Search

Examined the discriminant validity of the MMPI-2 in assessing comorbidity in a posttraumatic stress disorder (PTSD) Vietnam veteran population. The Structured Clinical Interview for the DSM-III-R (SCID) was used to diagnose veterans and to classify them into four groups: PTSD Only, PTSD with mood disorders, PTSD with other anxiety disorders, and PTSD with mood and anxiety disorders. All groups had clinical elevations on scales F, 1, 2, 3, 4, 6, 7, 8, 0, PK, and PS, with peak elevations on scales 8, 7, and 2. The PTSD Only group's MMPI-2 scores were not significantly lower than other groups' scores. The PTSD+Mood/Anxiety group was significantly more elevated on scales 2 and 7 than the PTSD Only and PTSD+Anxiety group but did not otherwise show significantly higher scale elevations than other groups. No significant differences existed between groups on scales F, L, K, PK, and PS. Implications of these results for PTSD and the current diagnostic system are explored. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a common neurodegenerative disease affecting up to 1 million individuals in the United States. Sleep disturbances, typically in sleep maintenance, are found in up to 88% of these individuals and are associated with a variety of poor outcomes. Despite being common and important, there are few data to guide clinical care. We conducted a 6-week, randomized, controlled trial of eszopiclone and placebo in 30 patients with PD and insomnia. Patients with other primary sleep disorders (PSG defined) were excluded. The primary outcome was total sleep time (TST), and secondary measures included wake after sleep onset (WASO), number of awakenings, and quality of sleep, among others. The groups did not significantly differ on TST, but significant differences, favoring eszopiclone, did emerge in number of awakenings ( P = 0.035), quality of sleep ( P = 0.018), and in physician-rated CGI improvement ( P = 0.035). There was also a trend toward significance in WASO ( P = 0.071). There were no significant differences between groups in measures of daytime functioning. The drug was well tolerated, with 33% of patients on eszopiclone and 27% of patients on placebo reporting adverse events. Although modest in size, this is the first controlled study of the treatment of insomnia in patients with PD. Eszopiclone did not increase TST significantly but was superior to placebo in improving quality of sleep and some measures of sleep maintenance, which is the most common sleep difficulty experienced by patients with PD. Definitive trials of the treatment of sleep disorders in this population are warranted. © 2010 Movement Disorder Society [ABSTRACT FROM AUTHOR]

The Kidney Transplant Program (KTP) at the Toronto General Hospital has taken great strides in preparing to meet the needs of patients and health care providers, as the number of end-stage renal disease patients in Ontario increases. The KTP has begun the process of increasing engagement and collaboration with various stakeholders from the pre- to the post-transplant phase through (1) the development of innovative programs to increase the number of live kidney donations, (2) the development and maintenance of information technology solutions that work simultaneously to provide data to manage and treat patients, and conduct research, and (3) the development, implementation, and delivery of educational presentations and tools to various stakeholders both at the referring centres and the transplant program. Future steps for the KTP include evaluating the impact of these programmatic tools and activities on the number of referrals received and the subsequent effect on the number of transplants performed.

Objective: This study describes a single-site investigation on the effects of a randomized double-blind placebo trial targeting duloxetine added to opioid use (duloxetine + opioid) against a comparator (placebo + opioid) in spine surgery patients, independent of major depression., Design: The double-blind comparator study assessed two groups on opioids: one using duloxetine and the other a placebo. Subjects were administered the respective medication 2 weeks prior to surgery and continued on this for more than 3 months. Subjects were assessed at three times: prior to surgery, 4 weeks postsurgery, and 12 weeks postsurgery. They completed a battery of tests assessing for pain, adjustment, and psychiatric problems., Setting: Neurosurgical outpatient and inpatient setting., Patients: Sixty-eight patients completed the study. They received one of three types of elective spine surgery., Interventions: Subjects were given duloxetine or placebo 2 weeks prior to surgery and continued with the regimen for more than 3 months., Outcomes: The primary focus was pain and second on adjustment factors and psychiatric symptoms: depression and anxiety. The amount of opioid use presurgery and postsurgery was also evaluated., Results: There were differences among the groups on Brief Pain Inventory (BPI)-Average, the core pain marker, and BPI-Sleep. Within-subject analyses showed that duloxetine subjects improved significantly from baseline. For function, post-CIBIC and post-Functional Adjustment Questionnaire were significant, favoring duloxetine. Reduction of opioid use was not a factor; both groups' utilization declined. For affect, both groups were significantly improved over time., Conclusions: Duloxetine seems to improve pain, assist with maintaining function, and reduce intensity of affect.

This study set out to clarify the association of apathy and depression in dementia as well as apathy's association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.

The profession of psychology is responding to this culture's rapidly changing problems related to an aging population. A central theme regarding the training of clinical geropsychologists has been that education should be sequentially organized across levels, from undergraduate, to graduate, internship, postdoctoral, and continuing education for current practitioners. This paper addresses issues related to geropsychology training at the internship level. We address the need for such training and consider a generic model that outlines competency areas and activities that should be included in an internship program's geropsychology training component. We discuss further one model for implementing a multi-site, multi-level geropsychology training program, and consider issues the of recruiting, identifying training sites, and coordinating with other disciplines. We then consider future goals and plans.

This study evaluated a new test for dementia, the Cognitive Testing Battery, used for over six years in outpatient clinics for aging-related disorders. This battery was developed to be brief, easy to administer, and to provide useful feedback as a cognitive profile for clinicians, patients, and caregivers. 489 participants were tested during a 5-yr. period. Multidisicplinary teams diagnosed these patients with dementia, depression, or Huntington's Disease. A control group was also included. Groups were then compared on the 10 key subscales that subserve dementia populations. Analysis showed there were significant differences among the groups on all measures and that selected scales differentiated the groups. The total score maximally differentiated the groups, and the dementia group was most different from the other groups.

The controlled treatment outcome studies that examined the efficacy of EMDR in the treatment of posttraumatic stress disorder have yielded a range of results, with the efficacy of EMDR varying across studies. The current study sought to determine if differences in outcome were related to methodological differences. The research was reviewed to identify methodological strengths, weaknesses, and empirical findings. The relationships between effect size and methodology ratings were examined, using the Gold Standard (GS) Scale (adapted from Foa & Meadows, 1997). Results indicated a significant relationship between scores on the GS Scale and effect size, with more rigorous studies according to the GS Scale reporting larger effect sizes. There was also a significant correlation between effect size and treatment fidelity. Additional methodological components not detected by the GS Scale were identified, and suggestions were made for a Revised GS Scale. We conclude by noting that methodological rigor removes noise and thereby decreases error measurement, allowing for the more accurate detection of true treatment effects in EMDR studies., (Copyright 2002 John Wiley & Sons, Inc.)