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Background: Hypertension has been associated with lower levels of quality of life (QoL). However, the specific correlates of lower QoL in this patient population have remained largely unclear. Methods: A cross-sectional design of 1,125 primary care patients with hypertension. We evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of hypertension treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and perceived QoL in the hypothetical absence of hypertension. Results: Worse financial status, poorer blood pressure control, worse subjective health, mental distress, lack of hypertension diet, and irregular hypertension care were all associated with worse QoL. Worse financial status, poorer blood pressure control, higher body mass index, mental distress, and following a hypertension diet were associated with better QoL in the hypothetical absence of hypertension. Conclusions: In addition to taking into consideration well known determinants of QoL, such as financial status, health status, and mental health, physicians need to be aware of the potential tradeoff between following medical recommendations that advocate for a strict diet and the impact these have on patients' QoL. Physicians also need to be aware of the effect of imparting information regarding imbalanced blood pressure on perceived QoL. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe and discuss both assessment and psychotherapeutic techniques that can be applied in primary-care medicine for older adults seeking mental health services in these settings. Assessment techniques that are amenable to primary-care settings include the Center for Epidemiological Studies Depression Scale, Revised; the Geriatric Depression Scale-15; two and nine-symptom Patient Health Questionnaire; the General Health Questionnaire; the Beck Depression Inventory–II; and the Beck Depression Inventory for Primary Care. Psychotherapeutic interventions that have been created and/or modified for primary-care settings are Problem solving therapy (PST–PC) and interpersonal therapy (IPT–PC). These detection tools and treatments are discussed in the context of primary-care medicine. [ABSTRACT FROM AUTHOR]

Symptoms in the early stages of Huntington's disease (HD) are assumed to reflect basal ganglia circuit dysfunction secondary to degeneration of striatal projections to the external segment of the globus pallidus (GPe). The hypothesis that GPe lesion would ameliorate HD symptoms by “normalizing” the circuit's functioning was tested in a rat model of this disease. The performance of rats sustaining quinolinic acid lesion to the striatum (a rat model of HD) in a position discrimination and reversal task was compared with the performance of rats sustaining in addition a bilateral excitotoxic lesion to the globus pallidus (GP) carried out simultaneously with the striatal lesion (Experiment 1) or 1 month after the striatal lesion (Experiment 2), as well as a unilateral temporary lesion of the GP (Experiment 3). The striatal lesion-induced deficit in the task was effectively reversed by a bilateral excitotoxic GP lesion carried out simultaneously or 1 month after the striatal lesion, as well as by a temporary unilateral GP inactivation. Given that a similar dysfunction of basal ganglia circuitry is thought to subserve the behavioral alterations seen in quinolinic acid lesioned rats and some of the symptoms in HD, these results raise the possibility that lesion or inactivation of the GPe may alleviate some of HD symptoms. © 2003 Movement Disorder Society [ABSTRACT FROM AUTHOR]

As modern technology advances, people live longer and are more likely to face death later in life from chronic or degenerative diseases. The location of death has also changed, resulting in more people dying in impersonal settings. The final months in the life of George, a terminally ill 89-year-old Caucasian male are discussed from four perspectives: existential approach, the stage model of death and dying, the reinforcement model, and an integrated model. Therapeutic interventions, aimed toward assisting George in dealing with his medical condition and existential issues, consisted of the following three major components: family therapy, religiosity, and preparation for death. Ethical and therapeutic considerations related to issues of death and dying are addressed. [ABSTRACT FROM AUTHOR]