Relationship between chronic pain and cognition in cognitively intact older persons and patients with Alzheimer's disease; the need to control for mood

Background: Brain areas that are involved in cognition and mood also play a role in pain processing. Objective: The goal of the present study was to examine the relationship between chronic pain and cognition [executive functions (EF) and memory], while controlling for mood, in cognitively intact older persons and in patients with Alzheimer's disease (AD). Methods: Two groups of subjects participated: 20 older persons without dementia and 19 patients in an early stage of probable AD who suffered from arthrosis/arthritis. Pain intensity and pain affect were assessed by the Colored Analogue Scale for Pain Intensity and for Pain Affect, the Faces Pain Scale (FPS) and the Number of Words Chosen-Affective (NWC-A). Level of depression and anxiety were evaluated by questionnaires. EF and memory were assessed by neuropsychological tests. Results: The results show that significant correlations between specific cognitive functions, pain intensity and pain affect were lacking in the cognitively intact older persons. Cognition, in particular memory, appeared to be related to depressive symptoms. In contrast, a significant positive correlation was observed between EF, pain intensity and pain affect measured by the FPS in the AD group. Conclusions: Although older persons with depression were excluded, in studies on pain and cognition one should control for the presence of depressive symptoms in older persons with and without dementia. Copyright © 2008 S. Karger AG

Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue

<p>Abstract</p> <p>Background</p> <p>Unexplained Chronic Fatigue is a medical condition characterized by the presence of persistent, severe and debilitating medically unexplained fatigue, leading to impaired functioning and lower quality of life. Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients. Based on the self-regulation (SR) theory of behaviour change, we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills, the "4-STEPS to control your fatigue" program.</p> <p>Methods/Design</p> <p>This is a multi-centre, randomised controlled trial (RCT) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association. Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue (ICF) and Chronic Fatigue Syndrome (CFS) will be recruited and randomly allocated to standard care (SC) or standard care plus a self-regulation based physical activity program (4-STEPS). Patients will be assessed at baseline, after the intervention (3 months) and at 12 months follow-up. The primary outcome is fatigue severity.</p> <p>Discussion</p> <p>The results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue. If the program proves to be effective, it may be considered as an adjunctive treatment for these patients.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.anzctr.org.au/ISRCTN70763996.aspx">ISRCTN70763996</a></p

Personal Project Content and Stress: Relations to Subjective Health and Depressive Mood

depressive mood, health, personal projects, stress,

Skills training groups for men with ADHD in compulsory care due to substance use disorder: a feasibility study

Dialectical behavior therapy (DBT)-based skills training has been developed and previously evaluated for adults with ADHD in a psychiatric outpatient context. The aim of the present study was to evaluate the feasibility of DBT-based skills training as a voluntary intervention for men with ADHD in compulsory care due to severe substance abuse. Forty sufficiently detoxified men with ADHD in compulsory care due to life-threatening substance use disorder (SUD) were included in DBT-based skills training groups. Self- and staff-rating scales were administered before and after the treatment. The refusal rate was 42.9 %. Of those who started the DBT-based skills training, 70 % completed the treatment (attendance at =75 % of the sessions). The treatment acceptability was good. Both ADHD and psychiatric symptoms decreased from pre- to post-intervention in self-ratings, but not in staff ratings. The patients reported improved general well-being. The correlation between self- and staff ratings was poor. Motivation for voluntary nonpharmacological treatment was low in a compulsory care context. However, the results indicate that a DBT-based skills training program for adults with ADHD may be feasible for some patients with ADHD in combination with SUD in compulsory care, provided that considerable resources are allocated with adjustments to the target group and compulsory care context