Shahrokh Golshan

Measurement and predictors of resilience among community-dwelling older women

BACKGROUND Resilience, the ability to adapt positively to adversity, may be an important factor in successful aging. However, the assessment and correlates of resilience in elderly individuals have not received adequate attention. METHOD A total of 1395 community-dwelling women over age 60 who were participants at the San Diego Clinical Center of the Womens Health Initiative completed the Connor-Davidson Resilience Scale (CD-RISC), along with other scales pertinent to successful cognitive aging. Internal consistency and predictors of the CD-RISC were examined, as well as the consistency of its factor structure with published reports. RESULTS The mean age of the cohort was 73 (7.2) years and 14% were Hispanic, 76% were non-Hispanic white, and nearly all had completed a high school education (98%). The mean total score on the CD-RISC was 75.7 (sd=13.0). This scale showed high internal consistency (Cronbachs alpha=0.92). Exploratory factor analysis yielded four factors (somewhat different from those previously reported among younger adults) that reflected items involving: (1) personal control and goal orientation, (2) adaptation and tolerance for negative affect, (3) leadership and trust in instincts, and (4) spiritual coping. The strongest predictors of CD-RISC scores in this study were higher emotional well-being, optimism, self-rated successful aging, social engagement, and fewer cognitive complaints. CONCLUSIONS Our study suggests that the CD-RISC is an internally consistent scale for assessing resilience among older women, and that greater resilience as assessed by the CD-RISC related positively to key components of successful aging.

Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder

BACKGROUND The development of a rapid-acting and sustainable treatment for bipolar disorder (BPD) depression has been a goal for decades. The most widely documented rapid-onset antidepressant therapy is sleep deprivation (SD), which acts within 24-48 hours in 40%-60% of depressed patients. Conventional antidepressants usually require 2-8 weeks to meet response criteria. The delay, which may prolong suffering and increase suicidal risk, underlines the urgency of alternative treatment strategies. This study evaluates the combined efficacy of three established circadian-related treatments (SD, bright light [BL]), sleep phase advance [SPA]) as adjunctive treatment to lithium and antidepressants. METHODS Forty-nine BPD patients were randomly assigned to a chronotherapeutic augmentation (CAT; SD+ BL+ SPA) or to a medication-only (MED) group. Clinical outcome was assessed using the Hamilton Rating Scale for Depression. RESULTS Significant decreases in depression in the CAT versus MED patients were seen within 48 hours of SD and were sustained over a 7-week period. CONCLUSIONS This is the first study to demonstrate the benefit of adding three noninvasive circadian-related interventions to SD in medicated patients to accelerate and sustain antidepressant responses and provides a strategy for the safe, fast-acting, and sustainable treatment of BPD.

Association Between Older Age and More Successful Aging: Critical Role of Resilience and Depression

OBJECTIVE There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging. METHOD In the Successful AGing Evaluation (SAGE) study, the authors used a structured multicohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, ages 50-99 years, with oversampling of people over 80. A modified version of random-digit dialing was used to recruit subjects. Evaluations included a 25-minute telephone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including positive psychological traits and self-rated successful aging, scaled from 1 (lowest) to 10 (highest). RESULTS The mean age of the respondents was 77.3 years. Their mean self-rating of successful aging was 8.2, and older age was associated with a higher rating, despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of the variance in the score for self-rated successful aging and included resilience, depression, physical functioning, and age (entering the regression model in that order). CONCLUSIONS Resilience and depression had significant associations with self-rated successful aging, with effects comparable in size to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have effects on successful aging as strong as that of reducing physical disability, suggesting an important role for psychiatry in promoting successful aging.

Heterogeneity in functional status among older outpatients with schizophrenia: employment history, living situation, and driving.

Schizophrenia and aging are both risk factors for deficits in independent functioning, yet relatively few studies have examined the level and predictors of functional status of older outpatients with schizophrenia. We compared employment history, current living situation, and driving status of 83 middle-aged and elderly outpatients with schizophrenia (mean age 59 years), and 46 demographically equivalent normal comparison subjects. We also examined the relationships of neuropsychological functioning and psychiatric symptoms to these aspects of everyday functioning. The schizophrenia patient group had consistently worse functional status than the normal comparison group, but 30% of the patients were employed at least 50% of the time during their post-schizophrenia-onset adult lives, 73% were living in a house or apartment and responsible for meeting most of their own daily needs, and 43% were current drivers. Severity of negative symptoms (but not that of positive symptoms) was inversely correlated with functional status. Worse performance on a neuropsychological battery was generally associated with worse functional status. These findings counter notions that functional impairment is inevitable in older schizophrenia patients, and highlight the importance of assessment of functional skills and possibly targeting them as a treatment focus.

Age at onset and clinical features of late life compulsive hoarding

Compulsive hoarding is a debilitating, chronic disorder, yet we know little about its onset, clinical features, or course throughout the life span. Hoarding symptoms often come to clinical attention when patients are in late life, and case reports of elderly hoarders abound. Yet no prior study has examined whether elderly compulsive hoarders have early or late onset of hoarding symptoms, whether their hoarding symptoms are idiopathic or secondary to other conditions, or whether their symptoms are similar to compulsive hoarding symptoms seen in younger and middle‐aged populations. The objectives of this study were to determine the onset and illustrate the course and clinical features of late life compulsive hoarding, including psychiatric and medical comorbitities.

Course of neurocognitive deficits in the prodrome and first episode of schizophrenia.

Understanding the trajectory of cognitive changes in the development of schizophrenia may shed light on the neurodevelopmental processes in the beginning stage of illness. Subjects at risk for psychosis (AR, n = 48), patients in their first episode of schizophrenia (FE, n = 20), and normal comparison subjects (n = 29) were assessed on a neurocognitive battery at baseline and at a 6-month follow-up. There were significant group differences across all cognitive domains as well as a significant group by time interaction in the verbal learning domain. After statistically controlling for practice effects and regression to the mean, a high proportion of FE subjects showed an improvement in verbal learning, and a significant number of AR subjects improved in general intelligence. Moreover, a higher than expected percentage of FE subjects, as well as AR subjects who later converted to psychosis, showed a deterioration in working memory and processing speed. These inconsistent trajectories suggest that some domains may improve with stabilization in the early stages of psychosis, whereas others may decline with progression of the illness, indicating possible targets for cognitive remediation strategies and candidate vulnerability markers for future psychosis.

Effects of a Tryptophan-Free Amino Acid Drink Challenge on Normal Human Sleep Electroencephalogram and Mood

BACKGROUND Serotonin has been implicated in the regulation of sleep and mood. In animals a tryptophan-free amino acid drink (TFD) challenge has been found to reduce brain serotonin. We hypothesized this TFD would produce alterations in electroencephalographic (EEG) sleep commonly associated with depression, i.e. an enhancement of rapid eye movement (REM) sleep, and adversely affect mood ratings in humans. METHODS We investigated the effects of a TFD challenge in 11 healthy male subjects on EEG sleep and mood (assessed by Profile of Mood States). All subjects received on separate occasions an experimental drink containing approximately 100 g of an amino acid mixture (100% TFD) and a control drink containing one fourth strength (25% TFD) of the experimental drink 5 hours prior to sleep (6:00 PM). RESULTS Both drinks significantly decreased plasma tryptophan levels 5 hours postchallenge (11:00 PM). Both drinks significantly decreased REM latency, and the 25% TFD also increased REM time and REM% compared to baseline. No significant changes were found in subjective ratings of depression; however, subjects reported confusion and tension and a decrease in elation, vigor, and friendliness compared with baseline. CONCLUSIONS These TFD findings further support the involvement of serotonin deficiency in EEG sleep findings commonly seen in depression.

A Spiritually Based Group Intervention for Combat Veterans With Posttraumatic Stress Disorder Feasibility Study

Purpose: To assess the feasibility, effect sizes, and satisfaction of mantram repetition—the spiritual practice of repeating a sacred word/phrase throughout the day—for managing symptoms of posttraumatic stress disorder (PTSD) in veterans. Design: A two group (intervention vs. control) by two time (pre- and postintervention) experimental design was used. Methods: Veterans were randomly assigned to intervention (n = 14) or delayed-treatment control (n = 15). Measures were PTSD symptoms, psychological distress, quality of life, and patient satisfaction. Effect sizes were calculated using Cohens d. Findings: Thirty-three male veterans were enrolled, and 29 (88%) completed the study. Large effect sizes were found for reducing PTSD symptom severity (d = –.72), psychological distress (d = –.73) and increasing quality of life (d = –.70). Conclusions: A spiritual program was found to be feasible for veterans with PTSD. They reported moderate to high satisfaction. Effect sizes show promise for symptom improvement but more research is needed.

Cellular immunity and the hypothalamic-pituitary axis in major affective disorder: A preliminary study

To assess cellular immune status and the hypothalamic-pituitary axis in patients with major depression, we examined peripheral blood mononuclear cells and measured the plasma levels of four neurohormones. Eleven patients with major depression had increased % of T4 lymphocytes and decreased concanavalin (Con A) stimulated T lymphocyte proliferation when compared with 11 age-, sex-, and race-matched control subjects. Percent of total lymphocytes labeled as all T lymphocytes, all B lymphocytes, and natural killer cells did not differ in the two groups, nor did mitogen-induced interleukin-2 production. These findings support theories of interaction between depression and immune cell function.

Brief evaluation of medication influences and beliefs: development and testing of a brief scale for medication adherence.

Purpose: The purpose of this study was to develop and test a brief scale (Brief Evaluation of Medication Influences and Beliefs [BEMIB]) designed to identify patients who are more likely to be nonadherent to their antipsychotic medication. Methods: Sixty-three outpatients with schizophrenia and related psychotic disorders were enrolled and given an assessment battery including the BEMIB, a previously published adherence scale, extrapyramidal symptom rating scales, and an adherence assessment with patient self-report and prescription refill records. The BEMIB consisted of 8 statements derived from the health belief model with a 5-point Likert-type scale for each statement. Subjects chose a single answer for each item depending on their level of agreement or disagreement. Results: According to refill records, subjects meeting BEMIB-based criteria for nonadherence had significantly larger gaps in antipsychotic therapy (greater nonadherence) compared with those of participants not meeting criteria for nonadherence. For the 1-week test-retest reliability, the BEMIB total score and 5 of 8 single items correlated significantly. BEMIB total scores correlated significantly with an established assessment of adherence (Drug Attitude Inventory), demonstrating adequate construct validity. Conclusion: The BEMIB represents a promising scale for identifying patients more likely to be nonadherent to their medications.