Samantha Loi

Tracking motor impairments in the progression of Huntington's disease

The Unified Huntingtons Disease Rating Scale is used to characterize motor impairments and establish motor diagnosis. Little is known about the timing of diagnostic confidence level categories and the trajectory of motor impairments during the prodromal phase. Goals of this study were to estimate the timing of categories, model the prodromal trajectory of motor impairments, estimate the rate of motor impairment change by category, and provide required sample size estimates for a test of efficacy in clinical trials. In total, 1010 gene‐expanded participants from the Neurobiological Predictors of Huntingtons Disease (PREDICT‐HD) trial were analyzed. Accelerated failure time models were used to predict the timing of categories. Linear mixed effects regression was used to model the longitudinal motor trajectories. Age and length of gene expansion were incorporated into all models. The timing of categories varied significantly by gene expansion, with faster progression associated with greater expansion. For the median expansion, the third diagnostic confidence level category was estimated to have a first occurrence 1.5 years before diagnosis, and the second and first categories were estimated to occur 6.75 years and 19.75 years before diagnosis, respectively. Motor impairments displayed a nonlinear prodromal course. The motor impairment rate of change increased as the diagnostic confidence level increased, with added acceleration for higher progression scores. Motor items can detect changes in motor impairments before diagnosis. Given a sufficiently high progression score, there is evidence that the diagnostic confidence level can be used for prodromal staging. Implications for Huntingtons disease research and the planning of clinical trials of efficacy are discussed.

Personality of mental healthcaregivers

Purpose of review Caring for a family member with a chronic mental illness can be a major challenge with putting caregivers at risk of burden and depression. This review investigated the recent evidence on the role of personality traits and features for caregiver burden and depression in caregivers of care recipients with mental illness. Recent findings Most of the evidence was found for caregivers looking after care recipients with dementia. Neuroticism was the personality trait showing the strongest association with caregiver burden and depression. Summary Certain personality traits and features can increase the risk of caregiver burden and depression in caregivers looking after family members with a mental illness. More research is needed especially focusing on caregivers looking after care recipients with mental illnesses other than dementia as well as on interventions aiming to support vulnerable caregivers.

Physical activity in caregivers: What are the psychological benefits?

Previous research demonstrates that physical activity has psychological benefits for people of all ages. However, it is unclear whether people caring for a frail or ill relative would derive similar psychological benefits, considering the potentially stressful caregiver role. This article reviews the current literature describing the effect of physical activity interventions on the psychological status of caregivers. A search from January 1975 to December 2012 identified five intervention studies investigating physical activity and psychological status in caregivers. These focused on female Caucasian caregivers who were older than 60 years. The physical activity interventions improved stress, depression and burden in caregivers, but small sample sizes, short-term follow up and varying results limited the generalizability of the findings. There were few trials investigating male caregivers, and most care-recipients were people with dementia. Studies with caregivers of different ages and gender, with a range of physical activity interventions, are needed to clarify whether physical activity has psychological benefits for caregivers.

Medical comorbidity in psychogeriatric patients.

Purpose of review To undertake a systematic review of articles published in the years 2008–2010 related to medical comorbidities in psychogeriatric patients. This paper addresses selected research findings on the prevalence and causes of medical comorbidity in elderly patients with psychiatric illnesses. MEDLINE, EMBASE and PsychINFO databases were used to identify potential studies. Specific medical comorbidities which were studied included osteoporosis and diabetes. Several studies investigated general medical comorbidities. Recent findings Elderly patients with psychiatric illness generally had the presence of at least one medical comorbidity compared with elderly patients without a psychiatric illness. Depression in elderly patients was the most commonly studied psychiatric illness. Summary Elderly patients with psychiatric illness commonly have comorbid medical conditions. The presence, appropriate investigations and management of these are often suboptimal and can affect quality of life and increase mortality.

A pilot study using “apps” as a novel strategy for the management of challenging behaviors seen in people living in residential care

BACKGROUND Many adults living in residential care will demonstrate challenging behaviors. Non-pharmacological strategies are recommended as first-line treatment. Using applications (apps) is a novel approach to managing these behaviors, and has yet to be assessed in this group. This paper describes a pilot study to test apps as a novel non-pharmacological strategy to manage challenging behaviors in adults living in residential care. METHODS A non-blinded, non-randomized crossover trial design was implemented which compared apps to a control situation and usual care to determine whether apps were able to decrease challenging behaviors. The primary outcome measure was the Neuropsychiatric Inventory (NPI) that measures the frequency and severity of these behaviors. RESULTS Fifteen residents participated whose mean age was 78.5 years. There were a range of diagnoses and comorbidities, including dementia and schizophrenia. IPads were used as the medium for delivering the apps and residential care staff implemented the interventions. There was a significant decrease in the total NPI score using the apps intervention (10.6 points) compared to the control (17.7 points) and to usual care (21.1 points). There was positive qualitative feedback from the staff who were involved in the study, but they also cited barriers such as lack of confidence using the apps and lack of time. CONCLUSIONS Although this was a small and limited study, results suggest that using apps may be a feasible and personalized approach to managing challenging behaviors. A more rigorous study design that includes larger sample sizes and staff training may enable further research and benefits in this area.

Depression and dementia

Depression in people with dementia is a common presentation in primary care, but it is often missed or mismanaged. This problem has substantial public health implications and adversely affects the quality of life and physical health of patients and carers. Many aspects of diagnosis and management remain controversial. A high degree of suspicion and repeated assessment is essential for diagnosis. Medication use should be considered. Psychological and social strategies should be incorporated into most management plans.

The adverse mental health of carers: Does the patient diagnosis play a role?

OBJECTIVES The adverse mental health effects of caring have been studied, frequently in carers of people with dementia. Less is known about the mental health of carers of people with other conditions. This study compared depression and burden in older carers looking after people with a variety of conditions. DESIGN, METHODS AND MEASURES Over 200 older carers interested in participating in the Improving Mood through Physical Activity in Carers and Care-recipient Trial were included in this cross-sectional study, using the Geriatric Depression Scale (GDS) and Zarit Burden Inventory (ZBI). RESULTS Overall there were 43% of carers who were depressed and a quarter of them reported moderate-to-severe burden. Carers of people with physical conditions had the highest levels of depression and burden. Patient diagnosis, hours spent caring, and burden were associated with depression, while hours spent caring and carer depression were associated with burden. These factors contributed approximately 25-30% of the variance of depression and burden, respectively. CONCLUSIONS The diagnosis of the patient was a factor associated with depression, and older carers of people with physical conditions were at the highest risk. It is important for clinicians to assess the mental health of all carers, regardless of the patient diagnosis.

Getting started in research: research questions, supervisors and literature reviews

Objectives: Research can seem daunting, especially for trainees and early career researchers. This paper focuses on how to formulate and begin a research project such as the RANZCP Scholarly Project. Methods: We outline an approach to framing a research question, developing theses and hypotheses, choosing a supervisor and conducting a literature review. Conclusions: Through systematic planning early career researchers and other clinicians can plan and conduct research suitable for the Scholarly Project or other research activity.

Improving mood through physical activity for carers and care recipients (IMPACCT): Protocol for a randomised trial

INTRODUCTION Family carers play an important role in providing care for frail older Australians. Carers have increased rates of depression, burden and poor physical health compared with non-carers. Physical activity has been shown to improve outcomes; however there is limited research investigating outcomes in older carers and less on physical activity for both the carer and care recipient. RESEARCH QUESTION Does a home-based individualised physical activity intervention designed for both the carer and care recipient improve depression severity in older carers? PARTICIPANTS AND SETTING 273 community-dwelling carers with depressive symptoms and their care recipients will be recruited for a randomised controlled trial. Baseline assessment will consist of functional, psychological, and physical measures and information about service use. INTERVENTION AND CONTROL: Participants will be randomised to receive either a physical activity program (intervention), a social support program (social control), or usual care (control). The intervention and social control groups will have five home visits over six months. MEASUREMENTS All participants will be re-assessed after completion of the program and then six months later to evaluate sustainability of outcomes. The primary outcome measure is the 15-item Geriatric Depression Scale for carers. Secondary outcomes include physical measures for carers and care recipients, carer burden, carer satisfaction, care recipient depression, and cost-effectiveness. All assessors will be blind to group allocation. DISCUSSION This study has the potential to demonstrate that physical activity interventions can be delivered simultaneously to older carers and care recipients to improve mental and physical outcomes.

Electroconvulsive therapy for treatment of late-onset obsessive compulsive disorder

An 81-year-old female with no previous psychiatric history presented with late-onset obsessive compulsive disorder following an acute right macular hemorrhage and loss of vision. Following a thorough organic screen to exclude a physical cause, various high doses of selective serotonin reuptake inhibitors were tried with no therapeutic benefit. The patient had significant remission of her symptoms following a course of electroconvulsive therapy.