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Resumen Introduccion El aumento de la poblacion de adultos mayores y de los indices de prevalencia de enfermedades neurodegenerativas conlleva el incremento de cuidadores familiares que deben supervisar a los enfermos o cuidarlos de forma permanente. En la literatura cientifica se califica a los cuidadores familiares como «segundas victimas» o «pacientes ocultos» debido a las repercusiones desfavorables que padecen en su salud como consecuencia de las tareas de cuidado que realizan. La Escala de sobrecarga del cuidador de Zarit evalua la presencia y los niveles del sentimiento de sobrecarga. Objetivo Presentar evidencias de validez de la Escala de sobrecarga del cuidador de Zarit en cuidadores familiares de pacientes con demencia para el uso en Argentina. Sujetos y metodos Se recogieron 2 muestras independientes para analizar evidencias de validez de constructo: muestra 1 para el estudio factorial exploratorio y de consistencia interna; muestra 2 para el analisis factorial confirmatorio. Resultados La muestra 1 consto de 150 cuidadores de 19 a 87 anos (M = 58,48; DE = 15,90) y la muestra 2 de 203 cuidadores de entre 22 y 90 anos (M = 66,74, DE = 11,13). Como resultado se obtuvo un instrumento compuesto por 17 items que permite evaluar unidimensionalmente el sentimiento de sobrecarga del cuidador de manera valida y confiable. Discusion Se discuten los resultados obtenidos a la luz de la teoria y de las implicaciones practicas de la aplicacion del instrumento. Conclusion La Escala de sobrecarga de Zarit, en su version argentina, ha demostrado apropiadas caracteristicas psicometricas que validan su utilizacion en nuestro medio.

Background: There is insufficient available information on behavioral changes in the absence of cognitive impairment as factors increasing the risk of conversion to dementia. Objective: To observe and analyze patients with mild behavioral impairment (MBI), mild cognitive impairment (MCI), and a psychiatry group (PG) to compare the risk of progression to dementia. Methods: From 677 initially assessed =60-year-old patients, a series of 348 patients was studied for a five-year period until censoring or conversion to dementia: 96 with MBI, 87 with MCI, and 165 with general psychiatry disorders, including 4 subgroups: Anxiety, Depression, Psychosis and Others. All patients were assessed with clinical, psychiatric, neurological, neuropsychological, and neuroimaging studies. Results: From 348 patients, 126 evolved to dementia (36.2%). Conversion was significantly higher in MBI (71.5%), followed by the MCI-MBI overlap (59.6%) and MCI (37.8%) groups, compared to PG (13.9%) (Log-rank p < 0.001). MCI patients mostly converted to Alzheimer's dementia, while MBI converted to frontotemporal dementia and Lewy body dementia. Patients in PG converted to Lewy body dementia and frontotemporal dementia. Conclusion: Conversion to dementia is significantly higher in patients with neuropsychiatric symptoms. The MBI concept generates a new milestone in the refining of diagnosis of neurodegenerative diseases and the possibility of creating neuropsychiatric profiles. Its earlier identification will allow new possibilities for therapeutic intervention. Fil: Taragano, Fernando Emilio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Allegri, Ricardo Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Heisecke Peralta, Silvina Lidia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Martelli, María I.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Feldman, Mónica L.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Sánchez, Viviana. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: García, Virginia A.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Tufro, Graciela. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Castro, Diego M.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Leguizamón, Patricio Perez. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Guelar, Verónica. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Ruotolo, Eva. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Zegarra, Cecilia. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Dillon, Carol. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina

Dementia is a clinical syndrome that is characterized by impairment of cognitive and functional abilities (daily life activities) as well as by neuropsychiatric symptoms. Cognitive impairment can include impairment of memory, visuospatial functions, language, and executive functions. Many neurodegenerative diseases turn over to dementia, Alzheimers Disease being the most frequent of them. Alzheimers Disease (AD) affect a large population worldwide. In the last decade, various medications have been used for the treatment of cognitive symptoms in AD. Many of them have few scientific evidence of their effectiveness. The aim of this paper is to review and update the current status of the pharmacological treatment of cognitive symptoms in Alzheimers Disease.

Frontotemporal dementia (FTD) is the main differential diagnosis with early stages of Alzheimer’s disease (AD). Usually, differential diagnosis between a first depressive episode and the beginning of an early degenerative dementia with mood disorders, either AD or FTD, can be difficult. Objective: To evaluate the clinical characteristics of patients with senile and presenile onset dementia, to compare their neuropsychiatric and neuropsychological profiles according to onset age and to provide clinical approach. Methods: A two year prospective-retrospective study was conducted. All patients were evaluated with a complete neuropsychiatric and neuropsychological battery, laboratory tests and neuroimaging. Healthy control subjects were also studied. Results: Included 366 subjects were divided into over or under 65 years old, and then matched for educational level. AD was the most common cause of dementia in subjects over 65 years of age, followed by depression and FTD. Subjects younger than 65 years old, showed higher prevalence of depression followed by FTD, AD, and finally primary progressive aphasia (PPA). At younger ages, the highest severity of cognitive impairment, behavioral disorder and major depression were observed. Conclusion: Onset age of cognitive and/or behavioral impairment may be one of the variables influencing the clinical heterogeneity of dementias. Many of the young-onset dementias may be potentially reversible so, its early identification and pathophysiology understand, increase pharmacological intervention opportunities of halting the cascade of events that lead inexorably to dementia. In the new era of biomarkers, their help in identifying each clinical phenotype could encourage their best use in clinical practice and help selecting more accurate pharmacological treatment. Fil: Serrano, Cecilia M.. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; Argentina Fil: Dillon, Carol. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Heisecke Peralta, Silvina Lidia. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Castro, Diego M.. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; Argentina Fil: Pérez Leguizamón, Patricio. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; Argentina Fil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Taragano, Fernando Emilio. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Resumen Introduccion El coste economico de las demencias es elevado. El perfil de deterioro cognitivo y neuropsiquiatrico puede predecir el gasto por demencia. Se desconoce en nuestro medio la diferencia entre los distintos subtipos de demencia. Objetivo Comparar los costes directos de la enfermedad en los distintos subtipos de demencia. Materiales y metodos Fueron evaluados pacientes con diagnostico de demencia tipo Alzheimer probable (DTA), frontotemporal (DFT) y vascular (DVASC) de acuerdo con criterios publicados (periodo 2002 a 2008). Se elaboro una entrevista estructurada sobre los gastos directos. Resultados Se seleccionaron 104 pacientes con demencia (DTA = 44, DFT = 34 y DVASC = 26) y fueron apareados con 29 controles normales. En las variables demograficas no se presentaron diferencias significativas (Kruskall-Wallis). El coste directo anual fue de 4.625 dolares para DTA, 4.924 dolares para la DFT y para la DVASC 5.112 dolares (p > 0,05 entre los grupos). En el analisis post hoc la DVASC presento mayor coste por internaciones que la DTA (p Conclusiones El coste entre los distintos tipos de demencia ha sido diferente. El derivado de los pacientes se vio incrementado con la presencia de depresion, la institucionalizacion y con el numero de medicamentos suministrados.

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies.To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia.A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006).In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion).MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas.Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa.Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006).No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão).Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.

Given the potential use of biomarkers in the diagnosis of Alzheimer's disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) and general public (GP) on the implementation of early diagnostic techniques in AD and the use of biomarkers for this purpose. A survey with multiple choice answers was elaborated in two versions: one for HP and the other for GP. Respondents were invited to participate through a system of mass mailing e-mail; e-mail addresses were collected from CEMIC database. A total of 1503 answers were analyzed: 807 HP and 696 GP. Most respondents, 84.7%, preferred the option of early diagnosis of AD even knowing the lack of curative treatment. Forty five percent of GP and 26.8% of HP replied that there is no ethical dilemma in the use of biomarkers and that no communication or ethical dilemma is generated to physicians when informing the diagnosis of the disease. The HP group showed more divergence in the views than the GP group. These results may indicate a change in the physician-patient relationship, showing the GP group with an active and supportive position towards the use of biomarkers for early diagnosis of AD.

Objective There is a paucity of evidence about insurance status and the likelihood of receiving medical services in Latin America. The objective of this analysis was to examine the association between insurance status and pharmacologic treatment for depression. Methods Patients referred to a memory clinic of a public hospital in Buenos Aires, Argentina, and identified with any of four types of depression (subsyndromal, dysthymia, major, and due to dementia) were included. Age, years of education, insurance status, Beck Depression Inventory score, and number of comorbidities were considered. Associations between these factors and not receiving pharmacologic treatment for depression were examined with logistic regression. Use of prescription neuroleptics, hypnotics, and anticholinesterase inhibitors was also explored. Results Out of 100 patients, 92 with insurance status data were used. Sixty-one patients (66%) had formal insurance and 31 patients (34%) lacked insurance. Twenty-seven (44%) insured patients and 23 (74%) uninsured patients did not receive antidepressants ( P = 0.001). Controlling for other factors, uninsured patients had 7.12 higher odds of not receiving treatment compared to insured patients (95% confidence interval 1.88–28.86). Older patients and those with more comorbidities had higher odds of not receiving treatment. More educated patients, those with higher Beck Depression Inventory score, and those without subsyndromal depression had lower odds of not receiving treatment. None of those associations were statistically significant. Conclusions These results suggest a potential negative effect of the lack of formal insurance regarding pharmacologic treatment for depression. These findings should be confirmed with larger samples, and for other diseases.

Anxiety disorders and, in particular, acute stress disorder are one of the principal reasons for medical assistance, being the women the ones who frequently consult.To describe and analyze, from a perspective of gender, the factors that unleash the consultation of an episode of acute stress disorder in the emergency.An exploratory descriptive study was performed. A semi-directed interview and a socio-demographic questionnaire were assessed and scales to evaluate anxiety and depression were administered to females that consulted for an acute stress disorder.Sixty nine percent of the patients described the physical discomfort as trigger factor, presenting in the 85% of the cases a degree of major anxiety; associating the family conflicts as the principal cause of distress, followed by violence against women. The situation of distress, in 75% of the cases, did not correspond with an isolated episode.The physical symptomatology was the principal cause for consultation of an episode of acute stress disorder in the emergency, being the family conflicts and the violence against women the principal reasons of distress. Therefore, interdisciplinary approach for the assistance of mental disorders in emergency should be taken in consideration.

Mild cognitive impairment (MCI) has 3 clinical subtypes: amnestic (aMCI), multiple domains (mdMCI) and non-amnestic single domain (na-SD-MCI) whose evolutive possibility to dementia has not been profoundly studied.This paper aims to determine the conversion to dementia of the different subtypes of MCI and determine risk factors associated to conversion to dementia.A total of 127 patients diagnosed with MCI (age=70.21; SD=13.17) were evaluated with a neuropsychological and neuropsychiatric battery. They were classified into 3 groups: amnestic MCI (n=20), multiple-domain MCI (n=98), non-amnestic MCI (n=9). Seventeen normal subjects (age=74.59; SD=10.63) were included.Of those included, 27.1% developed Alzheimer's type dementia [average time for conversion to Alzheimer's dementia (AD) 11.12 months (SD=0.183)]. None of the controls developed dementia. Thirty-five percent (n=7) of amnestic MCI converted to AD: 20% (n=4) at 6 months and 15% (n=3) at 12 months); 11.1% (n=1) of the non-amnestic single domain MCI converted to AD at 6 months. It was found that 31.6% (n=31) of multiple domain MCI rotated to AD: 15.3% (n=15) at 6 months and 16.3% (n=16) at 12 months. Age (p0.05, β=1.03) increased the likelihood of rotation to AD. Multi-domain MCI subtype was the most frequent. However, the conversion to dementia in amnestic subtype was the highest, age and retirement being the variables that increased the likelihood of conversion to Dementia.

Disinhibition is the loss of psychological and physiological inhibition that leads to cognitive and motor impulsivity. The notion of impulsiveness is often linked to the function of the prefrontal cortex, and is usually understood as a lack of response inhibition. In other words, the subject is unable to suppress or withhold a previously rewarding response and the behavior appears impulsive. This has a social impact as disinhibition often affects the human social behavior. The "human social behavior" is how a person behaves properly with other people in a social environment. Frontotemporal Dementia produces changes in patients' behavior that frequently, manifest as disinhibition. Patients' social cognition is impaired and this is one of the key points for early diagnosis. All of these concepts will be review for a better understanding of Frontotemporal Dementia, and therefore, being able to differentiate it from other psychogeriatric disorders.

Background: The economic cost of dementia is high and can be predicted by cognitive and neuropsychiatric profiles. The differential costs of the various subtypes of dementia are unknown in Argentina, and this study therefore aimed to compare these costs.Methods: Patients with a diagnosis of dementia of Alzheimer-type (DAT), frontotemporal dementia (FTD) and vascular dementia (VaD), and their primary caregivers, were evaluated between 2002 and 2008.Results: 104 patients with dementia (DAT = 44, FTD = 34, VaD = 26) were screened and matched by age and educational level with 29 healthy subjects. Demographic variables showed no significant differences among dementia patients. The annual direct costs were US$4625 for DAT, US$4924 for FTD, and US$5112 for VaD (p > 0.05 between groups). In the post hoc analysis VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher anti-dementia drug costs; FTD had higher psychotropic costs. In the multivariate analysis, depression, activities of daily living, and caregiver burden were correlated with direct costs (r2 = 0.76).Conclusions: The different dementia types have different costs. Overall, costs increased with the presence of behavioral symptoms, depression and functional impairment of activities of daily living.

Irrational use of drugs for the treatment of cognitive impairment can increase health costs in developing countries.to analyze the pattern of drug prescription related to the treatment of patients with dementia and to compare them with the income of patients.313 community-based outpatients that seeked medical advice for memory problems, in the Memory Center of Zubizarreta General Hospital (Buenos Aires, Argentina), were prospectively assessed during a period of a year.Patients' mean income was 502.81 "Pesos Argentinos" which is equivalent to US$152 per month (2007). Fourty one point fifty five percent (41.55%) of the patients had dementia, 15.65% psychiatric diseases, 15.01% mild cognitive impairment and 27.79% were normal. Patients received an average of 2.84 drugs/day, 20% of the patients took at least one drug for cognitive impairment (9.85% memantine, 6.38% donepezil and 4% nootropics, cerebral vasodilators or antioxidants), and 39.3% received psychotropic medication (28.11% benzodiazepines and 9.26 % atypical antipsychotics). Twelve point seventy six percent (12.76%) of the patients with mild cognitive impairment were treated with antidementials, 5.74% of normal subjects received antidementials. 4% of patients were exclusively treated with free samples.In our sample irrational degree of using antidemential drugs and psychotropic agents was found.

Background: Being a caregiver of a patient with Alzheimer’s disease is associated with impaired health status and declines in health-related quality of life (HRQoL). This paper evaluates the reliability and validity of the Argentinean version of the Medical Outcomes Study Short-Form Health Survey (SF-36) among caregivers of patients with Alzheimer’s disease. Methods: Forty-eight caregivers of Alzheimer’s disease patients completed the SF-36, the Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory (NPI). Patients were evaluated for dementia severity using the Clinical Dementia Rating (CDR) and for cognitive status using the Mini Mental State Examination (MMSE). Results: The SF-36 scales demonstrated adequate-to-strong internal consistency (Cronbach’s alpha range: 0.72 to 0.92). Correlations between the SF-36 scales and the ZBI were moderate to strong (range: –0.19 to –0.79, all p < 0.01 expect for physical function). Significant correlations between the SF-36 scales and the CDR, MMSE and NPI were lower (range: –0.30 to –0.40, p < 0.001) and strongest in mental health-related scales of the SF-36. The SF-36 demonstrated good factorial validity. Conclusions: The Argentinean translation of the SF-36 is reliable and valid for use to measure the HRQoL of caregivers of patients with Alzheimer’s disease.

SUMMARY Objective To examine behavioral, cognitive and functional factors associated with psychosocial burden in caregivers of geriatric patients. Methods Primary caregivers assessed were included if the geriatric patient cared for had a cognitive impairment or dementia (degenerative, vascular or mixed) (Group 1) or depression and cerebrovascular disease (CVD) (Group 2). Caregivers completed the Zarit questionnaire, the Neuropsychiatric Inventory (NPI) and Instrumental Activities of Daily Living (IADL). Patients were evaluated for dementia severity using the Clinical Dementia Rating (CDR), Mini Mental State Examination (MMSE) and Beck Depression Inventory (BDI). Structural equation modelling (SEM) was used to assess measurement models and the factors associated with burden. Results Two hundred and fifty-eight caregiver‐patient pairs were included. The best model fit was obtained with a model with two constructs: function-cognition (CDR, MMSE, and IADL) and behavior (neuropsychiatric symptoms from the NPI). In Group 1, both function (B ¼0.32. T ¼2.79) and behavior (B ¼0.72, T ¼7.84) were significantly correlated with caregiver burden, although the strength of association was more than two times higher for behavior. In Group 2, behavior was related to caregiver burden (B ¼0.68, T ¼6) but not function-cognition (B ¼0.16, T ¼1.36). Conclusion These findings suggest that behavioral symptoms are an important factor associated with caregiver burden in patients with cognitive impairment, dementia, or depression, while functional and cognitive factors seem to also have an influence in patients with cognitive impairment. Copyright # 2008 John Wiley & Sons, Ltd.

Several studies refer to the relationship between schizophrenia and cognitive dysfunctions. The most frequent disturbances accepted are the deficits in the executive, memory and verbal tests. However, there are few comparative data about the cognitive functioning of the different subtypes of schizophrenia.Analyze and compare the neuropsychological disturbances present in patients with paranoid and residual schizophrenia.Eleven patients with paranoid schizophrenia, eleven patients with residual schizophrenia (DSM-IV criteria), and thirty one normal subjects matched by age, educational level, and general cognitive level (Mini Mental State Examination (Folstein, 1975), were assessed with a semistructured psychiatric examination and an extensive neuropsychological battery.Significant differences were found in memory, language, and executive functions when schizophrenics were compared with normal subjects. Differences in similarities were found between paranoid and residual schizophrenics. Residual schizophrenics had more disturbances in neuropsychological tests in comparison with paranoid schizophrenics.Schizophrenics demonstrated disturbances in memory, language, executive functions and attention. Residual schizophrenics had more impairment in neuropsychological tests than paranoid schizophrenics.

Depression is named as one of the most prevalent Mental Health problem, affecting almost 10 % of the population. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) different subtypes are included. Dysthymic Disorder is characterized by a depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. The aim of this study was to investigate the neuropsychological profile of dysthymic disorder. Ninety three patients fulfilling criteria for dysthymia were examined on a variety of cognitive tasks, neurological exam and a semi-structured psychiatric interview. Forty one non-depressed individuals served as controls. Significant differences between groups were found in digit span; immediate and delayed recall of a story; and semantic and phonologic fluency. Logic memory was worse than serial learning task, and has a correlation with attention deficit and depressive features.This results indicate that the neuropsychological performance of patients with dysthymic disorder exhibit impairments in attention and memory. Attentional deficits appear to be the key of cognitive deficits in dysthymia.

Fil: Serrano, Cecilia M.. Gobierno de la Ciudad de Buenos Aires. Hospital "Dr. Abel Zubizarreta"; Argentina

Fifteen graduate students in the helping professions registered in a course that teaches helpers to use physical fitness as a counseling medium. The enrolled graduate students were matched with controls in four relevant areas, and both groups were pretested on 7 physiological and 11 psychological variables. The experimental students were given a 10-week treatment of physical fitness training, counseling in health habits, a life-style of well-being, and instruction in how to deliver these kinds of treatments to clients. For eight weeks the students used the skills in working with real clients. The experimental and control groups were posttested on the same variables; and multivariate and univariate analyses revealed significantly positive changes made by the experimental group. This article reports implications for graduate programs in the helping professions.