Search

• What is the primary question addressed by this study? Is there preliminary evidence for efficacy and mechanism-of-action, of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), for depression symptoms? • What is the main finding of this study? TranS-C improved depression response rates 6-months postintervention. During the acute treatment phase, improvements in interdaily stability (in older adults) and reduction in insomnia severity (in younger adults) correlated with the degree of depression symptom reductions 6-months later. • What is the meaning of the finding? Future studies are warranted to confirm that TranS-C, a targeted sleep-wake treatment, improves the durability of depression symptom response via the identified pathways. Perform a secondary analysis examining the efficacy of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for depression symptom responses, and explore changes in potential target mechanisms. Secondary analysis of a randomized controlled trial with convenience age subsamples (younger (20–49 year; n = 52) versus and older (50–71 years; n = 35)). Community mental health clinics. Eighty-seven adults with serious mental illness. TranS-C versus treatment as usual (TAU). Outcomes were depression symptoms (Quick Inventory of Depression Symptoms), insomnia symptoms (Insomnia Severity Index), and objective sleep-wake rhythm measures (interdaily stability and relative amplitude). Depression response rates (≥50% symptom reductions) were higher in the TranS-C (35.0%) than the TAU (8.8%) group 6-months postintervention (χ2 = 10.3, p = 0.001). There was a medium effect of TranS-C versus TAU on depression symptoms 6-months postintervention (Cohen's d = −0.40, 95% confidence interval (CI): −0.81, 0.01). In both age groups, there were large treatment effects on insomnia symptoms post-treatment (Cohen's d >0.90). In the older subsample, there were additionally medium treatment effects on post-treatment interdaily stability (Cohen's d = 0.60, 95% CI: −0.11, 1.61). Post-treatment reductions in insomnia symptoms correlated with depression symptom reduction 6-months later in the younger subsample (Spearman rho = 0.59, n = 20, p = 0.008). In older adults, postintervention increases in interdaily stability correlated with depression symptom reductions 6-months later (Spearman rho = −0.52, n = 15, p = 0.049). Confirmatory trials are needed, given the low age-specific sample sizes here, to determine if TranS -C's produces durable depression responses by increasing sleep-wake rhythm stability in older adults and improving insomnia symptoms in younger adults. The authors evaluated preliminary efficacy of a behavioral intervention that targets sleep/sleep-wake rhythms, the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), for depression symptoms in people with serious mental illness. TranS-C was associated with higher depression response rates than treatment as usual 6-months postintervention. The degree of depression symptom response 6-months later was related to the degree of treatment phase improvements in interdaily stability (in older adults) and reduction in insomnia severity (in younger adults). A pragmatic nonpharmacologic intervention, the Transdiagnostic Intervention for Sleep and Circadian Dysfunction, has preliminary efficacy for improving sleep-wake factors and depression symptoms. [ABSTRACT FROM AUTHOR]

A recent study published in JAMA Psychiatry compared the efficacy of Magnetic Seizure Therapy (MST) and Electroconvulsive Therapy (ECT) for major depressive episodes. The study found that the effectiveness of ECT and MST were similar. However, the remission rate after ECT in the study was lower than expected, raising questions about the validity and generalizability of the findings. It is speculated that patient selection and treatment technique may have influenced the results. The study highlights the challenges of conducting randomized trials in patients with high acuity and suicidality. [Extracted from the article]

Aspiration pneumonia and extreme weight loss are risks whenever globus pharyngeus (GP) complicates major depressive disorder (MDD) in the older adult. The timely administration of electroconvulsive therapy (ECT) may reverse GP in this context. We review cases of GP in depressed older adults and describe both successful outcomes, as well as a fatal outcome associated with delays in offering ECT. MDD in the older adult complicated by GP and marked weight loss, or repeated aspiration, should be considered an urgent indication for ECT. [ABSTRACT FROM AUTHOR]

Cognitive impairment of dementia patients affects their ability to communicate and cooperate with care. Dementia patients need a specialized communication to increase their cooperation during daily care and a scale to measure cooperation with care. To improve communication, we created and applied a digital communication platform (DCP) in an observational study. To measure cooperation with care, we created and tested psychometric properties of the Cooperation with Care Scale‐Revised (CWCS‐R) in an institutional review board–approved 6‐week prospective study. DCP intervention was associated with decreased agitation and use of psychotropic medications for nursing home (NH) dementia patients. CWCS‐R is both a reliable and valid tool to measure cooperation with care in NH dementia patients. Innovations in communication with dementia patients and a scale to measure cooperation with care could reduce burdens of care and improve quality of life for patients, their family members, and staff. It may potentially help decrease cost of dementia care. [ABSTRACT FROM AUTHOR]

Objective: There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study.Method: After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test).Results: With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility.Conclusion: To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression. [ABSTRACT FROM AUTHOR]

• How can clinicians best achieve equity in informed consent for geriatric minority patients considering treatment with electroconvulsive therapy (ECT)? • Elderly minorities, by virtue of their age and race/ethnicity, have witnessed and survived more healthcare injustices than most of their clinically-matched Caucasian peers will ever see. These actual experiences of medical mistreatment combine with ECT's pervasive social stigma to give elderly minority patients reasonable cause to doubt the clinical suggestion as a treatment as unfortunately stigmatized as ECT. • Reducing healthcare disparities for elderly minority patients in ECT requires clinicians to validate the unique lived experiences of medical injustice that elderly minorities have faced in order to become more trustworthy of their consent before, during, and after treatment. Electroconvulsive therapy (ECT) is highly efficacious to treat severe depression in older adults. Yet, patients of ethnic and racial minorities are consistently underrepresented amongst those who receive ECT across all age groups. One strong hypothesis to explain this disparity is that minority patients are less likely to trust medical professionals and are therefore less likely to consent for ECT. Increasing participation of depressed, elderly , minority patients is uniquely challenging. Senior minority individuals have survived decades of medical and social injustices that no other demographic, specifically younger minorities or clinically-matched Caucasian peers, can truly comprehend from a first-hand perspective. This article provides a perspective based in cultural translational science to conversations of informed consent for ECT that removes our self-imposed stigma against discussing past and ongoing injustices with minority patients. Reducing disparities to geriatric minorities through equity of informed consent means that clinicians must validate the unique minority experience in medicine as it pertains to agreeing to a treatment modality as emotionally, socially, and historically laden as ECT. [ABSTRACT FROM AUTHOR]

Focal Electrically-Administered Seizure Therapy (FEAST) is a form of electroconvulsive therapy (ECT) that spatially focuses the electrical stimulus to initiate seizure activity in right prefrontal cortex. Two open-label non-comparative studies suggested that FEAST has reduced cognitive side effects when compared to historical data from other forms of ECT. In two different ECT clinics, we compared the efficacy and cognitive side effects of FEAST and Right Unilateral Ultrabrief Pulse (RUL-UBP) ECT. Using a non-randomized, open-label design, 39 depressed adults were recruited after referral for ECT. Twenty patients received FEAST (14 women; age 45.2 ± 12.7), and 19 received RUL-UBP ECT (16 women; age 43.2 ± 16.4). Key cognitive outcome measures were the postictal time to reorientation and the Columbia University Autobiographical Memory Interview: Short-Form (CUAMI-SF). Antidepressant effects were assessed using the Hamilton Rating Scale for Depression (HRSD 24). In the Intent-to-treat sample, a repeated measures mixed model suggested no between group difference in HRSD 24 score over time (F 1,35 = 0.82, p = 0.37), while the response rate favored FEAST (FEAST: 65%; RUL-UBP ECT: 57.9%), and the remission rate favored RUL-UBP ECT (FEAST: 35%; RUL-UBP ECT: 47.4%). The FEAST group had numeric superiority in average time to reorientation (FEAST: 6.6 ± 5.0 min; RUL-UBP ECT: 8.8 ± 5.8 min; Cohens d = 0.41), and CUAMI-SF consistency score (FEAST: 69.2 ± 14.2%; RUL-UBP ECT: 63.9 ± 9.9%; Cohens d = 0.43); findings that failed to meet statistical significance. FEAST exerts similar efficacy relative to an optimal form of conventional ECT and may have milder cognitive side effects. A blinded, randomized, non-inferiority trial is needed. • This trial compared FEAST and RUL-UBP ECT to determine preliminary differences. • Using an open-label, non-randomized design, we assessed efficacy and amnestic effects. • There were no significant differences between the two groups in any primary outcome. • Our preliminary findings, however, suggest a larger comparative study is indicated. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies. To document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received. Patients were classified as receiving Weak, Strong, or HD BP BL ECT during three randomized trials at Columbia University. Nonresponders received HD BP BL ECT. In a separate multi-site trial, Optimization of ECT, patients were randomized to right unilateral or BL ECT and nonresponders also received further treatment with HD BP BL ECT. Remission rates with a second course of HD BP BL ECT were high in ECT nonresponders, approximately 60% and 40% in the Columbia University and Optimization of ECT studies, respectively. Clinical outcome was independent of the type of ECT first received. A second course with HD BP BL ECT resulted in greater retrograde amnesia immediately, two months, and six months following ECT. In the largest samples of ECT nonresponders studied to date, a second course of ECT had marked antidepressant effects. Since the therapeutic effects were independent of the technique first administered, it is possible that many patients may benefit simply from longer courses of ECT. Randomized trials are needed to determine whether, when, and how to change treatment technique in ECT. • In two samples, a second course of ECT resulted in remarkably high remission rates after nonresponse to a full first course. • Clinical outcome following the second course, using high dose bilateral ECT, was independent of the type of ECT first used. • A second ECT course of produced more severe long-term retrograde amnesia for autobiographical information. • Many patients may need longer ECT courses to show clinical benefit. • Randomized trials are needed to test optimal methods for when and how to change ECT treatment technique. [ABSTRACT FROM AUTHOR]

Currently 1.7 million individuals reside in 15,600 nursing homes in US (www.cdc.gov). These individuals often have difficulty adjusting to their new environment. They may refuse daily care, meals, and medications. Resistance-to-care behavior was reported in 9% of dementia patients in US studies and 96.9% in a Norwegian study (Konno R 2012). A definition of rejection of care and a conceptual framework of rejection of care incorporating 7 components was proposed by Ishii S. 2012). Increased caregiver stress can cause both physical and psychological injury to caregivers (Cody SJ 2001). Informant distress related to patients behavioral and psychological symptoms of dementia (BPSD) rather than symptoms themselves, were noted to be associated with higher healthcare utilization and costs (Maust D. 2017). Increased mortality and death rate are associated with use of antipsychotic medications (Tampi R 2017). Different interventions have been reported to decrease resistance to care behaviors including Music therapeutic caregiving (Hammer L 2011), simulated presence therapy (Woods p 1995), Family-generated videotapes Cohen-Mansfield J 1997), video simulated presence(VSP) (O'Conner C 2012). AlzhaTV displayed family videos to dementia patients to reorient, reassure, encourage to cooperate with care, showed decrease in NPI-NH (Neuropsychiatric inventory – Nursing home) scores by 85% by day 90 (Varshney S 2018). Noncooperation with healthcare workers to overall daily care, medications, and treatments is a major factor in increased cost of care for dementia patients in nursing homes. A Resistiveness to Care scale was developed by (Mahoney EK 1999) to measure a wide range of resistive behaviors. Some strategies can be implemented to improve cooperation. However, our literature search didn't find any study/scale to assess co-operation with care that would help compare outcomes of different studies that used different interventions to improve cooperation with care. We created and tested a scale to measure cooperation with the care (Varshney S 2018) then revised to add frequency component to obtain a comprehensive assessment on cooperation with the care. We applied Cooperation with Care Scale – Revised (CWCS-R) to nurses taking care of 15 nursing home dementia patients, in a systematic approach to test its validity and reliability. We recruited 17 nurses at a single nursing home who were caring for 15 MND patients of which 10 were female and 5 male patients. The study lasted for 6 weeks. For inter-observer reliability testing: We administered CWCS-R to a nursing home patient's nurse on first and second shift, once a week for the duration of 6 weeks. For validity testing: We administered Resistiveness to Care Scale (RTC) to the same patient's nurse on first and second shift, at the beginning of the study to test for external validity against CWCS-R. The integer of 1 was given to each yes on 13 item Resistiveness to Care Scale and were summed up at the end for each patient at the beginning of the study. Total 17 nurses enrolled in the study. Two nurses left after one month and 14 of the 15 nurses contributed a cooperation scale rating on at least one patient at least one point in time. 100% nurses were women (16 African American and 2 White). All nurses worked at the same nursing home for 6 months or more with mean work months was 81.5 months, median work months was 65 months with standard deviation (SD) 75.76 months. Mean age for nurse was 48?years, median was 47?years, and SD was 13. The patients included 10 women and 5 men. Mean for patients age was 88?years, median was 88?years and SD was 9?years. The mean (Mini Mental Status Examination) MMSE score was 7, and median MMSE score was 2, and SD was 8.3. All were white patients. 100% of patients were diagnoses with a MND. Inter-rater agreement Cooperation scores were 41.3 +/- 7.0 on first shift of week one, and 43.4 +/- 6.6 on second shift of week one (p= n.s). The median cooperation score across both shifts was 44. Using the median score of 44 as an indicator of which patients exhibited high versus low cooperation with care, a high degree of agreement was seen between the first and second shifts at week 1 (kappa=0.70; p<0.01) There difference in cooperation scores was non-significant between shifts 1 and 2 at week 1 (41.3 +/7.0 versus 43.4 +/-6.6, p=0.4) Criterion validity Resistance to Care (RTC) scores at week one was 2.6 +/- 3.0 for shift one and 1.8 +/- 1.7 for shift 2. Given the scoring rules for the cooperation scale and the RTC scale, the value of the Pearson's' r correlation was in the expected direction of r= -0.85, p<0.0001. The second shift, week 1 correlations were also in the expected negative direction, although the result was non-significant (r = -0.35, p=0.2) The effect of time: week 6 We created a two-factor model of all cooperation scores at both the first and second shifts and weeks 1 and 6, with "shift" and "weeks" an independent variable. The overall model was non-significant (F=1.5 df= 1,48, p=0.22) However, a matched pairs examination of week 1 versus week 6 score for first shift showed an increase in cooperation scores over time (+2.5 points over time, t=2.1 df=12, p< 0.05), while a similar matched pairs analysis for second shift showed no significant effect over time (difference = -1.1 points, t=-1.1, df=12, p=0.3) "Chronbach's standardized alpha": For First shift, week 1, it is 0.73 For Second shift, week 1, it is 0.70 All in all, these results indicate that the Cooperation with Care Scale -R has "good" internal consistency. Our study shows that CWCS-R for MND patients, is both reliable and valid. More studies are needed to replicate these results of CWCS -R and to compare the level of cooperation with the care against the cost of care for MND patients in nursing home setting. This research was funded by: Coop Study was not funded by any source. [ABSTRACT FROM AUTHOR]

Objective: There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.Methods: Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.Results: A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.Conclusion: This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable. [ABSTRACT FROM AUTHOR]

Objectives: Emergency Department (ED) utilization accounts for a large portion of healthcare services in the US. Disturbance of circadian rhythms may affect mental and behavioral health (MBH) conditions, which could result in increased ED visits and subsequent hospitalizations, thus potentially inducing staffing shortages and increasing ED wait time. Predicting the burden of ED admissions helps to better plan care at the EDs and provides significant benefits. This study investigates if increased ED visits for MBH conditions are associated with seasonality and changes in daylight savings time.Methods: Using ED encounter data from a large academic medical center, we have examined univariate and multivariate associations between ED visits for MBH conditions and the annual time periods during which MBH conditions are more elevated due to changes in the seasons. We hypothesize that ED visits for MBH conditions increase within the 2-week period following the daylight savings time changes.Results: Increased MBH ED visits were observed in certain seasons. This was especially true for non-bipolar depressive illness. We saw no significant changes in MBH visits as associated with changes in the daylight savings time.Conclusions: Data do not provide conclusive evidence of a uniform seasonal increase in ED visits for MBH conditions. Variation in ED MBH visits may be due to secular trends, such as socioeconomic factors. Future research should explore contemporaneous associations between time-driven events and MBH ED visits. It will allow for greater understanding of challenges regarding psychiatric patients and opportunities for improvement. [ABSTRACT FROM AUTHOR]

We report a case of sleep-isolated trichotillomania admitted to the hospital for alcohol detoxification. It would be helpful for patients with sleep-isolated trichotillomania to have diagnostic polysomnography to identify any other sleep-related pathology and correlate sleep-isolated trichotillomania behaviors with the sleep cycle to identify specific treatment for sleep-isolated trichotillomania. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) is highly efficacious to treat severe depression in older adults. Yet, patients of ethnic and racial minorities are consistently underrepresented amongst those who receive ECT across all age groups. One strong hypothesis to explain this disparity is that minority patients are less likely to trust medical professionals and are therefore less likely to consent for ECT. Increasing participation of depressed, elderly, minority patients is uniquely challenging. Senior minority individuals have survived decades of medical and social injustices that no other demographic, specifically younger minorities or clinically-matched Caucasian peers, can truly comprehend from a first-hand perspective. This article provides a perspective based in cultural translational science to conversations of informed consent for ECT that removes our self-imposed stigma against discussing past and ongoing injustices with minority patients. Reducing disparities to geriatric minorities through equity of informed consent means that clinicians must validate the unique minority experience in medicine as it pertains to agreeing to a treatment modality as emotionally, socially, and historically laden as ECT. [ABSTRACT FROM AUTHOR]