The factorial structure of the mini mental state examination (MMSE) in Japanese dementia patients

<p>Abstract</p> <p>Background</p> <p>The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients.</p> <p>Methods</p> <p>30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE.</p> <p>Results</p> <p>Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration.</p> <p>Conclusions</p> <p>Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.</p

Peer Perceptions of Social Skills in Socially Anxious and Nonanxious Adolescents

Previous studies using adult observers are inconsistent with regard to social skills deficits in nonclinical socially anxious youth. The present study investigated whether same age peers perceive a lack of social skills in the socially anxious. Twenty high and 20 low socially anxious adolescents (13–17 years old) were recorded giving a 5-min speech. Unfamiliar peer observers (12–17 years old) viewed the speech samples and rated four social skills: speech content, facial expressions, posture and body movement, and way of speaking. Peer observers perceived high socially anxious adolescents as significantly poorer than low socially anxious adolescents on all four social skills. Moreover, for all skills except facial expressions, group differences could not be attributed to adolescents’ self-reported level of depression. We suggest that therapists take the perceptions of same age peers into account when assessing the social skills of socially anxious youth

Longitudinal Associations Between Perceived Parent-Child Relationship Quality and Depressive Symptoms in Adolescence

This longitudinal study examined bidirectional paths between perceived parent-adolescent relationship quality and depressive symptoms, as well as the moderating role of sex, age, and personality type. 1313 Dutch adolescents (51% girls) from two cohorts (923 12-year olds and 390 16-year olds at Wave 1) reported on their personality, depressive symptoms, and perceived relationship quality to parents in four waves. Consistent with a relationship erosion perspective, depressive symptoms negatively predicted perceived relationship quality with parents. Relationship quality to mothers predicted depressive symptoms for boys and girls, but relationship quality to fathers predicted depressive symptoms only for boys. Personality type only moderated initial associations between relationship quality with mothers and depressive symptoms, which were stronger for Overcontrollers and Undercontrollers than for Resilients. Results thus reveal a pattern of mutual influence between perceived relationship quality and depressive symptoms that is moderated by the interplay among parent and adolescent sex and adolescent personality type

Bipolar affective disorder: Does psychosocial treatment add to the efficacy of drug therapy?

Given the efficacy of mood-stabilizing medications as prophylactic agents, what role does psychosocial intervention play in the treatment of bipolar affective disorder? Evidence is reviewed that (1) psychosocial stressors are associated with increased cycling of the disorder, and (2) the addition of psychosocial treatment to mood-stabilizing medications leads to improvements in the longitudinal course of adult bipolar disorder. Empirically supported psychosocial treatments include family-focused psychoeducational treatment, interpersonal and social rhythm therapy, and cognitive-behavioral therapy approaches. Randomized controlled studies suggest that these approaches, when combined with mood-stabilizing medications, can help reduce the likelihood of recurrences over 1- to 2-year periods of follow-up. Future studies should examine the cost-effectiveness of these treatments in community care settings and their applicability to child- and adolescent-onset bipolar patients

Psychosocial interventions for bipolar disorder.

Patients with bipolar disorder are prone to recurrences even when they are maintained on lithium or anticonvulsant regimens. The authors argue that the outpatient treatment of bipolar disorder should involve both somatic and psychosocial components. Psychosocial interventions can enhance patients' adherence to medications, ability to cope with environmental stress triggers, and social-occupational functioning. Family and marital psychoeducational interventions and individual interpersonal and social rhythm therapy have received the most empirical support in experimental trials. These interventions, when combined with medications, appear effective in improving symptomatic functioning during maintenance treatment. A beginning literature also supports the utility of individual cognitive-behavioral and psychoeducational approaches, particularly in enhancing medication adherence. Identifying the optimal format for psychosocial treatments and elucidating their mechanisms of action are topics for further study

Family-focused treatment for adolescents with bipolar disorder.

BACKGROUND: Research has begun to elucidate the optimal pharmacological treatments for pediatric-onset bipolar patients, but few studies have examined the role of psychosocial interventions as adjuncts to pharmacotherapy in maintenance treatment. This article describes an adjunctive family-focused psychoeducational treatment for bipolar adolescents (FFT-A). The adult version of FFT has been shown to be effective in forestalling relapses in two randomized clinical trials involving bipolar adults. METHODS: FFT-A is administered to adolescents who have had an exacerbation of manic, depressed, or mixed symptoms within the last 3 months. It is given in 21 outpatient sessions of psychoeducation, communication enhancement training, and problem solving skills training. We describe modifications to the adult FFT model to address the developmental issues and unique clinical presentations of pediatric-onset patients. RESULTS: An open treatment trial involving 20 bipolar adolescents (11 boys, 9 girls; mean age 14.8+/-1.6) found that the combination of FFT-A and mood stabilizing medications was associated with improvements in depression symptoms, mania symptoms, and behavior problems over 1 year. LIMITATIONS: These early results are based on a small-scale open trial. CONCLUSIONS: Results from an ongoing randomized controlled trial will clarify whether combining FFT-A with pharmacotherapy improves the 2-year course of adolescent bipolar disorder. If the results are positive, then a structured manual-based psychosocial approach will be available for clinicians who treat adolescent bipolar patients in the community