Identifying Cognitive and Demographic Variables That Contribute to Carer Burden in Dementia.

Identifying Cognitive and Demographic Variables That Contribute to Carer Burden in Dementia.

Dement Geriatr Cogn Disord. 2013 May 23; 36(1-2): 43-49
Miller LA, Mioshi E, Savage S, Lah S, Hodges JR, Piguet O

Background/Aims: Carer burden has been associated with other carer-reported factors (e.g. depression), but less is known about the influence of more independent variables. We aimed to determine the impact of cognitive deficits, demographic variables and dementia subtype on carer burden. Methods : Patients with Alzheimer’s dementia (n = 35) or frontotemporal lobar degeneration (n = 61) underwent assessment of anterograde memory, word generation, impulse control and emotion recognition. Age, sex, relationship type, disease duration and diagnosis were also considered. Carers completed the Zarit Burden Interview. Results: In bivariate regression analyses, carer burden was related to age, diagnosis, memory, impulse control and emotion recognition. Stepwise multivariate regression revealed independent contributions by patient age, memory and emotion recognition, explaining 23% of the variance. Conclusion: The findings could help refine interventions and carer support. HubMed – depression

Emotion Regulation Skills Training Enhances the Efficacy of Inpatient Cognitive Behavioral Therapy for Major Depressive Disorder: A Randomized Controlled Trial.

Psychother Psychosom. 2013 May 22; 82(4): 234-245
Berking M, Ebert D, Cuijpers P, Hofmann SG

Background: Deficits in emotion regulation skills are possible factors maintaining major depressive disorder (MDD). Therefore, the aim of the study was to test whether integrating a systematic emotion regulation training (ERT) enhances the efficacy of routine inpatient cognitive behavioral therapy (CBT) for MDD. Methods: In a prospective randomized controlled trial, 432 inpatients meeting criteria for MDD were assigned to receive either routine CBT or CBT enriched with an intense emotion regulation skills training (CBT-ERT). Results: Participants in the CBT-ERT condition demonstrated a significantly greater reduction in depression (response rates – CBT: 75.5%, CBT-ERT: 84.9%; remission rates – CBT: 51.1%, CBT-ERT: 65.1%). Moreover, CBT-ERT participants demonstrated a significantly greater reduction of negative affect, as well as a greater increase of well-being and emotion regulation skills particularly relevant for mental health. Conclusions: Integrating strategies that target emotion regulation skills improves the efficacy of CBT for MDD. HubMed – depression

How Patient Centered Are Medical Decisions?: Results of a National Survey.

JAMA Intern Med. 2013 May 27; 1-7
Fowler FJ, Gerstein BS, Barry MJ

IMPORTANCE Informing and involving patients in their medical decisions is increasingly becoming a standard for good medical care, particularly for primary care physicians. OBJECTIVE To learn how patients describe the decision-making process for 10 common medical decisions, including 6 that are most often made in primary care. DESIGN A survey of a national sample of adults 40 years or older who in the preceding 2 years had either experienced or discussed with a health care provider 1 or more of 10 decisions: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate, or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain. SETTING Adults living in households in the United States in 2011. PARTICIPANTS A national sample of adults drawn from a probability sample-based web panel developed by Knowledge Networks. MAIN OUTCOMES AND MEASURES Patients’ perceptions of the extent to which the pros and cons were discussed with their health care providers, whether the patients were told they had a choice, and whether the patients were asked for their input. RESULTS Responses were obtained from 2718 patients, with a response rate of 58.3%. Respondents reported much more discussion of the pros than the cons of all tests or treatments; discussions about the surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening. Most patients (60%-78%) said they were asked for input for all but 3 decisions: medications for hypertension and elevated cholesterol and having mammograms (37.3%-42.7%). Overall, the reported decision-making processes were most patient centered for back or knee replacement surgery and least for breast and prostate cancer screening. CONCLUSIONS AND RELEVANCE Discussions about these common tests, medications, and procedures as reported by patients do not reflect a high level of shared decision making, particularly for 5 decisions most often made in primary care. HubMed – depression

Impulse control and related behaviors after bilateral subthalamic stimulation in patients with Parkinson’s disease.

J Clin Neurosci. 2013 May 24;
Kim YE, Kim HJ, Kim HJ, Lee JY, Yun JY, Kim JY, Paek SH, Jeon BS

The effect of subthalamic nucleus deep brain stimulation (STN DBS) on impulse control and related behaviors (ICRB) in patients with Parkinson’s disease (PD) is conflicting. We evaluated ICRB before and after bilateral STN DBS in patients with PD. A total of 89 patients with PD treated with bilateral DBS of STN underwent retrospective assessment of ICRB before and after DBS. Of the 89 patients studied, 20 patients (22.5%) had ICRB in the preoperative period. In 13 of those 20 patients (65%), preoperative ICRB improved, including resolution in six patients. Nine patients developed de novo ICRB after DBS, thus 23 patients (25.8%) had ICRB in the postoperative period. There was no demographic difference between the patients with or without ICRB in the preoperative state. In the postoperative state, the patients with ICRB had higher levodopa equivalent daily dose (LEDD) levels and lower Mini-Mental State Examination (MMSE) scores than the patients without ICRB. However, postoperative worsening or de novo ICRB did not correlate with LEDD levels or MMSE scores. Severity of ICRB worsened more after DBS in older patients. Patients with worsened or de novo ICRB after surgery had a greater decrease in Beck Depression Index scores after surgery compared with patients whose ICRB improved. In conclusion, ICRB may resolve or improve, or new ICRB may appear, after bilateral STN DBS. The difference in risk factors for preoperative vs. postoperative ICRB suggests that the pathogenesis of those conditions is different, at least in part. HubMed – depression