Rationale and design: telepsychology service delivery for depressed elderly veterans

<p>Abstract</p> <p>Background</p> <p>Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas.</p> <p>Methods</p> <p>We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use).</p> <p>Discussion</p> <p>Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services.</p> <p>Trial registration</p> <p>National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).</p

Sur la signification en psychiatrie de certaines réponses évoquées par la stimulation lumineuse intermittente

Gastaut H., Dongier S., Dongier M. Sur la signification en psychiatrie de certaines réponses évoquées par la stimulation lumineuse intermittente. In: Bulletin de psychologie, tome 14 n°184, 1960. pp. 64-68

Informatics in psychiatric education and research: Some examples of applications

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Comparative study of 15 subjects with coronary angina and 30 subjects with myocardial infarction using the Rorschach test

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Does a History of Postictal Psychosis Predict a Poor Postsurgical Seizure Outcome?

Postictal Psychosis in Partial Epilepsy: A Case-Control Study. Alper K, Kuzniecky R, Carlson C, Barr WB, Vorkas CK, Patel JG, Carrelli AL, Starner K, Flom PL, Devinsky O. Ann Neurol 2008;63(5):602–610. OBJECTIVE: Divergent findings among prior studies on correlates of risk for postictal psychosis (PIP) suggest the value of a controlled study involving a relatively large number of patients. METHODS: The study population consisted of a consecutive series of 59 patients with partial epilepsy and a history of PIP, and 94 control patients with partial epilepsy and no history of PIP evaluated as inpatients with video-electroencephalography. The groups did not differ significantly regarding demographic features. Exact tests yielded a subset of variables and a tentative interpretation that were evaluated further utilizing principal components analysis and logistic regression. RESULTS: PIP was associated with extratemporal versus temporal ( p = 0.036) or undetermined ( p = 0.001) localization of seizure onset, bilateral interictal epileptiform activity ( p = 0.017), secondary generalization ( p = 0.049), and history of encephalitis ( p = 0.018). Interictal slow activity was more frequently absent in control patients ( p = 0.045). PIP was associated with family histories of psychiatric disorders ( p = 0.007) and epilepsy ( p = 0.042), which themselves were significantly intercorrelated (r 0.225; p = 0.006). Age of onset or duration of epilepsy and lateralized electroencephalographic or magnetic resonance imaging asymmetries did not differ significantly between control and PIP groups. The analysis indicated four underlying domains of risk for PIP: ambiguous/extratemporal localization, family neuropsychiatric history, abnormal interictal electroencephalographic activity, and encephalitis. Each unit increase on a simple additive scale composed of 9 dichotomous independent variables multiplied the odds ratio for PIP by 1.71 (95% confidence interval, 1.36–2.15; p < 0.0001). INTERPRETATION: PIP in partial epilepsy is associated with relatively broadly and bilaterally distributed epileptogenic networks, genetic determinants of psychiatric disorders and seizures, and encephalitis

Use of CCTV and VCR for teaching psychiatry

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Effects of Cerebral Electrical Stimulation on Alcoholism: A Pilot Study

Cerebral electrical stimulation (CES), born from research on electroanesthesia in the seventies, consists of the application of a pulsating current of small intensity (usually less than l mA, and below the threshold of perception) through the skull, e.g., in daily 30-min sessions. Claims of biological effectiveness (neurochemical, hormonal and EEG changes, naloxone-reversible analgesia in rats, etc.) and of clinical effectiveness (anxiety, depression, cognitive functions in alcoholics) have often relied on poorly controlled data. A recent controlled study in the treatment of opiate withdrawal has been positive. The present double-blind controlled study compares active CES with sham stimulation in 64 alcohol-dependent males. Over 4 weeks, both treatment groups improved significantly in most aspects. In the active treatment group additional significant improvement was observed in week-end alcohol consumption, and in two psychological measures: depression and stress symptoms index, but not in general drinking behavior. Key Words: Alcohol Consumption, Cerebral Electrical Stimulation, Psychological Measures, Craving, Controlled Clinical Trial. HE DEVELOPMENT OF psychopharmacological T treatments in alcohol dependence has been recently the object of several comprehensive reviews.lT3 They include for instance inhibitors of serotonin re-uptake: dopamine agonist~?-~ GABA agonists.&apos; Even if any of these experimental psychopharmacological approaches prove clinically helpful, they would meet serious obstacles in practice, such as problems with compliance; resistance to any pharmacotherapy in alcoholics by some members of the influential Alcoholics Anonymous, and finally, possibilities of dangerous interactions between the proposed drugs and alcohol. Therefore, a nonpharmacological adjunct, such as cerebral electrical stimulation (CES), may be easier to integrate with existing psychological and social approaches. CES was born from research on electroanaesthesia (electrosleep) in the 1960s and 1970~.~-ll It was noted that some subjects undergoing this procedure exhibited favorable changes in mood. The technique of CES is variable but Human clinical studies have claimed: a favorable influence on anxiety and d e p r e s~i o n l~-~~ in psychiatric patients; improvement of cognitive dysfunctions in alcoholics;10923 an improvement in anxiety and depression in clinically drug dependent individuals, although not specifically in alcohol- There are methodological problems with many of these studies which appear more optimistic than well controlled.26 They are often poorly designed, have unclear dependent variables, and/or have confusing treatment outcomes. An uncontrolled study of 400 narcotic addi~ts~~~&apos;&apos; claimed that CES reduced craving and eased the withdrawal from narcotic abuse, although this finding was quest i~n e d .~~ In a more recent double-blind placebo-controlled experiment, CES effectively alleviated symptoms of opiate ~ithdrawal.~&apos; To our knowledge, none of the studies on CES effects have attempted to measure its influence on drinking behavior per se, i.e., craving and/or alcohol consumption. Therefore, the first objective of this work was to assess the possible effect of CES on drinking behavior. In addition, it seemed appropriate to examine the effects of CES on psychiatric symptoms secondary to alcohol abuse, because anxiety, depression, and decreased tolerance to stress are major symptoms of primary alcoholism. Results of these studies were communicated in a preliminary form.31 An independent study of CES effects on the cocaine withdrawal syndrome is in progress and will be reported separately

Einsatz von elektronischen Rechnern in der psychiatrischen Elektroenzephalographie

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