The Older the Better: Are Elderly Study Participants More Non-Representative? a Cross-Sectional Analysis of Clinical Trial and Observational Study Samples.

The older the better: are elderly study participants more non-representative? A cross-sectional analysis of clinical trial and observational study samples.

Filed under: Depression Treatment

BMJ Open. 2012; 2(6):
Golomb BA, Chan VT, Evans MA, Koperski S, White HL, Criqui MH

Study participants can differ from the target population they are taken to represent. We sought to investigate whether older age magnifies such differences, examining age-trends, among study participants, in self-rated level of activity compared to others of the same age.Cross-sectional examination of the relation of participant age to reported ‘relative activity’ (ie, compared to others of the same age), a bidirectionally correlated proxy for relative vitality, in exemplars of randomised and observational studies.University of California, San Diego (UCSD) PARTICIPANTS: 2404 adults aged 40-79 including employees of UCSD, and their partners (San Diego Population Study, observational study). 1016 adults (aged 20-85) not on lipid medications and without known heart disease, diabetes, cancer or HIV (UCSD Statin Study, randomised trial).Self-rated activity relative to others’ age, 5-point Likert Scale, was evaluated by age decade, and related via correlation and regression to a suite of health-relevant subjective and objective outcomes.Successively older participants reported successively greater activity relative to others of their age (greater departure from the norm for their age), p<0.001 in both studies. Relative activity significantly predicted (in regression adjusted for age) actual activity (times/week exercised), and numerous self-rated and objective health-predictors. These included general self-rated health, CES-D (depression score), sleep, tiredness, energy; body mass index, waist circumference, serum glucose, high-density lipoprotein-cholesterol, triglycerides and white cell count. Indeed, some health-predictor associations with age in participants were 'paradoxical,' consistent with greater apparent health in older age-for study participants.Study participants may not be representative of the population they are intended to reflect. Our results suggest that departures from representativeness may be amplified with increasing age. Consequently, the older the age, the greater the disparity may be between what is recommended based on 'evidence, ' and what is best for the patient.UCSD Statin Study-Clinicaltrials.gov # NCT00330980 (http://ClinicalTrials.gov). HubMed – depression

Tiny moments of great importance: The Marte Meo method applied in the context of early mother-infant interaction and postnatal depression. Utilizing Daniel Stern’s theory of ‘schemas of being with’ in understanding empirical findings and developing a stringent Marte Meo methodology.

Filed under: Depression Treatment

Clin Child Psychol Psychiatry. 2012 Dec 14;
Vik K, Rohde R

This paper provides an overview of basic Marte Meo video interaction guidance concepts and describes the therapeutic performance of the method applied in the context of early mother-infant interaction and postnatal depression. Weight is put upon the importance of the therapeutic relationship. Further Marte Meo therapy is understood in the light of Daniel Stern’s theory of ‘schemas of being with’ and accompanied by clinical vignettes from therapy sessions. The empirical basis for the paper is a study of postnatal depression, mother-infant interaction and video guidance, carried out in Southern Norway. The study examined Marte Meo from a phenomenological perspective. Marte Meo was offered to mothers with either postnatal depression or depressive symptoms. In in-depth interviews the participants reported that the Marte Meo method, ‘from the outside looking in’, increased their reflections about their infants and their own mental states as well as their sensitive interaction with their newborn. Their mothering was improved and they reported feeling less depressed. We argue that Marte Meo methodology can guide new mothers with depressive symptoms, and contribute to the creation of new schemas of being together.
HubMed – depression

Apathy in Parkinson’s disease: Diagnosis, neuropsychological correlates, pathophysiology and treatment.

Filed under: Depression Treatment

Behav Neurol. 2012 Dec 14;
Santangelo G, Trojano L, Barone P, Errico D, Grossi D, Vitale C

Apathy has been defined as lack of motivation. It has been traditionally considered as a symptom of psychiatric disorders, such as major depression and schizophrenia, but more recently it has been recognized as a specific neuropsychiatric syndrome associated with neurodegenerative such as Parkinson’s disease (PD). As a consequence the reported prevalence of apathy in PD ranges from 13.9% to 70%; the mean prevalence is 35%. Prevalence of “pure apathy” (i.e., of apathy without comorbid depression and dementia) seems to be substantially lower, from 3 to 47.9%. High levels of apathy in PD are associated with decreased daily function, specific cognitive deficits and increased stress for families. Although neuroimaging studies do not provide a unique anatomic pattern, several data suggest that the ventromedial prefrontal cortex and the basal ganglia connected through frontal-subcortical circuits, are particularly involved in the genesis of apathy. At present, there are no approved medications for the treatment of apathy in and no proof of efficacy exists for any drug in current use. Further studies and innovative pharmacologic approaches are thus needed to ameliorate our understanding and treatment of apathy in PD.
HubMed – depression

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