Telephone-based, cognitive-behavioral therapy for African American dementia caregivers with depression: initial findings.

OBJECTIVES: Discuss initial findings of a randomized clinical trial comparing the effects of telephone-based and face-to-face (f-to-f) cognitive-behavioral therapy (CBT) on changes in caregiver (CG) burden, assistance support, depression, and health status for African American (AA) CGs with depression. DESIGN: Pilot study using a prepost, two-group design with 14 enrolled and randomized participants. MEASURES: Subjective Burden subscale of the Caregiver Appraisal Inventory, Assistance Support subscale of the Interpersonal Support Evaluation List, Physical Symptoms subscale of the Caregiver Health and Health Behavior Inventory and the Center for Epidemiologic Studies Depression Scale. RESULTS: Prepost improvements were found on 11 completers across all measures for both telephone and f-to-f CBT. Moderate and similar effects sizes for CG subjective burden and assistance support were found for both the telephone and f-to-f groups. Effect sizes for physical symptoms and depression varied from low to moderate, respectively, with a trend toward smaller improvements in f-to-f CBT than in telephone CBT. Qualitative analysis highlighted CGs' perceptions of the active ingredients of treatment and provided indirect support for similar gains in emotional and psychosocial functioning across the two treatment modalities. CONCLUSIONS: Both telephone-based and f-to-f CBT showed improvements in depression, subjective burden, and assistance support in dementia AA CGs. Replication with a larger sample size (N = 106) is currently in progress. Study limitations and future directions for research are also addressed.

How well do we communicate autopsy findings to next of kin?

CONTEXT: A failure of communication among families, physicians, and pathologists is recognized as a major cause of declining autopsy rates and may be involved in increased litigation. OBJECTIVE: To determine how effectively autopsy results are communicated to the next of kin and how satisfied families are with the process from consent to relaying of the results. DESIGN: A retrospective telephone survey of next of kin of 106 consecutive patients autopsied at a major teaching hospital. The family was asked questions on the process of obtaining consent and the information they received back from health care providers. RESULTS: Thirty-two percent of relatives indicated that they were not adequately informed as to the purpose of the autopsy. Eighty percent of respondents were notified of or obtained the results. The ways in which the autopsy findings were communicated varied, but 54% were involved in a discussion of the results with a medical professional. More than half of the families wished to have a copy of the results. Two-thirds felt they were satisfied with the explanation of the results, but an important cause of dissatisfaction was the use of unfamiliar medical terminology. When the family's understanding of the cause of death was compared with the diagnoses on the autopsy reports, 65% of families demonstrated an accurate knowledge of the autopsy findings, 28% had a general understanding, and for only 8% was their knowledge judged inaccurate. Overall, 92% of notified respondents felt the autopsy had served a useful purpose, mostly for personal reasons. CONCLUSIONS: We conclude that the autopsy fulfills an important need for many families; however, the purpose of the autopsy and the findings need to be more effectively communicated.

Psychogenic coma: case report.

Coma is present when the patient appears asleep, is unrousable, and unresponsive. Where no underlying medical condition is found, the role of the psychiatrist may become prominent. We present a clinical case and review the literature on psychogenic coma. According to DSM-IV-TR, psychogenic coma is a dissociative disorder not otherwise specified. Management is largely supportive. Principles include speaking in a reassuring manner and avoiding repeated painful stimuli. Education of family and other professionals that symptoms are real and not consciously feigned may be important. There may be a short-term role for anxiolytic and/or antipsychotic medication to assist return to consciousness.