Victor Molinari

One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease

BACKGROUND We hypothesized that compared to an educational intervention, a single 2 h session of cognitive behavioural therapy (CBT), with 6-week follow-up, would reduce anxiety and depression, improve physical and mental functioning, and lead to a better quality of life and greater satisfaction with treatment in older patients with chronic obstructive pulmonary disease (COPD). METHODS Fifty-six subjects were recruited from a large, urban, academically affiliated Veterans Affairs (VA) Hospital, a non-profit private hospital, and a local newspaper, for a single blind randomized controlled clinical trial. One 2 h session of group CBT was designed to reduce symptoms of anxiety, with specific components including relaxation training, cognitive interventions, and graduated practice, followed by homework and weekly calls for 6 weeks. This was compared to a group that received 2 h of COPD education, followed by weekly calls. Pre- and post-intervention subjects in both groups were administered SF-36, Geriatric Depression Scale, Beck Anxiety Inventory, 6 min walk test, and the FEV-1. Following the intervention, both groups completed the Client Satisfaction Questionnaire. RESULTS When compared with a group that received education about COPD, 2 h CBT group showed decreased depression and anxiety. Contrary to our hypothesis, despite the decrease in depression and anxiety, there was no change in the physical functioning of the patients. CONCLUSIONS Twenty to 40% of patients with COPD have high levels of anxiety and depression. Our study finds that as little as 2 h of CBT administered in a group setting is able to reduce these anxious and depressive symptoms.

Life Review Reminiscence in the Elderly: A Review of the Literature

The literature on life review reminiscence in the elderly is reviewed. Research indicates that life review is a personal, self-evaluative form of reminiscence with intrapersonal and interpersonal dimensions. The nature and quality of these dimensions change with age. The process and outcome of life review in the elderly may vary as a function of independent, as compared with institutional, living. There needs to be closer correspondence between clinical and research endeavors since empirical documentation is lacking regarding the efficacy of life review groups. It is suggested that an integration of intrapersonal and interpersonal approaches may provide the basis for a broad conceptualization of life review reminiscence in aged adults.

Accuracy of self-reported depression in persons with dementia.

Objectives: To investigate the reliability and validity of self‐reported depression in demented elderly patients.

The efficacy and tolerability of divalproex sodium in elderly demented patients with behavioral disturbances

Behavioral disturbances are commonly encountered in elderly demented patients. The records of all patients admitted to a geropsychiatric inpatient unit within a 2‐year period who had a primary diagnosis of dementia and an accompanying behavioral disturbance treated with divalproex sodium were reviewed. Of the 13 patients identified, all tolerated divalproex sodium without significant side‐effects. General psychiatric symptoms, overall agitation, physical aggression and non‐aggressive physical agitation decreased significantly, but verbal agitation did not. Divalproex sodium is well tolerated and may be effective in ameliorating certain behavioral disturbances in elderly demented patients with agitation.

Prevalence of personality disorders in community-living elderly.

There has been limited research on the prevalence of personality disorders in the aged. No studies have documented the extent of personality disorders in community-dwelling elderly with the use of a structured scale specifically designed to detect personality disorders and anchored to DSM-III-R criteria. One hundred male and 100 female community-living elderly (mean age, 72.1 years) were administered the Structured Interview for Disorders of Personality-Revised to compare prevalence rates for specific personality disorders with those of young adults (mean age, 41.7 years) and to identify demographic variables associated with personality disorders in the elderly. Results indicate a tendency toward fewer personality disorders in older than young adults, no differences in the frequency of personality disorders between male and female elderly, and significantly more prior mental health consultations in elderly with personality disorders than in elderly without these disorders. Aging processes and methodologic issues that could accountfor differences in personality disorder distribution between young and older adults are discussed. Recommendations for future research are outlined.

Prevalence of personality disorders in two geropsychiatric inpatient units

One hundred males from a Veterans Affairs geropsychiatric inpatient ward, and 100 females from a geropsychiatric inpatient ward of a private hospital completed the Structured Interview for Disorders of Personality-Revised (SIDP-R). Chart reviews provided information including age, years of education, marital status, race, as well as Axis I and Axis II psychiatric diagnoses. Data from a young adult sample, drawn from an initial SIDP-R validation study, were used for comparison. Results indicate a 56.5% rate of personality disorders (PD) for older patients. Significantly more elderly men than elderly women were diagnosed with PD by psychiatric evaluation, and elderly men were also more likely to be diagnosed with paranoid, avoidant, and multiple PD using the SIDP-R. Psychiatrists gave far fewer Axis II diagnoses than were yielded by the SIDP-R, particularly with females. There were no significant differences in total PD rates between aged and young subjects, but older adults with PD were diagnosed less frequently with multiple PD. Older adults were also less likely to be diagnosed with the “Dramatic” cluster PD, and more likely to be diagnosed with the “Odd” cluster PD. The level of depression was related to both clinical and SIDP-R diagnoses.

Dementia Deficits Scale. Rating self-awareness of deficits.

Impaired deficit awareness is important to detect because of its clinical implications; for example, patients with impaired awareness are more likely to engage in potentially dangerous activities, such as operating the stove. This study evaluated the reliability and validity of the Dementia Deficits Scale (DDS), a new multidimensional instrument for the assessment of self-awareness of cognitive, emotional, and functional deficits associated with dementia. Three parallel forms of the DDS were independently completed by the patient, clinician, and informant. The DDS yields two measures of deficit awareness: the discrepancy between clinician and patient assessments of the patient’s deficits, and the discrepancy between informant and patient assessments. The DDS demonstrated adequate reliability and good divergent and convergent validity. Clinician and informant reports each added unique information, highlighting the importance of including both perspectives in the awareness assessment process. The DDS is recommended as a reliable and valid tool for the clinical and empirical assessment of deficit awareness in patients with dementia.

Depressive Symptoms among Older Residents in Assisted Living Facilities

Responding to the dramatic growth in Assisted Living Facilities (ALFs), the present study focused on mental health among older residents in ALFs. We assessed the effects of physical health constraints (chronic conditions, functional disability, and self-rated health) and psychosocial resources (social network, sense of mastery, religiosity, and attitude toward aging) on depressive symptoms. A sample of 150 residents (Mage = 82.8, SD = 9.41) from 17 facilities in Florida was used for analyses. Higher levels of depressive symptoms were observed among older residents with a greater level of functional disability, poorer self-rated health, lower sense of mastery, less religiosity, and less positive attitude towards aging. In addition, the linkages between physical and mental health were modified by psychosocial resources. For older residents with more positive beliefs and attitudes (a higher sense of mastery, greater religiosity, and more positive attitudes toward aging), the adverse effects of functional disability or poorer self-rated health on depressive symptoms were attenuated. The protective roles of psychosocial resources against physical health constraints yield important implications for designing prevention and intervention strategies for the mental health of older populations in ALF settings.

Spouses of Patients with Dementia

Abstract Caregiver spouses struggle to cope with the multiple demands of caregiving and complexities of medical care. In this article, the emotional, marital, attachment, and spiritual aspects of spousal caregiving for patients with dementia are addressed. This paper explores what keeps spouses together during this devastating illness. The literature has been reviewed to identify value systems that enable spouses to continue caregiving in these challenging circumstances. Articles were targeted that focus on the psychological and spiritual meaning of the marital bond, and its disruption when a spouse develops dementia. Recommendations for the clinical management of caregiver burden emerge from a pluralistic understanding that encompasses such constructs as “quid pro quo”; commitment and family solidarity; holding on to the familiar versus “letting go”; rupture and repair of the marital bond; mastery of separation-individuation; spirituality; changes in the sexual relationship; and reaching out for emotional support. Techniques are highlighted to help couples deal with loss, and changes in communication and intimacy. A multidimensional approach by the geriatric mental health team is emphasized in order to provide optimal care to caregiver spouses.

Age-related differences in the frequency of personality disorders among inpatient veterans

This cross‐sectional study explored age‐related differences in the frequency of diagnosis of personality disorder (PD) among 790 veterans admitted to a psychiatric inpatient unit across three age groups: 20–39, 40–59, and 60+. Older adults obtained a lower frequency (55.4%) of PD diagnosis than middle‐aged adults (69.0%), who in turn obtained a lower frequency of PD diagnosis than young adults (75.9%). Older adults and middle‐aged adults were less likely to receive a diagnosis of Borderline PD than young adults. Older adults were also less likely to receive a diagnosis of Mixed PD than young adults, but received significantly more diagnoses of Narcissistic PD than young adults. Patients diagnosed with PD had higher rates of psychiatric hospitalization than those with no diagnosis of PD. Older adults and middle‐aged adults with PD had significantly fewer psychiatric hospitalizations than young adults with PD, whereas there were no age‐related differences in the frequency of medical hospitalizations. These findings are consistent with research suggesting an overall softening of PD features with age, particularly those characteristic of the ‘dramatic‐erratic’, Cluster B types. Copyright