The development of a technique to assess the quality of life (QOL) of patients with dementia and of their carers

Although there are quality of life measures, both generic and disease-specific, for most medical conditions, to date none has been developed for the elicitation of subjective reports from patients with dementia. There are a number of methodological issues which make such assessments potentially difficult. Since progressive, global cognitive problems are the cardinal feature of the disorder, the first consideration is whether interviewing patients about their own QOL is feasible. The aim of this research was to develop a quality of life assessment schedule for patients with dementia and to ascertain at what point in the disease-process patient self-report of QOL is no longer possible. A subjective, respondent-driven QOL assessment technique was developed and psychometrically validated. This was based on an existing psychological theory and methods, namely, Personal Construct Theory and Repertory Grid Technique. The resulting Quality of Life Assessment Schedule (QOLAS) is a generic technique. Five domains of functioning are assessed by the method: physical, psychological, social/family, work/economic and cognitive. In order to test the psychometric properties of the new technique, the method was tested in two groups of patients with epilepsy in addition to psychometric testing in patients with dementia and their carers. After piloting the technique in patients with dementia and their carers, the method was slightly modified for use in this context. A group of patients with mild-to-moderate dementia, plus their primary carer, were recruited and interviewed 3 times: at baseline, 6 months later and 12 months from baseline. The interviews conducted were: patient rating self; carer rating patient and carer rating their own QOL. The streamlined, simplified Quality of Life Assessment Schedule (QOLAS) formed the core of the interview in each case. A number of existing generic and disease-specific questionnaires were administered and qualitative data were also collected. The question of the reliability or stability of the patients' perception of their own QOL was addressed in two ways: (i) by looking at correlations between scores obtained on a number of instrument subscales assessing the same, or similar, items; (ii) by a head-to-head comparison of the patients rating themselves and the carer rating the patient on the same instrument. Methodological issues in dementia research such as patient heterogeneity, variations in the pattern of cognitive decline, anosognosia, denial, ambiguity of questions, coping and adjustment are addressed and recommendations are made. Patients with dementia are able to assess and report their own QOL at the onset of their illness but reliability diminishes with disease progression. The findings suggest that the simplified QOLAS technique is a valid procedure in assessing the QOL of patients with mild-to-moderate dementia and the QOL of their principal carer

The Role of Cognitive-Behavioural Therapy for Patients with Depression in Parkinson's Disease

Depression is a common complication of Parkinson's disease (PD) with considerable impact on patients' quality of life. However, at present the most appropriate treatment approach is unclear. There are limited data on antidepressant medications in PD-associated depression (dPD) and those available suggest limited efficacy and tolerability of these drugs. Cognitive behavioural therapy (CBT) has been shown to be an effective treatment of depressive disorders. Treatment of dPD with CBT may pose particular challenges, including possible different pathophysiology, physical and mental comorbidities, and barriers to treatment through disability, which do not allow simple transfer of these results to patients with dPD. However, a number of case reports, case series, and small pilot studies suggest that this is a promising treatment for patients with PD. We here summarise the published evidence on this treatment in dPD

Group psychotherapy format guided self-help for patients with FNSD awaiting inpatient multidisciplinary treatment: A pilot study

Background: We describe our experience of developing Guided Self Help for patients with Functional Neurological Symptom Disorder as group therapy, delivered remotely, via Zoom. // Aims: The aims of the current study are (a) to describe how the original Queen Square Guided Self-Help (QGSH) was adapted for group therapy, and (b) to present a service evaluation of the first 8 months of running QGSH therapy groups remotely. // Methods: We carried out a review after 8 months, from 11 May 2021 until 31 January 2022. // Results: A total of 16 patients were treated in three groups. Assessing our outcomes in terms of Yalom's framework for group psychotherapy, we found that the group provided 10/11 of Yalom's therapeutic factors. Patient satisfaction was high. // Discussion: We outline for plans for further devaluation and development, including the development of a stand-alone group. // Conclusion: The group therapy format is a promising addition to our service

Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms

INTRODUCTION AND HYPOTHESIS: Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS: A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS: Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS: The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment