Guided self-help for generalized anxiety disorder in older adults

Objective: The main objective of this study was to examine the efficacy of a guided self-help treatment based on cognitive behavioral principles (CBT-GSH) for generalized anxiety disorder (GAD) in older adults.

Methods: Three older adults aged from 66 to 70 and diagnosed with GAD were included in a single-case experimental multiple-baseline protocol. Data were collected using daily self-monitoring, standardized clinician ratings, and self-report questionnaires at pretest, posttest, and 6-month and 12-month follow-ups. Treatment consisted of awareness training, worry interventions, relaxation training, pleasant activities scheduling, and relapse prevention. Participants used a manual presenting weekly readings and at-home practice exercises. They also received weekly supportive phone calls from a therapist.

Results: At posttest, participants showed improvement on worries and GAD severity, on psychological process variables targeted by treatment (intolerance of uncertainty, negative problem orientation, cognitive avoidance, and perceived usefulness of worry), and on secondary variables associated with GAD (anxiety, depression, sleep difficulties, cognitive functioning, and disability). These results were generally maintained at 12 months after the end of treatment. Participants had favorable opinions toward the treatment.

Conclusion: The results of this study suggest that CBT-GSH is both feasible and effective for the treatment of GAD in older adults.     

Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Objective: Analysis of three case reports of nerve root anomalies detected intra-operatively and its implications.

Design: Data collected during one year prospective non-randomised study using hospital records.

Setting: Single tertiary care centre.

Subjects: 3 patients in one year period.     

Possible error in the Danish version of the WHO Quality of Life (WHOQOL-BREF) Questionnaire

Background: The WHOQOL-BREF is widely used to measure quality of life.

Aims: The goal of the present study was to use the questionnaire in a doctoral study.

Methods: We studied all the instructions provided by the WHO.

Results: In the Danish version of the WHOQOL-BREF there is a discrepancy between the negatively phrased question 9 and both the syntax file and the verbal instructions for coding the data provided by the WHO.

Conclusions: This is a notification of possible error interpretations in projects that use the questionnaire. This could be corrected by manual correction in the coding process or by changing the negatively phrased question 9.     

Does social capital influence preferences for aging in place? Evidence from urban China

Objective: This study investigated the relationships between social capital and preferences for aging in place among older urban adults in eastern China.

Method: Quota sampling was used to recruit 456 respondents aged 60 and older from Gusu District, Suzhou City, in 2015. Random-effects logistic regression was used to test the proposed model.

Results: Respondents who had better quality family social capital, a higher level of social trust, and more organization memberships were more likely to choose to live in local communities, even after we controlled for individual characteristics.

Discussion: The findings highlight the important role of both family and community social capital in influencing preferences for aging in place among older adults in urban China. This is particularly important for developing long-term care systems for older adults living in naturally occurring retirement communities.     

Death ideation in older adults: psychological symptoms of depression,thwarted belongingness,and perceived burdensomeness

Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation.

Objectives: The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation.

Method: A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression.

Results: The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled.

Conclusion: This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.     

The interactive effect of subjective age and subjective distance-to-death on psychological distress of older adults

Objectives: Subjective age refers to how young or old people experience themselves to be, while subjective distance-to-death reflects how far or close they experience themselves to be from their death. The present study examined whether subjective age and subjective distance-to-death interact in predicting psychological distress.

Method: A sample of 1073 community-dwelling older adults at the age range of 50–86 (M = 58.1, SD = 5.3) evaluated their subjective age, subjective distance-to-death, psychological distress, and rated several measures of physical health.

Results: After controlling for background characteristics and physical health indices, perceiving death as far and reporting younger subjective age predicted lower psychological distress. The combination of feeling close to death and older subjective age was related to the highest ratings of psychological distress. Moreover, the effect of subjective distance-to-death on psychological distress was mitigated by younger subjective age.

Conclusion: The findings underscore the importance of an integrative view of two time perspectives – one that focuses on time since birth and another that concerns time left till death – to psychological distress of older adults.     

Maternal responsivity in mothers of young children with Down syndrome

Objective: The purpose of this study was to examine maternal responsivity and directive behaviors in mothers of children with Down syndrome (DS).

Methods: Participants included 22 mothers with a young child with DS compared to 22 mothers of chronologically age-matched typically developing (TD) children using a cross-sectional design. The dyads participated in videotaped structured activities that were coded for responsive and directive behaviors.

Results: Results indicated that the mothers of children with DS used a more facilitative style with the older children while these behaviors decreased with older children with TD; one directive behavior, request for behavioral comply, increased with the older children with DS.

Conclusion: The mothers of children with DS adapted their parenting style to be facilitative of their children's linguistic development.     

Cervical myelitis presenting as occipital neuralgia

Aim: Occipital neuralgia is a common form of headache that is characterized by paroxysmal severe lancinating pain in the occipital nerve distribution.

Methods: The exact pathophysiology is still not fully understood and occipital neuralgia often develops spontaneously. There are no specific guidelines for evaluation of patients with occipital neuralgia.

Result: Cervical spine, spinal cord and posterior neck muscle lesions can induce occipital neuralgia. Brain and spine imaging may be necessary in some cases, according to the nature of the headache or response to treatment.

Discussion: We report a case of cervical myelitis presenting as occipital neuralgia.     

Marital satisfaction and depressive symptoms among Chinese older couples

Background: Depression is one of the most prevalent mental disorders among older people. Consistent with the Marital Discord Model of Depression (MDMD), research in Western cultures has found that marital distress is one of the risk factors for depression among older adults. However, the effect of marital distress on depression among older adults has not been examined in a collectivistic society, such as China.

Objectives: The purpose of this study was to examine the relationship between marital satisfaction and depressive symptoms in a sample of Chinese older adults. Considering the dyadic nature of the data, the Actor–Partner Interdependence Model was used to test for the actor and partner effects.

Methods: The study investigated 139 older couples who were recruited from communities in Beijing, the capital of China. The Lock–Wallace Marital Adjustment and the CES-D scales were administered to the participants.

Results: The results indicated that neither of the actor effects was significant. One of the partner effects was significant, with the husbands’ marital satisfaction predicting their wives’ depressive symptoms.

Conclusions: The MDMD was only partially supported among older couples in China. An asymmetrical pattern of cross-spouse effects was found, suggesting that the husbands’ perception of marital dissatisfaction could significantly predict their wives’ depressive symptoms.     

Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer–prescriber communication patterns

Objective: The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample.

Methods: Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns.

Results: The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction.

Conclusions: Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation.

Practice implications: Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.     

Prefrontal-limbic connectivity during worry in older adults with generalized anxiety disorder

Objectives: Although generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders in older adults, very little is known about the neurobiology of worry, the hallmark symptom of GAD in adults over the age of 60. This study investigated the neurobiology and neural circuitry of worry in older GAD patients and controls.

Method: Twenty older GAD patients and 16 age-matched controls (mean age = 67.88) were compared on clinical measures and neural activity during worry using functional magnetic resonance imaging.

Results: As expected, worry elicited activation in frontal regions, amygdala, and insula within the GAD group, with a similar but less prominent frontal pattern was observed in controls. Effective connectivity analyses revealed a positive directional circuit in the GAD group extending from ventromedial through dorsolateral prefrontal cortices, converging on the amygdala. A less complex circuit was observed in controls with only dorsolateral prefrontal regions converging on the amygdala; however, a separate circuit passing through the orbitofrontal cortex converged on the insula.

Conclusion: Results elucidate a different neurobiology of pathological versus normal worry in later life. A limited resource model is implicated wherein worry in GAD competes for the same neural resources (e.g. prefrontal cortical areas) that are involved in the adaptive regulation of emotion through cognitive and behavioral strategies.     

Spinocerebellar ataxia type 3 presenting with writer's cramp without ataxia

Aim of the study: Spinocerebellar ataxia type 3 is the most common cause of autosomal dominant inherited ataxia worldwide.

Material and methods: Clinically, it exhibits wide phenotypic variability. Presentation as isolated dystonia is exceptional.

Results: Here, the case of a woman with writers cramp without ataxia is presented as a paucisymptomatic manifestation of this disease.

Conclusions: This association has not been described to date and extends the clinical variability of the disease.     

The effect of time perspectives on mental health information processing and help-seeking attitudes and intentions in younger versus older adults

Socioemotional selectivity theory posits that changes in time perspective over the lifespan are associated with distinct goals and motivations. Time perspectives and their associated socioemotional motivations have been shown to influence information processing and memory, such that motivation-consistent information is more likely to be remembered and evaluated more positively.

Objective: The aim of this study was to examine the effect of motivation-consistent mental health information on memory for and evaluations of this information, as well as help-seeking attitudes and intentions to seek mental health services.

Method: We randomly assigned an Internet-based sample of 160 younger (18–25) and 175 older (60–89) adults to read a mental health information pamphlet that emphasized time perspectives and motivations relevant to either young adulthood (future-focused) or late adulthood (present-focused). Participants completed measures assessing their time perspective, memory for and subjective evaluation of the pamphlet, and help-seeking attitudes and intentions.

Results: The time perspective manipulation had no effect on memory for pamphlet information or help-seeking attitudes and intentions. There was, however, a significant interaction between time perspective and pamphlet version on the rated liking of the pamphlet.

Conclusion: Although motivation-consistent information only affected perceptions of that information for present-focused (mostly older) individuals, this finding has important implications for enhancing older adults’ mental health literacy.     

Group cognitive behavioral therapy targeting intolerance of uncertainty: a randomized trial for older Chinese adults with generalized anxiety disorder

Objectives: China has entered the aging society, but the social support systems for the elderly are underdeveloped, which may make the elderly feel anxiety about their health and life quality. Given the prevalence of generalized anxiety disorder (GAD) in the elderly, it is very important to pay more attention to the treatment for old adults. Although cognitive behavioral therapy targeting intolerance of uncertainty (CBT-IU) has been applied to different groups of patients with GAD, few studies have been performed to date. In addition, the effects of CBT-IU are not well understood, especially when applied to older adults with GAD.

Method: Sixty-three Chinese older adults with a principal diagnosis of GAD were enrolled. Of these, 32 were randomized to receive group CBT-IU (intervention group) and 31 were untreated (control group). GAD and related symptoms were assessed using the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale–Chinese Version, Beck Anxiety Inventory, Beck Depression Inventory, Why Worry-II scale, Cognitive Avoidance Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and Generalized Anxiety Disorder Severity Scale across the intervention. The changes between pre and after the intervention were collected, as well as the six-month follow-up. F test and repeated-measures ANOVA were conducted to analyze the data.

Results: Compared to control group, the measures’ scores of experimental group decreased significantly after the intervention and six-month follow-up. Besides the main effects for time and group were significant, the interaction effect for group × time was also significant. These results indicated the improvement of the CBT-IU group and the persistence of effect after six months.

Conclusion: Group CBT-IU is effective in Chinese older adults with GAD. The effects of CBT-IU on GAD symptoms persist for at least six months after treatment.     

Saying it with a natural child's voice! When affective auditory manipulations increase working memory in aging

Objectives: Working memory functions and their relations with affective auditory factors, have not been extensively investigated in aging yet.

Method: In this study, younger and older participants completed a classical working memory test (a running working memory task) pronounced by three different voices. In particular, in Experiment 1 the natural voices of a 3-year-old child, a 26-year-old young adult and an 86-year-old older adult were used for task presentation. In Experiment 2 stimuli were morphed in order to better control for sound properties across the three voices.

Results: Results showed that working memory increased for older adults compared to younger adults when the task was presented with natural voices and especially so when the task was presented in a child's voice. However, the child-voice effect disappeared with morphed voices.

Conclusion: Data confirm the importance of studying the relationship between auditory features and emotional variations as a possible practical means of reducing typical age-related working memory deficits.     

Cognitive bibliotherapy and memory training for older adults with depressive symptoms

Objectives: Substantial evidence indicates that depressed participants perform more poorly than nondepressed participants on a number of memory tasks. Cognitive deficits associated with depression (i.e., poor allocation of attention, poor encoding strategies), may help explain why depressed older adults are particularly prone to evidence poorer memory performance.

Method: The present study compared the impact of two self-administered treatment protocols, cognitive bibliotherapy for depression plus memory training (CBT + MT) and cognitive bibliotherapy alone (CBT), to a wait-list control condition on measures of memory functioning and depression in a group of older adults experiencing depressive symptoms and memory complaints.

Results: Results provide partial support for CBT as a treatment for depressive symptoms; however, memory training augmentation did not produce improvements.

Conclusion: Suggestions for improving retention of older adults in self-administered treatments are discussed.     

The role of glutamate and its receptors in central nervous system in stress-induced hyperalgesia

Purpose: To explore the potential mechanisms of glutamate and its receptors in stress-induced hyperalgesia.

Materials and methods: The stress-induced hyperalgesia, glutamate and its receptors are listed as key items in the pubmed database and the related articles are searched.

Results: Glutamate level is increased under stress and associated with stress-induced hyperalgesia. Moreover, the role of glutamate in stress-induced hyperalgesia depends on its subtypes of its receptors.

Conclusions: Increased glutamate during stress connect with ionotropic glutamate receptors can prompt hyperalgesia, but connect with metabotropic glutamate receptors can inhibit hyperalgesia.     

Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean Blacks

Objective: The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks.

Method: This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis.

Results: Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms.

Conclusion: This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.     

Perceived anxiety control is associated with sleep disturbance in young and older adults

Objective: This study examined the extent to which perceived anxiety control was related to subjective sleep disturbance in young and older adults.

Method: Fifty-one young adults (18 to 30 years old) and 48 older adults (aged 65 years and older) completed questionnaires including the Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbance, Anxiety Control Questionnaire to assess perceived control over anxiety, a perceived health rating, and demographic questionnaire. Correlation and multivariable adjusted hierarchical regression analyses examined the extent to which anxiety control was associated with sleep disturbance.

Results: Anxiety control and health status were associated with global sleep quality on the PSQI, but no age differences in PSQI scores were found. In post hoc analyses, greater anxiety control was related to shorter sleep latency. Both older age and greater anxiety control were associated with less daytime dysfunction, whereas only older age was associated with better sleep quality.

Discussion: Although some variations in sleep quality by age were found, overall findings suggest that perceived anxiety control contributes to sleep disturbance in young and older adults. Greater anxiety control could lead to shorter sleep latency through reduced anxiety and worry symptoms at bedtime. Future studies should examine whether improved anxiety control with psychological treatments is one mechanism through which beneficial and lasting effects on sleep disturbance can be achieved.