Cognitive behaviour therapy versus treatment as usual in the treatment of depression in older people

BACKGROUND. Late life depression has been called the common cold of geriatric psychiatry, but usually it is treated in primary care settings using medication, however because of fears about side effects and poor compliance rates with medication, psychological treatments approaches may be a valuable treatment alternative. This study provides an empirical evaluation of Cognitive Behaviour Therapy (CBT) alone versus Treatment as usual (TAU) alone (generally pharmacotherapy) for late life depression in a UK primary care setting.METHOD. General Practitioners in Fife and Glasgow referred 114 Participants to the study with 44 meeting inclusion criteria and 40 participants providing data that permitted analysis. All participants had a diagnosis of Major Depressive Episode. Participants were randomly allocated to receive either TAU alone or CBT alone.RESULTS. Participants in both treatment conditions benefited from treatment with reduced scores on primary measures of mood at end of treatment. However, one-Way ANOVAs and repeated measures ANOVAs performed between the two treatment conditions showed no differences between each treatment at the end of treatment and at 3 and 6 months follow-up on any of the primary outcome measures. When taking account of differences in living arrangements, CBT may be beneficial in reducing depression scores and hopelessness at the end of treatment and at 6 months follow-up. When evaluating outcome in terms of numbers of participants meeting Research Diagnostic Criteria for depression, there were significant differences favouring the CBT condition at the end of treatment and at 3 months follow-up after treatment.CONCLUSIONS. Both the CBT alone and the TAU alone treatment conditions produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up. Psychological therapy (CBT) on its own is shown to be an effective treatment procedure for mild to moderate late life depression and has utility as a treatment alternative for older people who cannot or will not tolerate physical treatment approaches for depression

Wisdom enhancement and life skills to augment CBT outcomes for depression in later life: A series of N-of-1 trials

Background: It has been suggested that cognitive behavioural therapy for older adults be augmented with age-appropriate methods to enhance outcomes for depression treatment. Aims: This study investigated whether a CBT wisdom enhancement timeline technique for older adults reduced depression, as well as increase self-compassion and self-assessed wisdom. Method: An N-of-1 series trial with non-concurrent multiple-baseline AB design was conducted. Older adults experiencing depression, recruited from mental health service waiting lists, were randomly assigned to baseline conditions. Participants received five individual sessions of the examined intervention, offering a structured way of utilising one's life experiences to evolve the psychological resource of wisdom within a cognitive behavioural framework, in order to improve mood. Participants completed idiographic daily measures and self-report standardised measures of depression, anxiety, self-compassion and wisdom during baseline and intervention phases, and at 1 month follow-up. Results: Six participants competed the study and were subject to standardised and single-case data analyses. Four participants were deemed responders with reliable changes in depression post-intervention with idiographic changes coinciding with intervention onset. Two participants saw clinically significant changes in depression scores at follow-up. One responder saw significant changes in measures of self-compassion and self-assessed wisdom. Conclusions: The examined technique shows promise as an effective technique for reducing depression in older adults. There is insufficient evidence to implicate wisdom and/or self-compassion as significant mechanisms of change. Clinical and theoretical implications are discussed

Systematic review investigating multi-disciplinary team approaches to screening and early diagnosis of dementia in primary care:what are the positive and negative effects and who should deliver it?

BACKGROUND: Primary care services frequently provide the initial contact between people with dementia and health service providers. Early diagnosis and screening programmes have been suggested as a possible strategy to improve the identification of such individuals and treatment and planning health and social care support. OBJECTIVE: To determine what early diagnostic and screening programmes have been adopted in primary care practice, to explore who should deliver these and to determine the possible positive and negative effects of an early diagnostic and screening programme for people with dementia in primary care. METHODS: A systematic review of the literature was undertaken using published and unpublished research databases. All papers answering our research objectives were included. A narrative analysis of the literature was undertaken, with the CASP tools used appropriately to assess study quality. RESULTS: Thirty-three papers were identified of moderate to high quality. The limited therapeutic options for those diagnosed with dementia means that even if such a programme were instigated, the clinical value remains questionable. Furthermore accuracy of the diagnosis remains difficult to assess due to poor evidence and this raises questions regarding whether people could be over- or under-diagnosed. Given the negative social and psychological consequences of such a diagnosis, this could be devastating for individuals. CONCLUSIONS: Early diagnostic and screening programme have not been widely adopted into primary care. Until there is rigorous evidence assessing the clinical and cost-effectiveness of such programmes, there remains insufficient evidence to support the adoption of these programmes in practice

Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review

Background: The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. Objective: The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. Methods: This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. Results: Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. Conclusions: In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed

Aeroelastic and Aerothermoelastic Behavior in Hypersonic Flow

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/77151/1/AIAA-36711-537.pd

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A Deficit in Psychotherapeutic Care for Older People with Depression and Anxiety

In this article, the current state of evidence for psychological therapy for depression and anxiety in later life is briefly reviewed and a number of deficits in psychotherapeutic care are outlined and discussed. Deficits are identified as important in preventing older people from accessing the range and types of psychological interventions that would potentially enhance quality of life. In the main, researchers have overlooked anxiety and, relatively speaking, focused more on late life depression even though this occurs less frequently than anxiety disorders and anxiety symptoms. Similarly, psychotherapists have not given due consideration to the global demographic change in lifespan, with the implications of this unprecedented and profound event for psychotherapists rarely discussed. With the current cohort of older people living beyond the expected lifespans of previous generations, most research in psychotherapy with older people recruits from the younger-old age group (60-74 years). As such it is not known how well existing models of psychotherapy will fit this new cohort of older people. This paper briefly reviews these issues