Rationale and design: telepsychology service delivery for depressed elderly veterans

BACKGROUND: 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. METHODS: 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 inhome Telepsychology 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). DISCUSSION: 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. TRIAL REGISTRATION: National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701)

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

Remedying the Achilles Heel of Behavior Research and Therapy: Prescriptive Matching of Intervention and Psychopathology

Recent calls for eclecticism in clinical practice have been fueled by the putative limitations of behavioral techniques in treating a variety of psychological problems. However, calls for such integration do not appear to be justified for two related reasons. First, the precise conditions under which behavioral interventions are and are not effective have not yet been adequately delineated. consequently, rejection of behavioral interventions in favor of relatively indiscriminate application of cognitive strategies is premature. Second, behavior therapy has as its hallmark a thorough grounding in inductive empiricism, while cognitive/dynamic theories are wholly based in deductive rationalism. As a result, wholesale acceptance of alternative theories and techniques by behaviorists is both inconsistent and retrogressive. Cognitive interventions have their place, but only when cognitive distortions have been specifically identified. Therefore, refinement of behavioral treatments into prescriptive interventions is warranted. The parameters of prescriptive behavior therapy are described in this paper

Interventions for Panic Disorder: A Critical Review of the Literature

Initial etiological theories of panic were largely grounded in a biological framework due to the seemingly spontaneous nature of most attacks. More recently, however, cognitive, hyperventilatory, and conditioning theories of panic have been proposed. Cognitive theorists emphasize the causal role of catastrophic misattributions of benign somatic cues in panic; therefore, treatment involves providing the client with corrective information. Proponents of the hyperventilatory theory of panic implicate inappropriately increased ventilation; consequently, interventions emphasize breathing retraining. Finally, conditioning theorists hold that initial attacks are caused by hyperventilation or some other discrete event and that contiguous interoceptive stimuli become conditioned elicitors of future panics; as a result, treatment consists of exposure to the interoceptive cues which trigger panic. Combinations of treatments address possible multiple causal pathways and have been found to be relatively more effective than interventions based on only one etiological perspective

Social Skills Training for Depressed, Visually-Impaired Older Adults: A Treatment Manual

Late-onset visual impairment due to cataracts, glaucoma, macular degeneration, or diabetic retinopathy afflicts approximately 10% of people older than 65, and often results in depression and social dysfunction. Whereas the majority of sighted older adults are active participants in their community, individuals suffering from progressively worsening vision experience heightened levels of isolation and reduced social support, and participate in fewer reinforcing recreational activities. This article describes our social skills training package for the treatment of depressed, visually impaired, older adults. Our treatment focuses on increasing the frequency and level of assertiveness with which visually impaired older adults interact with each other. In addition to specified treatment methods, our empirically derived program employs standardized assessment measures to evaluate therapeutic progress. Sessions are implemented to reinforce efforts to apply social skills in the environment and reestablish skills that have begun to fade

Phenotypic and genomic comparisons of community-associated Staphylococcus aureus Clone ST93

© 2015 Justin StepnellStaphylococcus aureus is an opportunistic bacterial pathogen that primarily colonises the anterior nares of 30-50% of individuals at any one time, without causing disease. S. aureus does however cause a wide range of diseases including skin and soft tissue infections, pneumonia, osteoarticular infections and bacteraemia or septicaemia, frequently resulting in hospitalisation and a high mortality rate for invasive disease. S. aureus strains have acquired resistance to many classes of antibiotics, most importantly resistance to beta-lactam antibiotics (methicillin-resistant S. aureus, MRSA). While traditionally a health care associated issue, community-acquired MRSA (CA-MRSA) clones are increasing worldwide resulting in severe, antibiotic resistant infections occurring in patients without healthcare contact. The ST93 clone of CA-MRSA is essentially unique to Australia, and has been associated with severe, invasive S. aureus infections in otherwise healthy individuals. ST93 CA-MRSA is also the most common CA-MRSA clone in Australia. The overall aims of this study were to determine the virulence characteristics of a collection of ST93 S. aureus isolates from around Australia, and to uncover the molecular determinants of virulence in ST93 S. aureus. Fifty-eight ST93 isolates were assessed for virulence using the Galleria mellonella invertebrate virulence model and by measuring expression of key virulence factors. Whole genome sequencing and genomic analysis of all isolates was used to uncover genetic differences that might account for differences in virulence characteristics. In this study ~50% of isolates (n=28) were avirulent when compared to a virulent reference ST93 isolate JKD6159 using the G. mellonella model. This study also revealed that the G. mellonella model does not respond to exotoxin expression of isolates with no significant differences in G. mellonella mortality between culture supernatant of virulent and avirulent isolates used in the G. mellonella model. The expression levels of PSMα3 and δ-toxin varied significantly amongst the isolate collection, and the concentration of δ-toxin was found not to correlate with that of PSMα3, indicating that systems other than the quorum-sensing agr system must be controlling the expression of PSMα3 in ST93 S. aureus

Review of the Validation and Dissemination of Eye-movement Desensitization and Reprocessing: A Scientific and Ethical Dilemma

Eye-Movement Desensitization and Reprocessing (EMDR), a technique that combines imaginai exposure with eye movement, recently has been proposed by its originator, F. Shapiro, as a prescriptive treatment for trauma-related anxiety. To date, several uncontrolled case studies have found EMDR to be effective. However, none employed objective or standardized dependent measures of therapeutic improvement and all combined EMDR with other interventions. In contrast to results obtained from case studies, controlled experiments utilizing objective and standardized dependent measures have failed to support the efficacy of the technique beyond that of its imaginal exposure component. Unfortunately, these experiments employed small samples with a limited range of disorders, indicating the need for further evaluation. However, unbiased replication is impeded by Shapiro\u27s practice of prohibiting individuals not associated with her EMDR Institute from training others in the technique. We articulate our concern that despite its lack of empirical validation clinical application of the technique by behavior therapists is rapidly increasing