patients over age 60 with depression with moderate to severe subcortical hyperintensities (SH) localized to the periventricular white matter were identified by quantitative MRI. Using the California Verbal Learning Test, they were compared with 12 age‐, education‐, and severity‐matched patients with depression with minimal white matter changes on specific aspects of memory performance. Patients with cortical lesions, neurologic or systemic illness affecting cognition, and history of substance abuse were excluded. Patients in the group with high SH showed reduced use of semantic encoding strategies (p < 0.05), reduced learning efficiency (p < 0.05), and a greater discrepancy between free recall and recognition discriminability (p < 0.05) than their low SH counterparts. This pattern of performance on memory tasks is similar to that found in previous studies to be associated with subcortical degenerative disorders such as Huntingtons and Parkinsons diseases. Geriatric patients with depression with SH may represent a subgroup with greater subcortical involvement, with associated cognitive and functional decline.

Clinical Features of Obsessive-Compulsive Disorder in Elderly Patients

There has been no systematic study of the clinical features of obsessive-compulsive disorder (OCD) in elderly patients. This study describes the symptoms and characteristics of OCD among 32 outpatients age 60 or older and 601 younger patients meeting DSM-III-R criteria and given the Yale-Brown Obsessive-Compulsive Scale (YBOCS), NIMH scale, and a 41-item symptom questionnaire. Elderly patients had a later age at onset compared with younger patients. No differences were found in severity of symptoms on the YBOCS. Elderly patients had fewer concerns about symmetry, need to know, and counting rituals. Handwashing and fear of having sinned were more common. There were few differences in clinical features of OCD among the elderly patients compared with younger OCD patients.

Pathological jealousy appearing after cerebrovascular infarction in a 25-year-old woman

Objective: To report pathological jealousy (Othello syndrome) occurring in a young woman with a right hemisphere cerebrovascular infarction and to review diagnosis and possible organic mechanisms for the generation of this syndrome. Clinical picture: A 20-year-old woman was admitted to hospital with a right hemisphere stroke associated with a history of severe migraine and the use of oral contraceptives. The patient made a good recovery with minimal neurological deficits but 5 years later developed the syndrome of morbid jealousy with depression and a near fatal overdose. Treatment and outcome: Morbid jealousy subsided, almost completely disappearing over a 6-week period of treatment with a selective serotonin re-uptake inhibitor (SSRI). Conclusions: Case reports of the Othello syndrome and other content specific delusions following right hemisphere cerebrovascular infarction have appeared in geriatric psychiatry literature. The occurrence of a similar association in a young patient lends support to the suggestion of a causal relationship and has implications for diagnosis, clinical care and research.

Self and External Monitoring of Weight

Subjects were 23 obese men and women who received a behavioral weight control program and were randomly assigned to one of two experimental conditions: (1) subjects were weighed at the beginning of each treatment session and were encouraged to weigh themselves at home for “continuous feedback” or (2) subjects were not weighed at group meetings and were instructed to avoid weighing themselves at home in order to “concentrate on behavioral change.” At posttreatment and at 4-wk. follow-up, the groups did not differ for change in bodyweight or change in percentage overweight. There was, however, a tendency for subjects who did not weigh themselves to lose more weight and to display lower attrition than weighed subjects at posttreatment and at the 4-wk. and 6-mo. follow-ups.