THE PSYCHOLOGICAL SYMPTOMS OF CONJUGAL BEREAVEMENT IN ELDERLY MEN OVER THE FIRST 13 MONTHS

Objective. The purpose of this study was to investigate the psychological symptoms experienced by recently widowed older men. It was hypothesized that conjugal bereavement in this group would be characterized by a mixture of depression, anxiety and loneliness. Design. Double cohort study. Setting. Suburban community population of Brisbane, Australia. Participants. Consecutive widowers (65+ years; N = 57) identified from official death records. Married men (65+ years; N = 57) identified from the electoral roll. Widowers interviewed at 6 weeks, 6 months and 13 months post-bereavement. Married men interviewed at similar intervals. Measures. Bereavement Phenomenology Questionnaire (BPQ), a 22-item self-report measure employing a four-point response scale to rate the frequency of phenomena over the previous fortnight. Zung Self-rating Depression Scale (SDS). State component of the Spielberger State/Trait Anxiety Inventory (STAI). Revised UCLA Loneliness Scale (ULS). 28-item General Health Questionnaire (GHQ). Results. Widowers reported more state anxiety and general psychological distress, but not more depression or loneliness, than matched married men over the first 13 months post-bereavement. Widowers also reported more sleep disturbance and thoughts of death and suicide than married men. Level of state anxiety was strongly correlated with intensity of grief, but not with age, income, education, occupational prestige, cognitive function, duration of wife's final illness or expectedness of wife's death. Conclusions. The main hypothesis was not supported, as anxiety symptoms were the predominant clinical feature of recent conjugal bereavement among older men. The nature of these anxiety symptoms requires further investigation in recently widowed older persons. © 1997 John Wiley & Sons, Ltd.     

CLINICAL PREDICTORS OF SOMATIC AND PSYCHOLOGICAL SYMPTOMS OF DEPRESSION IN ALZHEIMER'S DISEASE

The Hamilton Rating Scale for Depression was employed to assess the severity of somatic and psychological symptoms of depression in 42 outpatients with dementia of the Alzheimer type. The severity of somatic symptoms increased in the more severe stages of dementia whereas the severity of psychological symptoms did not vary. Psychological symptoms were more severe in female patients and in patients with a better awareness of cognitive decline. In contrast, the degree of cognitive dysfunction was the only significant predictor of the severity of somatic symptoms. These results suggest that, in Alzheimer's disease, somatic symptoms are secondary to dementia rather than manifestations of a coexistent depressive disorder and point to the limited value of the Hamilton scale for detecting depression in demented patients.     

AMBULANT TREATMENT OF ALCOHOL WITHDRAWAL SYMPTOMS WITH CARBAMAZEPINE: A FORMAL MULTICENTRE DOUBLE-BLIND COMPARISON WITH PLACEBO

One hundred male out-patients were treated for alcohol withdrawal symptoms with either carbamazepine or placebo in a double-blind, multicentre trial carried out at five Finnish A-clinics (alcoholism treatment centres) in different parts of the country. In both the carbamazepine and the placebo groups two thirds of the patients completed the 7-day treatment successfully, and the final treatment results were considered equally good in both groups. However, the withdrawal symptoms, especially the sleep disturbances, subsided faster in the carbamazepine group than in the placebo group. The change in the total symptom score from the first day of treatment to the second was significantly greater in the carbamazepine group than in the placebo group. The patients' ability to work improved significantly faster in the carbamazepine group.     

A PILOT STUDY COMPARING PSYCHOLOGICAL AND PHYSICAL MORBIDITY IN CARERS OF ELDERLY PEOPLE WITH DEMENTIA AND THOSE WITH DEPRESSION

A pilot study compared the difficulties faced by co-resident relatives caring for elderly patients with dementia and those with depression, referred to a psychogeriatric service in London. The mean GHQ-28 score of 23 dementia carers was significantly higher than that of 17 carers of elderly people with depression. The relatively low level of distress in the latter group of carers may have been related to the majority of the depressed patients suffering minor depression. Behavioural difficulties in the patient, a poor premorbid relationship with patient and dissatisfaction with their social contacts were associated with a significant GHQ-28 score (over 4) in carers. However, the two groups of carers reported comparable levels of physical health.     

TOWARD THE APPLICATION OF FUNCTIONAL NEUROIMAGING TO INDIVIDUALIZED TREATMENT FOR ANXIETY AND DEPRESSION

Functional neuroimaging has led to significant gains in understanding the biological bases of anxiety and depressive disorders. However, the ability of functional neuroimaging to directly impact clinical practice is unclear. One important method by which neuroimaging could impact clinical care is to generate single patient level predictions that can guide clinical decision‐making. The present review summarizes published functional neuroimaging studies of predictors of medication or psychotherapy outcome in major depressive disorder, obsessive‐compulsive disorder (OCD), posttraumatic stress disorder, generalized anxiety disorder, panic disorder, and social anxiety disorder. In major depressive disorder and OCD, there is converging evidence of specific brain circuitry that has both been implicated in the disordered state itself, and where pretreatment activation levels have been predictive of treatment response. Specifically, in major depressive disorder, greater pretreatment ventral and pregenual anterior cingulate cortex (ACC) activation may predict better antidepressant medication outcome but poorer psychotherapy outcome. In OCD, activation in the ACC and orbitofrontal cortex has been inversely associated with pharmacological treatment response. In other anxiety disorders, research in this area is just beginning, with the ACC potentially implicated. However, the question of whether these results can directly translate to clinical practice remains open. In order to achieve the goal of single patient level prediction and individualized treatment, future research should strive to establish replicable models with good predictive performance and clear incremental validity.     

PAIN-RELIEVING EFFECTS OF ACUPUNCTURE AND ELECTROACUPUNCTURE IN AN ANIMAL MODEL OF ARTHRITIC PAIN

The effects of acupuncture and electroacupuncture on an animal model of arthritic pain were examined. Under halothane anesthesia, arthritic pain was induced by the injection of carrageenan into the knee joint cavity of male Sprague-Dawley rats. Behavioral performance was tested before and after the termination of acupuncture or electroacupuncture. Electrophysiologically, the responses of afferents to a movement cycle were recorded before and after acupuncture or electroacupuncture. After the acupuncture procedure, the weight-bearing force of the rats was significantly improved and the neural responses to noxious movement stimulation were reduced. Electroacupuncture significantly improved weight-bearing behavior and inhibited neural responses of articular afferents to noxious stimulation. These results indicate that acupuncture and electroacupuncture may provide a potent strategy in relieving arthritic pain.     

Review of the relationship between obsession and depersonalization

Depersonalization is discussed and a brief outline of the primary symptoms is presented. The relationship between obsessionalism and depersonalization is reviewed in the literature, and subsequent similarities are presented. The intellectual obsessive depersonalization syndrome is postulated as a variant, and also as an exposition of what might occur in many other cases of depersonalization. Finally, a picture is presented which takes into account a strong component of obsessionalism in both the etiology and course of depersonalization.