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Objective: International appeals call for interventions to prevent aggression and other behavioral problems in individuals with dementia (IWD). Aggression Prevention Training (APT), based on intervening in three contributors to development of aggression (IWD pain, IWD depression, and caregiver-IWD relationship problems) aims to reduce incidence of aggression in IWD over 1 year.Design: Randomized, controlled trial.Setting: Three clinics that assess, diagnose, and treat dementia.Participants: Two hundred twenty-eight caregiver-IWD dyads who screened positive for IWD pain, IWD depression, or caregiver-IWD relationship problems randomized to APT or Enhanced Usual Primary Care (EU-PC).Intervention: APT, a skills-based intervention delivered over 3 months to address pain/depression/caregiver-IWD relationship issues. EU-PC included printed material on dementia and community resources; and eight brief, weekly support calls.Measurements: The primary outcome was incidence of aggression over 1 year, determined by the Cohen Mansfield Agitation Inventory-Aggression Subscale. Secondary outcomes included pain, depression, caregiver-IWD relationship, caregiver burden, positive caregiving, behavior problems, and anxiety.Results: Aggression incidence and secondary outcomes did not differ between groups. However, in those screening positive for IWD depression or caregiver-IWD relationship problems, those receiving EU-PC had significant increases in depression and significant decreases in quality of the caregiver-IWD relationship, whereas those receiving APT showed no changes in these outcomes over time.Conclusion: The cost to patients, family, and society of behavioral problems in IWD, along with modest efficacy of most pharmacologic and nonpharmacologic interventions, calls for more study of novel preventive approaches. [ABSTRACT FROM AUTHOR]

Psychological distress, such as anxiety, depression, and posttraumatic stress disorder (PTSD), is commonly comorbid with obesity in veterans. The feasibility and acceptability of an integrated cognitive behavioral treatment approach has been tested in nonveteran settings but has yet to be tested among obese veterans with comorbid anxiety, depression, and PTSD. This paper describes such a framework, highlighting a flexible delivery method, transdiagnostic treatment approach, and attention to treatment barriers examined in a prior qualitative assessment. Brief vignettes are used to illustrate clinical decision-making procedures and treatment activities. The feasibility and acceptability as well as potential next steps for research and clinical benefits are also described. • Lack of treatment of psychological disorders creates barriers to weight management. • HERO was an integrated CBT for psychological symptom and weight management. • HERO participants improved dietary and sedentary behaviors and HRQOL. • HERO participants had significant reductions in depression and anxiety symptoms. • This trial highlights the benefit of an integrated CBT in this population. [ABSTRACT FROM AUTHOR]

Objective: To determine whether Calmer Life (CL) improved worry, generalized anxiety disorder-related (GAD-related) symptoms, anxiety, depression, sleep, trauma-related symptoms, functional status, and quality of life better than Enhanced Community Care with Resource Counseling (ECC-RC) at 6 months and 9 months.Methods: A randomized, controlled, comparative-effectiveness study involving underserved, low-income, mostly minority neighborhoods in Houston, Texas, looked at individuals ≥50 with significant worry and interest in psychosocial treatment. Interventions were CL, cognitive behavioral therapy with resource counseling, facilitation of communication with primary care providers about worry/anxiety, integration of religion/spirituality, person-centered skill content and delivery and nontraditional community providers, ECC-RC, and enhanced standard community-based information/ resource counseling addressing basic unmet and mental health needs. Primary outcomes were worry and GAD-related symptom severity. Secondary outcomes were anxiety, depression, sleep difficulties, trauma-related symptoms, functional status, quality of life, service use and satisfaction.Results: Similar, moderate improvements followed CL and ECC-RC on worry, GAD-related symptoms, anxiety, depression, sleep, trauma-related symptoms, and mental health quality of life at 6 and 9 months, but with symptoms at both times and higher satisfaction with CL at both. Fewer ECC-RC participants reported a hospital admission in the prior 3 months than those in CL at 6 and 9 months; at 9 months, fewer reported a visit with a provider in the previous 3 months.Conclusion: Both interventions showed similar improvements at 6 and 9 months, but symptoms remained that might require care. Either intervention or a combination may be useful for low-income older adults with identified worry/anxiety. [ABSTRACT FROM AUTHOR]

Despite the efficacy of evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) and efforts to disseminate them, only 6–13% of veterans seeking care through the Veterans Affairs health care system receive these treatments. EBPs such as prolonged exposure (PE) and cognitive processing therapy (CPT) are exposure-based treatments. Provider and patient fears regarding the tolerability of exposure-based treatments likely impede their delivery and completion. The present study utilized qualitative interviews with 23 veterans who completed at least eight sessions of either PE or CPT to elicit firsthand accounts of veterans’ experiences in these EBPs. Results suggest that while a minority of veterans reported initial symptom worsening, the majority of veterans reported positive experiences and felt that, despite being stressful, these EBPs were “worth it.” Most veterans discussed thoughts of discontinuing treatment prematurely, but stated that adherence was encouraged by their commitment to finishing, desperation for relief, therapist/group support, and family support. Veterans believed exposure made an important contribution to symptom improvement, as did greater self-understanding and changing negative or unhelpful beliefs. These findings indicate veteran satisfaction with PE and CPT, and may assist providers to develop strategies to increase adherence and treatment completion. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes).Design: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX.Participants: A total of 203 community-dwelling veterans with pain and dementia and their caregivers.Intervention: PAVeD, 6 to 8 weekly sessions of 45-minute home visits with masters-level clinicians providing instruction to caregivers on recognizing pain, enhancing communication, and making daily activities pleasant and enjoyable, and at least two elective sessions.Measurements: Cohen-Mansfield Agitation Inventory (primary outcome), Philadelphia Geriatric Pain Intensity Scale, Geriatric Depression Scale, Pleasant Events Schedule-AD, Burden Interview, Mutuality Scale (secondary outcomes), Client Satisfaction Questionnaire.Results: There were no significant differences in aggression incidence between intervention and control groups, although the PAVeD group had significantly better mutuality than controls.Conclusions: PAVeD may need to address a broader range and more in-depth coverage of aggression risk factors with person-centered tailoring to target certain types of distress. Interventions to prevent aggression may also need to address medical providers in addition to caregivers. [ABSTRACT FROM AUTHOR]

National Veterans Health Administration (VHA) data suggest that Veterans with obsessive-compulsive disorder (OCD) are often unrecognized and poorly treated. We investigated the experience of VHA mental health providers in treating Veterans with OCD and related disorders and perceptions of available resources. Psychiatrists, psychologists, social workers and nurses were invited through email distribution lists to complete an anonymous 25-question survey through www.surveymonkey.com from 10/20/14 to 12/19/14. Questions pertained to experience and knowledge of treating Veterans with OCD and related disorders, such as body dysmorphic disorder, hoarding disorder, trichotillomania and excoriation disorder. Of 166 completers, 81 (49%) had seen 10 or fewer Veterans with OCD and related disorders at the VHA, and 147 (88%) were seeing 10 or fewer of these patients at survey completion. Only 38 (23%) had received specialized training in treating these patients. Participant-recommended treatments for these conditions did not correspond with evidence-based practice: only 47% recommended exposure and response prevention. Most reported insufficient assessment and treatment resources for Veterans with OCD. Many VHA mental health providers lack sufficient knowledge and expertise in diagnosing and treating OCD and related disorders. Additional resources need to be developed to facilitate improved care for Veterans with OCD and related disorders. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility of the Calmer Life and Enhanced Community Care interventions delivered by community and expert providers and test their preliminary effectiveness on worry, generalized anxiety disorder (GAD) severity, anxiety, depression, sleep, health-related quality of life, and satisfaction.Design: Small randomized trial, with measurements at baseline and 3 months.Setting: Underserved, low-income, mostly minority communities in Houston, TX.Participants: Forty underserved adults 50 years and older, with significant worry and principal or coprincipal GAD or anxiety disorder not otherwise specified.Intervention: Combination of person-centered, flexible skills training to reduce worry; resource counseling to target unmet basic needs; and facilitation of communication with primary care providers developed through a community-academic partnership with social service and faith-based organizations. Religion/spirituality may be incorporated.Measurements: Primary Outcomes: worry (Penn State Worry Questionnaire-Abbreviated), GAD severity (GAD-7), anxiety (Geriatric Anxiety Inventory-Short Form).Secondary Outcomes: depression (Patient Health Questionnaire-8 and Geriatric Depression Scale-Short Form), sleep (Insomnia Severity Index), health-related quality of life (12-item Medical Outcomes Study Short Form), satisfaction (Client Satisfaction Questionnaire and exit interviews).Results: Provider training was valid; mean ratings for community providers were well above average, with none less than adequate. Reach was excellent. Participants receiving the Calmer Life intervention had greater improvement in GAD severity and depression than those receiving Enhanced Community Care. Satisfaction with both treatments was equivalent.Conclusions: A larger comparative-effectiveness trial needs to examine outcomes following the Calmer Life intervention relative to standard community-based care and to evaluate more fully issues of implementation potential. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate alcohol consumption among older patients with generalized anxiety disorder (GAD) in primary care and alcohol's relationship to insomnia, worry and anxiety. Researchers evaluated 223 patients aged 60 and older with generalized anxiety disorder. They found that older adults with GAD used alcohol at an increased rate and that mild to moderate drinkers did not experience sleep problems and concluded that a modest amount of alcohol may minimize anxiety and insomnia.

The authors comment on proposed revisions to the fifth edition of the book "Diagnostic and Statistical Manual of Mental Disorders" (DSM5) regarding anxiety disorders in the elderly. They note challenges in the diagnosis of anxiety in older adults such as declining autonomic nervous system function, social stigmas, and social isolation. Other topics include avoidance and excessiveness as diagnostic criteria, comorbidity of anxiety and depression, and fear of falling.

Objectives: To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care.Design: Pilot randomized controlled trial including assessments at baseline and 3 and 6 months.Setting: Houston, TX.Participants: Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them.Intervention: Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3-6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status.Measurements: Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire.Results: Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy.Conclusions: Results support that Peaceful Mind is ready for future comparative clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: This case report examines the unusual symptom presentation of a middle-aged, Caucasian man referred for treatment of intrusive somatic concerns and behaviors involving mucous sensations. Although the patient's symptoms overlapped phenomenologically and functionally with multiple disorders, including obsessive-compulsive disorder, hypochondriasis, panic disorder and tic disorder, the patient did not meet criteria for any one. This case challenged the DSM-IV nosology and supports the shift to conceptualize obsessive-compulsive disorder and other related disorders as comprising a spectrum or family of disorders. Despite complexities in diagnosis, treatment was tailored to the patient's unique symptom set and employed cognitive behavioral therapy with exposure and response prevention. Across 16 sessions of treatment, the patient's somatic obsessions and intrusive safety and reassurance seeking improved. His total score on the Yale-Brown Obsessive Compulsive Scale – Second edition decreased from 43 at the start of treatment to 17 at the end of treatment, with gains maintained at one-month follow-up. Frequency of emergency-room visits decreased, respectively, from 22 to 0 in the month preceding and following treatment. This case highlights the importance of continued examination of uncommon cases to further advance conceptualization and treatment of obsessive-compulsive related disorders. [Copyright &y& Elsevier]

Objectives: Older adults face a number of barriers to receiving psychotherapy, such as a lack of transportation and access to providers. One way to overcome such barriers is to provide treatment by telephone. The purpose of this study was to examine the effects of cognitive behavioral therapy delivered by telephone (CBT-T) to older adults diagnosed with an anxiety disorder.Design: Randomized controlled trial.Setting: Participants' homes.Participants: Sixty participants age 60 and older with a diagnosis of generalized anxiety disorder, panic disorder, or anxiety disorder not otherwise specified.Intervention: CBT-T versus information-only comparison.Measurements: Coprimary outcomes included worry (Penn State Worry Questionnaire) and general anxiety (State Trait Anxiety Inventory). Secondary outcomes included clinician-rated anxiety (Hamilton Anxiety Rating Scale), anxiety sensitivity (Anxiety Sensitivity Index), depressive symptoms (Beck Depression Inventory), quality of life (SF-36), and sleep (Insomnia Severity Index). Assessments were completed prior to randomization, immediately upon completion of treatment, and 6 months after completing treatment.Results: CBT-T was superior to information-only in reducing general anxiety (ES = 0.71), worry (ES = 0.61), anxiety sensitivity (ES = 0.85), and insomnia (ES = 0.82) at the posttreatment assessment; however, only the reductions in worry were maintained by the 6-month follow-up assessment (ES = 0.80).Conclusions: These results suggest that CBT-T may be efficacious in reducing anxiety and worry in older adults, but additional sessions may be needed to maintain these effects. [ABSTRACT FROM AUTHOR]

Abstract: Generalized anxiety disorder (GAD) is common in older adults and, although cognitive behavioral therapy (CBT) is an efficacious treatment for late-life GAD, effect sizes are only moderate and attrition rates are high. One way to increase treatment acceptability and enhance current cognitive behavioral treatments for GAD in older adults might be to incorporate religion/spirituality (R/S). The cases presented here illustrate the use of a 12-week modular CBT intervention for late-life anxiety, designed to allow incorporation of R/S elements in accordance with patient preferences. The three women treated using this protocol chose different levels and methods of R/S integration into therapy. All three women showed substantial improvement in worry symptoms, as well as a variety of secondary outcomes following treatment; these gains were maintained at 6-month follow-up. These preliminary results suggest that the incorporation of R/S into CBT might be beneficial for older adults with GAD. Strengths, limitations, and future directions are discussed. [Copyright &y& Elsevier]

Objectives: To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults. Design: Substudy of larger randomized controlled trial. Setting: Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006. Participants: Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse. Intervention: CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed). Measurements: Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment. Results: Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment. Conclusion: Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD. [ABSTRACT FROM AUTHOR]

Abstract: Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention. [Copyright &y& Elsevier]

Objectives: The purposes of this study are to determine the frequency and severity of insomnia symptoms and related complaints experienced by older adults with Generalized Anxiety Disorder (GAD) and compare them with older adults without GAD; compare insomnia symptoms among older adults with GAD with and without comorbid depression; determine if there are age differences in insomnia severity among people with GAD; and determine if there are differences in insomnia severity between older adults with GAD and older adults diagnosed with insomnia.Design: Cross-sectional.Setting: Participants were recruited through primary care clinics, advertisements, and mass mailings.Participants: One hundred ten older adults; 31 with GAD, 25 with GAD and depression, 33 worried well, and 21 with no psychiatric diagnosis.Measurements: Psychiatric diagnosis, sleep disturbance, and health.Results: Participants with GAD with and without comorbid depression reported significantly greater sleep disturbance severity than participants with no psychiatric diagnosis and the worried well. There were no differences in sleep disturbances between older adults with GAD only and older adults with comorbid GAD and depression. The severity of sleep disturbance reported by older participants with GAD was greater than reports by young and middle-aged participants with GAD, and comparable with reports by older adults with a diagnosis of insomnia.Conclusions: Ninety percent of older adults with GAD report dissatisfaction with sleep and the majority report moderate to severe insomnia. These findings support the assessment of sleep disturbances within the context of late-life GAD. [ABSTRACT FROM AUTHOR]

Objective: To develop and test a modular psychotherapy protocol in older primary care patients with anxiety disorders. Design: Randomized, controlled pilot study. Setting: University-based geriatric medicine clinics. Participants: Thirty-one elderly primary care patients with generalized anxiety disorder or anxiety disorder not otherwise specified. Intervention: Modular form of psychotherapy compared with enhanced community treatment. Measurements: Self-reported, interviewer-rated, and qualitative assessments of anxiety, worry, depression, and mental health-related quality of life. Results: Both groups showed substantial improvements in anxiety symptoms, worry, depressive symptoms, and mental health-related quality of life. Most individuals in the enhanced community treatment condition reported receiving medications or some other form of professional treatment for anxiety. Across both conditions, individuals who reported major life events or stressors and those who used involvement in activities as a coping strategy made smaller gains than those who did not. Conclusions: Results suggest that modular psychotherapy and other treatments can be effective for anxiety in older primary care patients. Results further suggest that life events and coping through increased activity may play a role in the maintenance of anxiety in older adults. [ABSTRACT FROM AUTHOR]

Objective: Recent research by Wetherell et al. investigating the differential response to group-administered cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults found that GAD severity, homework adherence, and psychiatric comorbidity predicted statistically significant improvement. The current study investigated whether the presence/absence of cognitive errors on separate domains of the Mini-Mental State Exam (MMSE) predicted baseline differences in symptom severity and improvement following CBT above and beyond already established predictors. Methods: Baseline characteristics were investigated in a sample of 208 older patients diagnosed with GAD. Predictors of treatment response were examined in a subsample of 65 patients who completed CBT and were included in a prior study by Wetherell et al. of response predictors. Results: Results from the baseline sample indicated that only subjects who committed an error on the MMSE Working Memory domain exhibited increased severity in anxiety and depressive symptoms. Results from the treatment sample indicated that an error on the MMSE Orientation domain was a significant predictor of outcome at 6-month follow-up, while controlling for previously established predictors. Patients who committed at least one error in this domain showed decreased response relative to patients who committed no errors. Conclusion: In this sample of older adults diagnosed with GAD, poor performance on the MMSE Working Memory domain was associated with increased baseline anxiety and depression, while baseline performance differences on the MMSE Orientation domain predicted outcome six months after CBT intervention. [ABSTRACT FROM AUTHOR]

Abstract: Despite the widespread nature and significant impact of trichotillomania (TTM), relatively few controlled studies have evaluated treatment options for people with this disorder. Pharmacological treatment and behavior therapy are the two most widely accepted approaches to treating TTM, but few mental health professionals with appropriate expertise are available to provide care. The cost of treatment also is prohibitive in some cases. A number of self-help books are available for people with TTM, but no empirical data have documented associated outcomes. This paper describes the development and two phases of program evaluation for an alternative, Internet-based self-help treatment strategy for repetitive hair pulling. StopPulling.com is an on-line, interactive self-help approach derived from evidence-based cognitive behavioral models of treatment for TTM. Following program development, an initial test phase elicited feedback from individuals with repetitive hair pulling and professionals with expertise in the treatment of TTM or Web site development. StopPulling.com was modified in accordance with feedback from this initial test phase, and a revised version was made available to the public in January 2003. Preliminary data from 265 users of the program during the first year of public availability suggested significant improvement in symptoms, with some evidence that duration of program use accounted for reductions in symptom severity. Response rates were comparable to long-term follow-up after more intense cognitive behavioral treatment. StopPulling.com may provide a potentially useful self-help alternative or adjunctive strategy for repetitive hair pulling. [Copyright &y& Elsevier]

Anxiety and depression coexist frequently in chronic obstructive pulmonary disease and compound the impact of the disease on quality of life and functional status. However, little attention has been given to the development of treatment strategies for this subset of patients. The current article describes the development of a new, multicomponent cognitive behavioral treatment for reducing anxiety and depression among patients with respiratory disease (CBT-RADAR). Outcome data from a group of 5 patients who participated in an ongoing clinical trial are reviewed to illustrate the strengths and limitations of this intervention. [Copyright &y& Elsevier]

Deals with a study which addressed the psychometric properties of self-report measures of anxiety in a sample of older adults with generalized anxiety disorder. Method; Results; Discussion.

Compares the efficacy of cognitive behavior therapy (CBT) and nondirective supportive psychotherapy (SP) for forty-eight adults, ages fifty-five and up, with well-diagnosed General Anxiety Disorder (GAD). Assessments of effect of treatment; Measures used to assess treatment credibility and expectations for improvements.

Presents an overview of available literature concerning the psychopathology, assessment and behavioral treatment of the anxiety disorders in later life. Definition of anxiety in the elderly; Epidemiology; Diagnosis; CBT of anxiety disorders in the elderly.

Studies the prevalence and psychopathology of nonclinical panic disorder and suicidality. Relationship between nonclinical panic and suicide; Insignificance of the risk of suicidal behaviors in nonclinical panickers; Frequency and length of panic attacks in subjects.

Identifies psychometric properties of four measures for anxiety disorders in older adults. Internal consistency of all measures; Alternative psychometric assessment strategy; Discussion of generalized anxiety disorder.

Background: We have recently demonstrated an increase in apoptosis in Han:SPRD rat kidneys with autosomal-dominant polycystic kidney disease (ADPKD). Caspase-3 and caspase-7 are major mediators of apoptosis. There are two pathways of caspase-3 and caspase-7-mediated apoptosis: (1) the "extrinsic" pathway involving the death receptor Fas, Fas ligand (FasL), and caspase-8 and (2) the "mitochondrial" or "intrinsic" pathway involving Bcl-2 proteins, caspase-2, cytochrome c release, and caspase-9. The aim of the present study was to investigate the pathways of apoptosis in 3-week-old Han:SPRD rats with ADPKD.Methods: Fluorescent substrates were used to measure caspase activity. mRNA and protein was determined by ribonuclease protection assays and immunoblotting, respectively. The effect of caspase inhibitors on caspase activity in polycystic kidneys was determined.Results: Caspase-3 and caspase-7 activity was more than 100% increased in homozygous (Cy/Cy) compared to heterozygous (Cy/+) and normal littermate control (+/+) kidneys. Ribonuclease protection assays demonstrated no difference in caspase-3 mRNA. On immunoblotting, there was an increase in the proform of caspase-3 and caspase-7 in Cy/Cy compared to +/+ and Cy/+ kidneys. Caspase-8 and caspase-9 activity was more than 100% increased in Cy/Cy compared to Cy/+ and +/+ kidneys. On immunoblotting, there was an increase of the proform of both caspase-8 and caspase-9 in Cy/Cy kidneys. There was also an increase in cytochrome c release into the cytosol and an increase in caspase-2 protein and activity in Cy/Cy kidneys. On ribonuclease protection assay there was no difference in FasL mRNA between +/+, Cy/+, and Cy/Cy kidneys. Short-term treatment of Cy/Cy rats with the caspase inhibitor IDN-8050 resulted in inhibition of caspase-3 and caspase-7 activity in the kidney.Conclusion: In Cy/Cy kidneys with ADPKD, there was an increase of the proform of caspase-9, an increase in cytochrome c release into the cytosol, and an increase in caspase-2 protein and activity demonstrating involvement of the intrinsic pathway. There was an increase in the proform of caspase-8 demonstrating involvement of the extrinsic pathway. No differences in FasL mRNA were seen suggesting that the extrinsic pathway is independent of the death receptor ligand, FasL. [ABSTRACT FROM AUTHOR]

The relationship between measures of shame, guilt, and psychopathology was examined in a heterogeneous inpatient sample (n=82) using the Test of Self-Conscious Affect (TOSCA) and the Personal Feelings Questionnaire-2 (PFQ-2). It was predicted that both shame scales would correlate positively with measures of psychopathology. This hypothesis was supported in bivariate analyses, however, when partialed for each respective guilt scale, only the TOSCA maintained significant associations with measures of psychopathology. It was predicted that only the PFQ-2 guilt scale would correlate positively with measures of psychopathology, and this hypothesis was supported in both bivariate analyses and partial correlations, controlling for shame scores. These findings support previous work, suggesting that the TOSCA and PFQ-2 guilt scales assess different constructs of guilt. Methodological issues of shame and guilt assessment with psychiatric patients also are discussed. [Copyright &y& Elsevier]

Background. Apoptosis is a characteristic feature of human autosomal-dominant polycystic kidney disease (ADPKD). The Han:Sprague-Dawley (SPRD) rat model closely resembles human ADPKD and presents an opportunity to investigate the apoptotic pathway in the pathogenesis of this disease. Methods. Han:SPRD rats were studied during the early stages of ADPKD (newborn, 2 and 6 weeks old). Apoptotic cells were detected by the TUNEL (Tdt-mediated dUTP nick end-labeling) assay. Caspase-3 activity was measured using the fluorescent substrate DEVD-AMC and cleavage of poly (ADP-ribose) polymerase [PARP]. Expression of pro- and anti-apoptotic B-cell lymphoma (Bcl-2) proteins was detected on Western blot analysis. Results. TUNEL (+) cells, caspase-3 activity and caspase-mediated PARP breakdown were significantly increased in 2-week-old heterozygous (Cy/+) and homozygous (Cy/Cy) rat kidneys compared to normal littermate controls. In Cy/+ rat kidneys, decreased expression of anti-apoptotic Bcl-X[sub L] coincided with increased caspase-3 activity at 2 weeks of age while expression of Bcl-2, another anti-apoptotic protein, increased at 6 weeks of age. In Cy/Cy rat kidneys, decreased expression of Bcl-X[sub L] and increased expression of Bcl-2 was present at 2 weeks of age. Pro-apoptotic Bax and Bad expression was unchanged at 2 weeks of age in both Cy/+ and Cy/Cy rat kidneys. Conclusions. Activation of caspase-3 and dysregulation of the balance between pro- and anti-apoptotic Bcl-2 family members, specifically a down-regulation of anti-apoptotic Bcl-X[sub L], correlates with increased apoptosis in polycystic Han:SPRD rat kidneys. [ABSTRACT FROM AUTHOR]

Objective This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans. Method Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and health-related quality of life (QOL). Results Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (≥ 1 MH encounter or psychiatric medications). Greater depression (p = 0.047) and adaptive coping (p = 0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p < 0.001), higher internal locus of control (p = 0.037), and poorer physical health-related QOL (p = 0.014) were associated with greater likelihood of MH service use. Discussion Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL. [ABSTRACT FROM AUTHOR]

Violence can lead to posttraumatic stress disorder (PTSD), which in turn is related to perpetration of aggression. Importantly, not all aggression is motivated by the same mechanisms, and understanding the driving force behind the aggression is imperative in order to select treatments that will assist the individual in decreasing the behavior. PTSD is specifically related to impulsive aggression, or aggression that is emotionally charged and uncontrolled, rather than premeditated aggression, which is planned, unemotional, and goal-directed. Emotion regulation, or the ability to recognize emotions, accept them, and control emotion-related behaviors, is related to both PTSD and impulsive aggression. This conceptual paper uses the Catalyst Model to review the literature on PTSD, impulsive aggression, and emotion regulation. Because of their high rates of PTSD, veterans are presented as a demonstration of the relationship between emotion regulation and impulsive aggression. The integrative model can be viewed as an alternative to the traditional model that proposes anger is the primary underlying mechanism of impulsive aggression in adults. Treatment recommendations, such as helping clients develop emotion regulation skills, are offered for providers who are working with individuals who have experienced trauma and who are now perpetrating impulsive aggression. [ABSTRACT FROM AUTHOR]

This pilot study examines the feasibility, acceptability, and potential effectiveness of delivering an intensive weekend group treatment for panic disorder (PD) to Veterans returning from deployments to Iraq and Afghanistan with co-occurring posttraumatic stress disorder (PTSD). The treatment program lasted 6 h each day and was delivered by two experienced therapists. Patients received core components of panic treatment, including psychoeducation, cognitive restructuring, and interoceptive exposure. The interoceptive exposure exercises directly targeted anxiety sensitivity, a psychological construct also implicated in the maintenance of PTSD. Eighty-nine percent of patients who expressed interest in the treatment attended a baseline evaluation, and 63% of those who were study eligible initiated treatment. Treatment retention was high, with all 10 patients who initiated treatment completing the program. Veterans reported finding the treatment and delivery format highly acceptable and reported high levels of satisfaction. Panic symptoms improved significantly following the treatment and were maintained at a 7-month follow-up, with 71.4% of the sample reporting being panic free. Co-occurring PTSD symptoms also improved along with symptoms of anxiety and depression. Preliminary findings suggest that brief and intensive group treatments for PD/PTSD are a promising method of delivering cognitive behavioral therapy that may rapidly improve symptoms. This innovative treatment delivery format also may be a cost-effective way of increasing treatment engagement through increased access to quality care. [ABSTRACT FROM AUTHOR]

Cognitive–behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran ( n = 101) and community-based ( n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. Method: This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. Results: Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). Conclusion: Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings. [Copyright &y& Elsevier]

Abstract: We compared the psychometric performance of two validated self-report anxiety symptom measures when rated by people with dementia versus collaterals (as proxies). Forty-one participants with mild-to-moderate dementia and their respective collaterals completed the Geriatric Anxiety Inventory, the Penn State Worry Questionnaire-Abbreviated, and a structured diagnostic interview. We used descriptive and nonparametric statistics to compare scores according to respondent characteristics. Receiver operating characteristic (ROC) curves were calculated to establish the predictive validity of each instrument by rater type against a clinical diagnosis of an anxiety disorder. Participant and collateral ratings performed comparably for both instruments. However, collaterals tended to give more severe symptom ratings, and the best-performing cut-off scores were higher for collaterals. Our findings suggest that people with mild-to-moderate dementia can give reliable self-reports of anxiety symptoms, with validity comparable to reports obtained from collaterals. Scores obtained from multiple informants should be interpreted in context. [Copyright &y& Elsevier]

Abstract: The Pittsburgh Sleep Quality Index (PSQI) is a widely used, comprehensive self-report measure of sleep quality and impairment, which has demonstrated good psychometric properties within various populations, including older adults. However, the psychometric properties of the PSQI and its component scores have not been evaluated for older adults with generalized anxiety disorder (GAD). Additionally, changes in PSQI global or component scores have not been reported following cognitive-behavioral treatment (CBT) of late-life GAD. This study examined (1) the psychometric properties of the PSQI within a sample of 216 elderly primary care patients age 60 or older with GAD who were referred for treatment of worry and/or anxiety; as well as (2) response to CBT, relative to usual care, for 134 patients with principal or coprincipal GAD. The PSQI demonstrated good internal consistency reliability and adequate evidence of construct validity. Those receiving CBT experienced greater reductions in PSQI global scores at post-treatment, relative to those receiving usual care. Further, PSQI global and component scores pertaining to sleep quality and difficulties falling asleep (i.e., sleep latency and sleep disturbances) demonstrated response to treatment over a 12-month follow-up period. Overall, results highlight the usefulness of the PSQI global and component scores for use in older adults with GAD. [Copyright &y& Elsevier]

Abstract: Previous research has demonstrated that comorbid obsessive–compulsive personality disorder (OCPD) in patients with obsessive–compulsive disorder (OCD) is associated with greater overall OCD severity, functional impairment, and poorer treatment outcomes (). However, research has only examined the effects of OCPD categorically and has yet to thoroughly examine the impact of individual OCPD characteristics dimensionally. Thus, the present study sought to investigate the relationships between various OCPD-related dimensions (e.g., perfectionism, rigidity) and OCD symptomology and severity. The study recruited a sample of OCD patients (n =51) in the OCD units of two residential treatment facilities. Findings yielded significant relationships between OCD severity and the following OCPD dimensions: flexibility, doubts about actions (a dimension of perfectionism), and hoarding. Interpretations of these results and the implications for diagnosis, prognosis, and treatment outcome are discussed. Furthermore, the current study provides insight into a unique perspective which leaves room for more symptom overlap and variability between OCD and OCPD. [Copyright &y& Elsevier]

Abstract: Dysfunctional beliefs in obsessive–compulsive disorder (OCD) and worry are thought to contribute to vulnerability and maintenance of pathological anxiety. In this study, five belief domains concerning responsibility/threat estimation, perfectionism, intolerance of uncertainty, importance/control of thoughts and thought–action fusion were examined to see whether they differentially predicted worry and obsession severity in patients with severe OCD. Correlational analysis revealed that perfectionism and intolerance of uncertainty were associated with worry, whereas beliefs in the importance and control of thoughts and thought–action fusion were associated with obsession severity when obsession severity and worry, respectively, were controlled. In regression analyses, thought–action fusion and intolerance of uncertainty predicted OCD severity. The relation between dysfunctional beliefs and specific subtypes of OCD symptoms was also examined. Specific relationships were identified, including perfectionism with ordering, obsessions with control/importance of thoughts and checking and washing with threat estimation. [Copyright &y& Elsevier]

Abstract: Despite the prevalence and impact of Generalized Anxiety Disorder (GAD) in the primary care setting, little is known about its presentation in this setting. The purpose of this study is to examine age and racial differences in the presentation and treatment of GAD in medical patients. Participants were recruited from one family medicine clinic and one internal medicine clinic. The prevalence of GAD was lowest for older adults. Age differences were found in the presentation of GAD, with young adults reporting greater cognitive symptoms of anxiety, negative affect, and depressive symptoms. African-Americans with GAD reported more positive affect and lower rates of treatment. The lower levels of negative affect and depressive symptoms reported among older adults may affect the recognition of GAD by primary care physicians. Further research is needed to better understand the causes of racial differences in treatment. [Copyright &y& Elsevier]

Abstract: Until recently, little attention has been paid to anxiety symptoms in dementia. However, anxiety is common in this population, and associated with poor outcome and quality of life. The current review examines the existing literature around three major themes: the definition of anxiety in dementia, the properties of available instruments for assessment, and the clinical characteristics of anxiety in this population. Defining anxiety in individuals with dementia is complicated by the overlap between symptoms of anxiety, depression and dementia, and by the influence of the source of information. Several instruments are available to assess anxiety in this population, including general neuropsychiatric instruments and two scales designed specifically for this purpose. The reliability of these instruments is acceptable, but their validity has not been sufficiently examined, and they may discriminate poorly between anxiety and depression. Anxiety may be higher in vascular dementia than in Alzheimer''s Disease, and it decreases in the severe stages of dementia. It is associated with poor quality of life and behavioral disturbances, even after controlling for depression. Little is known, however, about its social and environmental correlates. Limitations of the existing literature and key directions for future research are discussed. [Copyright &y& Elsevier]

The authors pooled data from three independently conducted treatment outcome studies to examine predictors of outcome from group-administered cognitive-behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD). Data were collected from 65 patients with a mean age of 67.7 years (SD = 6.6). Average reliable change indices (RCI) based on 3 outcome measures were calculated at posttreatment and at 6-month follow-up. Approximately half of patients achieved a significant RCI at post-treatment and two-thirds achieved a significant RCI at follow-up. Factors associated with better outcomes included better homework adherence, higher baseline GAD severity, and presence of a comorbid psychiatric diagnosis. Results suggest that at-home practice is associated with better and longer-lasting outcomes from CBT in older adults with GAD. [ABSTRACT FROM AUTHOR]

Subsyndromal emotional symptoms are common in older adults and are associated with increased disability, health care utilization, and risk for developing psychiatric disorders. The purpose of this study was to examine subsyndromal generalized anxiety disorder (GAD) in older adults. Participants included 30 older adults with diagnosable GAD, 19 with subsyndromal anxiety symptoms [minor GAD; (MGAD)], and 21 normal control volunteers (NC). Participants were assessed using the Anxiety Disorders Interview Schedule for DSM-IV and completed self-report measures of anxiety, worry, depression, and life satisfaction. Excessive worry on more days than not, difficulty controlling worry, and clinically significant distress or impairment were the diagnostic criteria endorsed by MGAD participants least often. Therefore, these criteria may be useful in distinguishing between GAD and subsyndromal GAD. Self-reported anxiety and worry also systematically differed across groups in the expected directions, with a discriminant analysis yielding good classification of the GAD and NC groups based on these measures. Categorization of MGAD participants generally was poor, with most misclassified as GAD patients. Clinical implications of these findings are discussed. [Copyright &y& Elsevier]