State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143772/1/jgs15343.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143772/2/jgs15343_am.pd

F2‐02‐03: “Wecare Advisor”: a Clinical Trial of a Caregiver Focused, IPAD Administered Algorithm to Manage Behavioral Symptoms

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152585/1/alzjjalz201606386.pd

Older, church-going African Americans’ attitudes and expectations about formal depression care

Journal articleThis phenomenological study involved focus groups with church-affiliated, African American women and men (N ¼ 50; ages 50 and older) in southeast Michigan to determine their attitudes and expectations around formal mental health care. Data analysis employed a constant comparative approach and yielded themes related to formal mental health care, along with delineating concerns about defining depression, health, and well-being. Health and wellbeing were defined as inclusive of physical and spiritual aspects of self. Churches have a central role in how formal mental health care is viewed by their attendees, with prayer being an important aspect of this care. Provider expectations included privacy and confidentiality; respect for autonomy and need for information, having providers who discuss treatment options; and issues related to environmental cleanliness, comfort, and accessibility. Implications include providing effective, culturally tailored formal depression care that acknowledges and integrates faith for this group.Michigan Center for Urban African American Aging ResearchNational Institutes of Health, 5P30 AG015281Program for Positive Aging at the University of Michigan Department of PsychiatryPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152349/1/Wharton Watkins Mitchell Kales 2018 Older Church going African Americans attitudes and expectations about formal depression care.pd

The Relevance of Transference during Medication Management: A Case of Erotized Transference

Forces existing in psychiatry may diminish the importance of psychotherapy training as psychiatrists are increasingly given the task of medication management. Psychotherapeutic relationships can be created in medication management settings, however, and the neglect of concepts such as transference could have deleterious consequences. The authors describe the case of a man with a traumatic brain injury referred for medication management who developed an erotized transference toward his female resident-physician. This case illustrates the concept that an understanding of transference is relevant to the setting of medication managemen

A qualitative comparison of DSM depression criteria to language used by older church-going African Americans

Objective: Depression in late life is associated with substantial suffering, disability, suicide risk, and decreased health-related quality of life. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a depression diagnosis is derived from a constellation of symptoms that may be described differently by different people. For example, the DSM language may be inadequate in capturing these symptoms in certain populations such as African-Americans, whose rates of depression misdiagnosis is high. Methods: This study reports the findings from a church-based, qualitative study with older African Americans (n = 50) regarding the language they use when discussing depression and depression treatment, and how this compares to the DSM-IV depression criteria. Content analyses of the in-depth discussions with African-American male and female focus group participants resulted in a deeper understanding of the language they used to describe depression. This language was then mapped onto the DSM-IV depression criteria. Results: While some words used by the focus group participants mapped well onto the DSM-IV criteria, some of the language did not map well, such as language describing irritability, negative thought processes, hopelessness, loneliness, loss of control, helplessness, and social isolation. Conclusions: The focus group setting provided insight to the language used by older, church-going African-Americans to describe depression. Implications include the advantages of using qualitative data to help inform clinical encounters with older African-Americans.This project was supported by the Program for Positive Aging in the Department of Psychiatry at the University of Michigan, and the original study was titled ‘Attitudes, perceptions, and beliefs pertaining to mental health, depression, and depression care of elder African-American church attendees’ (Principal Investigator: Helen Kales, MD, UM Department of Psychiatry).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152353/1/Akinyemi Watkins Kavanagh Johnson-Lawrence Lynn Kales_2017_A qualitative comparison of DSM depression criteria to language used by older church going African Americans.pd

Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139936/1/gps4599.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139936/2/gps4599_am.pd

With a little help from my friends?: Racial and gender differences in the role of social support in later-life depression medication adherence

Background: Social support has been shown to be an important factor in improving depression symptom outcomes, yet less is known regarding its impact on antidepressant medication adherence. This study sought to evaluate the role of perceived social support on adherence to new antidepressant medication prescriptions in later-life depression. Methods: Data from two prospective observational studies of participants ≥60 years old, diagnosed with depression, and recently prescribed a new antidepressant (N = 452). Perceived social support was measured using a subscale of the Duke Social Support Index and medication adherence was assessed using a validated self-report measure. Results: At four-month follow up, 68% of patients reported that they were adherent to antidepressant medication. Examining the overall sample, logistic regression analysis demonstrated no significant relationship between perceived social support and medication adherence. However, when stratifying the sample by social support, race, and gender, adherence significantly differed by race and gender in those with inadequate social support: Among those with low social support, African-American females were significantly less likely to adhere to depression treatment than white females (OR = 4.82, 95% CI = 1.14–20.28, p = 0.032) and white males (OR = 3.50, 95% CI = 1.03–11.92, p = 0.045). Conclusions: There is a significant difference in antidepressant medication adherence by race and gender in those with inadequate social support. Tailored treatment interventions for low social support should be sensitive to racial and gender differences.The National Institute of Mental Health (5R21MH073002)Veterans Affairs Health Services Research & Development (IIR 04-104-2)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152350/1/Gerlach Kavanagh Watkins Chiang Kim Kales 2017 with_a_little_help_from_my_friends_racial_and_gender_differences_in_the_role_of_social_support_in_laterlife_depression_medicat.pd

Depression in veterans with Parkinson's disease: frequency, co-morbidity, and healthcare utilization

Objective To determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization. Methods Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 ( n  = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models. Results A depression diagnosis was recorded for 18.5% of PD patients, including major depression in 3.9%. Depression decreased in frequency and severity with increasing age. In multivariate logistic regression models, depressed patients had significantly greater psychiatric and medical co-morbidity, including dementia, psychosis, stroke, congestive heart failure, diabetes, and chronic obstructive pulmonary disease than non-depressed patients (all p  < 0.01). Depressed PD patients were also significantly more likely to have medical (OR = 1.34, 95% CI = 1.25–1.44) and psychiatric hospitalizations (OR = 2.14, 95% CI = 1.83–2.51), and had more outpatient visits ( p  < 0.01), than non-depressed PD patients in adjusted models. Conclusion Depression in PD in non-tertiary care settings may not be as common or as severe as that seen in specialty care, though these findings also may reflect under-recognition or diagnostic imprecision. The occurrence of depression in PD is associated with greater psychiatric and medical co-morbidity, and greater healthcare utilization. These findings suggest that screening for depression in PD is important and should be embedded in a comprehensive psychiatric, neuropsychological, and medical evaluation. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56073/1/1712_ftp.pd

Clinical Follow‐up of Parkinson’s Disease With Newly Prescribed Quetiapine

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162820/2/mds28193_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162820/1/mds28193.pd

Predicting Risk of Potentially Preventable Hospitalization in Older Adults with Dementia

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151826/1/jgs16030_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151826/2/jgs16030.pd