[Short and Simple Is Not Always Better: Limitations of Cognitive Screening Tests].

[Short and Simple is Not Always Better: Limitations of Cognitive Screening Tests].

Fortschr Neurol Psychiatr. 2013 Apr; 81(4): 188-94
Uttner I, Wittig S, von Arnim CA, Jäger M

The increasing prevalence of Alzheimer’s dementia (AD) and limited resources in outpatient care have encouraged the distribution of cognitive screening tests, in spite of their frequently unsatisfying accuracy regarding the differentiation between incipient AD, depression and age-associated memory impairment. 8 patients with probable AD and 17 controls completed a neuropsychological follow-up two years after initial examination. Beside four screening tests a memory based testing-the-limits (TtL) paradigm as well as the German version of the California Verbal Learning Test were administered. Based on hierarchical cluster analysis we could demonstrate that only well elaborated tests, such as a plasticity based TtL paradigm, did classify AD-patients correctly. The findings confirm reservations against cognitive screening procedures in detecting dementia and suggest that dynamic test strategies offer a powerful diagnostic alternative to traditional status-oriented tests. HubMed – depression


Predictors of adequate depression treatment among Medicaid-enrolled youth.

Soc Psychiatry Psychiatr Epidemiol. 2013 May; 48(5): 757-65
Stein BD, Sorbero MJ, Dalton E, Ayers AM, Farmer C, Kogan JN, Goswami U

To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment.We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6-24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930).Fifty-nine percent of depressed youth received minimally adequate psychotherapy, but 13 % received minimally adequate pharmacotherapy. Youth who began their treatment episode with an inpatient psychiatric stay for depression and racial minorities were significantly less likely to receive minimally adequate pharmacotherapy and significantly more likely to receive inadequate overall treatment.While the majority of youth appear to be receiving minimally adequate acute care for depression, a substantial number are not. Given current child mental health workforce constraints, efforts to substantially improve the provision of adequate care to depressed youth are likely to require both quality improvement and system redesign efforts. HubMed – depression


Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment.

Breast Cancer Res Treat. 2013 Apr 16;
Avis NE, Levine B, Naughton MJ, Case LD, Naftalis E, Van Zee KJ

Younger women being treated for breast cancer consistently show greater depression shortly after diagnosis than older women. In this longitudinal study, we examine whether these age differences persist over the first 26 months following diagnosis and identify factors related to change in depressive symptoms. A total of 653 women within 8 months of a first time breast cancer diagnosis completed questionnaires at baseline and three additional timepoints (6, 12, and 18 months after baseline) on contextual/patient characteristics, symptoms, and psychosocial variables. Chart reviews provided cancer and treatment-related data. The primary outcome was depressive symptomatology assessed by the Beck Depression Inventory. Among women younger than age 65, depressive symptoms were highest soon after diagnosis and significantly decreased over time. Depressive symptoms remained stable and low for women aged 65 and older. Age was no longer significantly related to depressive symptoms in multivariable analyses controlling for a wide range of covariates. The primary factors related to levels of and declines in depressive symptomatology were the ability to pay for basics; completing chemotherapy with doxorubicin; and decreases in pain, vasomotor symptoms, illness intrusiveness, and passive coping. Increased sense of meaning/peace and social support were related to decreased depression. Interventions to reduce symptoms and illness intrusiveness, improve a sense of meaning and peace, and increase social support, may help reduce depression and such interventions may be especially relevant for younger women. HubMed – depression



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