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1.
Mol Psychiatry ; 26(9): 5171-5179, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32382137

RESUMO

Drugs that target glutamate neuronal transmission, such as memantine, offer a novel approach to the treatment of late-life depression, which is frequently comorbid with cognitive impairment. The results of our recently published double-blind, randomized, placebo-controlled trial of escitalopram or escitalopram/memantine in late-life depression with subjective memory complaints (NCT01902004) indicated no differences between treatments in depression remission, but additional benefits in cognition at 12-month follow-up with combination treatment. To identify pathways and biological functions uniquely induced by combination treatment that may explain cognitive improvements, we generated transcriptional profiles of remission compared with non-remission from whole blood samples. Remitters to escitalopram compared with escitalopram/memantine combination treatment display unique patterns of gene expression at baseline and 6 months after treatment initiation. Functional enrichment analysis demonstrates that escitalopram-based remission associates to functions related to cellular proliferation, apoptosis, and inflammatory response. Escitalopram/memantine-based remission, however, is characterized by processes related to cellular clearance, metabolism, and cytoskeletal dynamics. Both treatments modulate inflammatory responses, albeit via different effector pathways. Additional research is needed to understand the implications of these results in explaining the observed superior effects of combination treatment on cognition observed with prolonged treatment.


Assuntos
Transtorno Depressivo Maior , Memantina , Citalopram , Depressão , Método Duplo-Cego , Escitalopram , Humanos , Transcriptoma , Resultado do Tratamento
2.
J Geriatr Psychiatry Neurol ; 34(2): 162-168, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32208884

RESUMO

OBJECTIVE: Cognitive impairment is frequently comorbid with late-life depression (LLD) and often persists despite remission of mood symptoms with antidepressant treatment. Increasing understanding of factors that predict improvement of cognitive symptoms in LLD is useful to inform treatment recommendations. METHODS: We used data from 2 randomized clinical trials of geriatric depression to examine the relationships between sociodemographic factors (resilience, quality of life) and clinical factors (age of depression onset, severity of depression, apathy) with subsequent cognitive outcomes. One hundred sixty-five older adults with major depression who had completed one of 2 clinical trials were included: (1) methylphenidate plus placebo, citalopram plus placebo, and citalopram plus methylphenidate or (2) citalopram combined with Tai Chi or health education. A comprehensive neuropsychiatric battery was administered; 2 measures of cognitive improvement were examined, one defined as an increase in general cognitive performance score of at least 1 standard deviation and the other 0.5 standard deviation pre-post treatment. RESULTS: At posttreatment, 59% of participants had remitted, but less than a third of those who remitted showed cognitive improvement (29%). Cognitive improvement was observed in 18% of nonremitters. Lower baseline depression severity, greater social functioning, and depression onset prior to 60 years of age were significantly associated with cognitive improvement. None of the other measures, including baseline apathy, resilience, and depression remission status, were significantly associated with cognitive improvement. CONCLUSIONS: Lower severity of depression, earlier onset, and greater social functioning may predict improvement in cognitive functioning with treatment for depression in LLD.


Assuntos
Depressão , Transtorno Depressivo Maior , Idoso , Citalopram/uso terapêutico , Cognição , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Humanos , Qualidade de Vida
3.
Int Psychogeriatr ; 33(2): 149-156, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-31969201

RESUMO

OBJECTIVES: Geriatric depression often presents with memory and cognitive complaints that are associated with increased risk for Alzheimer's disease (AD). In a parent clinical trial of escitalopram combined with memantine or placebo for geriatric depression and subjective memory complaints, we found that memantine improved executive function and delayed recall performance at 12 months (NCT01902004). In this report, we used positron emission tomography (PET) to assess the relationship between in-vivo amyloid and tau brain biomarkers and clinical and cognitive treatment response. DESIGN: In a randomized double-blind placebo-controlled trial, we measured 2-(1-{6-[(2-[F18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene) malononitrile ([18F]FDDNP) binding at baseline and assessed mood and cognitive performance at baseline, posttreatment (6 months), and naturalistic follow-up (12 months). PARTICIPANTS: Twenty-two older adults with major depressive disorder and subjective memory complaints completed PET scans and were included in this report. RESULTS: Across both treatment groups, higher frontal lobe [18F]FDDNP binding at baseline was associated with improvement in executive function at 6 months (corrected p = .045). This effect was no longer significant at 12 months (corrected p = .12). There was no association of regional [18F]FDDNP binding with change in mood symptoms (corrected p = .2). CONCLUSIONS: [18F]FDDNP binding may predict cognitive response to antidepressant treatment. Larger trials are required to further test the value of [18F]FDDNP binding as a biomarker for cognitive improvement with antidepressant treatment in geriatric depression.


Assuntos
Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/psicologia , Função Executiva , Memória , Tomografia por Emissão de Pósitrons , Idoso , Doença de Alzheimer/complicações , Peptídeos beta-Amiloides/metabolismo , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Masculino , Projetos Piloto , Proteínas tau/metabolismo
4.
Am J Geriatr Psychiatry ; 28(2): 178-190, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31519517

RESUMO

OBJECTIVE: Geriatric depression is difficult to treat and frequently accompanied by cognitive complaints that increase risk for dementia. New treatment strategies targeting both depression and cognition are urgently needed. METHODS: We conducted a 6-month double-blind placebo-controlled trial to assess the efficacy and tolerability of escitalopram + memantine (ESC/MEM) compared to escitalopram + placebo (ESC/PBO) for improving mood and cognitive functioning in depressed older adults with subjective memory complaints (NCT01902004). Primary outcome was change in depression as assessed by the HAM-D post-treatment (at 6 months). Remission was defined as HAM-D ≤6; naturalistic follow-up continued until 12 months. RESULTS: Of the 95 randomized participants, 62 completed the 6-month assessment. Dropout and tolerability did not differ between groups. Mean daily escitalopram dose was 11.1 mg (SD = 3.7; range: 5-20 mg). Mean daily memantine dose was 19.3 mg (SD = 2.6; range 10-20 mg). Remission rate within ESC/MEM was 45.8% and 47.9%, compared to 38.3% and 31.9% in ESC/PBO, at 3 and 6 months, respectively (χ2(1) = 2.0, p = 0.15). Both groups improved significantly on the HAM-D at 3, 6, and 12 months, with no observed between-group differences. ESC/MEM demonstrated greater improvement in delayed recall (F(2,82) = 4.3, p = 0.02) and executive functioning (F(2,82) = 5.1, p = 0.01) at 12 months compared to ESC/PBO. CONCLUSIONS: The combination of memantine with escitalopram was well tolerated and as effective as escitalopram and placebo in improving depression using HAM-D. Combination memantine and escitalopram was significantly more effective than escitalopram and placebo in improving cognitive outcomes at 12 months. Future reports will address the role of biomarkers of aging in treatment response.


Assuntos
Citalopram/administração & dosagem , Transtorno Depressivo Maior/tratamento farmacológico , Memantina/administração & dosagem , Memória/efeitos dos fármacos , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Idoso , Citalopram/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Memantina/efeitos adversos , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Resultado do Tratamento
5.
Nicotine Tob Res ; 22(4): 560-569, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-30874289

RESUMO

INTRODUCTION: Smoking is a lethal public health problem that is common in US military veterans, particularly those with posttraumatic stress disorder (PTSD). Mobile applications (apps) to promote smoking cessation are a scalable and low-cost approach that may facilitate treatment engagement. METHODS: This qualitative study examined the acceptability, user experience, and perceptions of a smoking cessation app, Stay Quit Coach (SQC), when incorporated into evidence-based smoking cessation treatment. US military veterans with PTSD who smoked at least five cigarettes per day for 15 of the past 30 days and stated an interested in cessation were eligible to participate. Participants' baseline comfort levels with mobile technology was measured using the Perceptions of Mobile Phone Interventions Questionnaire-Patient version (PMPIQ-P). At treatment end, semi-structured qualitative interviews were conducted. RESULTS: Twenty participants were enrolled and 17 (85.0%) participated in the qualitative interview at treatment end. PMPIQ-P scores at baseline ranged from 4.97 to 5.25 (SDs = 0.73-1.04), reflecting moderately high comfort with mobile technology among participants. Qualitative analyses indicated that most participants: (1) endorsed mobile technology as an appealing format for smoking cessation treatment, due to convenience and instantaneous access; and (2) expressed highest perceived helpfulness for interactive app features. Recommendations to improve SQC clustered into four thematic areas: (1) increasing personalization, (2) including more self-tracking features, (3) increasing visual cues, and (4) sharing progress with peers. CONCLUSIONS: SQC was perceived as an acceptable and useful tool to support smoking cessation in a sample of veteran smokers with PTSD. Qualitative data provided valuable insights that can inform the continued development of SQC and other apps for smoking cessation. IMPLICATIONS: Given the high lethality associated with cigarette smoking, it is crucial to identify scalable, low-risk strategies to promote smoking cessation, particularly in high-risk populations. Mobile technology is a promising approach that can be used to augment evidence-based smoking cessation treatment. Results of this qualitative study support the use of the SQC mobile app when incorporated into evidence-based smoking cessation treatment for veterans with PTSD and provide future directions for refinement of the SQC app. These findings also highlight the importance of using a patient-centered approach in designing apps intended for a clinical population.


Assuntos
Telefone Celular/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Aplicativos Móveis/normas , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Transtornos de Estresse Pós-Traumáticos/complicações , Veteranos/psicologia , Adolescente , Adulto , Idoso , Terapia Comportamental/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Pesquisa Qualitativa , Fumantes , Fumar/epidemiologia , Fumar/psicologia , Inquéritos e Questionários , Veteranos/estatística & dados numéricos , Adulto Jovem
6.
J Pediatr Psychol ; 45(5): 509-520, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32388554

RESUMO

OBJECTIVE: Stigma is associated with many health conditions, including chronic pain. Research on health-related stigma is limited by the lack of validated instruments that distinguish among various stigma-related constructs. We aimed to develop and validate such a measure for pediatric functional abdominal pain (FAP). Felt stigma (FS) was defined as comprising both perceived and internalized stigma. Stigma concealment (SC) was defined as efforts by stigmatized individuals to prevent others from learning of their condition. METHODS: Using a theory-driven approach, we adapted items from existing self-report measures of stigma to construct the health-related FS and Concealment Questionnaire (FSC-Q). Patients with FAP (N = 179, ages 11-17) completed the preliminary FSC-Q and health-related measures hypothesized to be associated with stigma. Cognitive interviewing and exploratory factor analysis (EFA) informed the final version of the measure. RESULTS: EFA identified a 2-factor model comprised of FS and SC. The FS and SC scales exhibited good internal consistency and construct validity. Consistent with study hypotheses, both factors were significantly associated with anxiety, depression, pain catastrophizing, pain threat, physical symptoms, and pain interference/disability. Higher FS was associated with higher mental healthcare utilization. The subset of participants meeting criteria for irritable bowel syndrome (IBS) reported higher FS and SC compared with those without IBS. CONCLUSION: The FSC-Q may help advance research on health-related stigma in FAP and other chronic health conditions by allowing for assessment of distinct stigma-related constructs.


Assuntos
Dor Abdominal , Ansiedade , Catastrofização , Estigma Social , Dor Abdominal/psicologia , Adolescente , Criança , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
7.
Psychogeriatrics ; 20(2): 140-148, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31332902

RESUMO

BACKGROUND: Late-life depression (LLD) is associated with significant medical comorbidity, cognitive impairment, and suboptimal treatment response compared to depression experienced earlier in life. Levomilnacipran (LVM) is a novel antidepressant the effects of which on neuroplasticity have not yet been investigated. We investigated the effect of LVM on cortical thickness in a pilot randomised placebo-controlled trial in LLD. METHODS: Twenty-nine adults (≥ 60 years) with major depression (48.3% female; mean age = 71.5 ± 5.8 years; mean education = 16.0 ± 1.7 years) were randomised to either LVM or placebo for 12 weeks. T1-weighted images were acquired at baseline and 12 weeks. Thirteen subjects (six LVM and seven placebo) completed the study. Group differences in cortical thickness change across the study period were evaluated, with age and total intracranial volume included as covariates. RESULTS: Dropout rates did not differ significantly between groups. The LVM group had significantly more side effects, but no serious adverse events were reported. Lower LVM dose (≤ 40 mg) was better tolerated than higher doses (80-120 mg). Additionally, the LVM group showed a larger increase in cortical thickness in the right postcentral gyrus (primary somatosensory), supramarginal gyrus (sensory association region), and lateral occipital cortex (visual cortex) compared to the placebo group and greater reductions in the left insula. CONCLUSIONS: LVM may be less tolerable by older adults with depression and the effects on cortical thickness across sensory and sensory association regions may be related to the experience of side effects. Larger studies are necessary to evaluate treatment efficacy, tolerability, and neural effects of LVM in LLD.


Assuntos
Antidepressivos/uso terapêutico , Córtex Cerebral/efeitos dos fármacos , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Levomilnaciprano/uso terapêutico , Idoso , Córtex Cerebral/diagnóstico por imagem , Método Duplo-Cego , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Projetos Piloto , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
8.
Am J Geriatr Psychiatry ; 27(1): 12-17, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30262406

RESUMO

OBJECTIVE: Increasing understanding of the neurocognitive correlates of resilience in late-life depression (LLD) could inform interventions to promote more sustained remission. We investigated cross-sectional relations between baseline resilience and domains of neurocognitive functioning in depressed older adults enrolled in one of four trials. METHODS: Participants (N = 288) completed neurocognitive tests of memory, language performance, and executive functioning as well as measures of subjective memory performance and components of resilience (grit, active coping self-efficacy, accommodative coping self-efficacy, and spirituality). RESULTS: Medium-sized associations were observed between greater resilience (overall resilience, accommodative coping) and lower frequency of self-reported forgetting. Small positive associations were observed between language performance and total resilience, active coping self-efficacy, and accommodative coping self-efficacy. Small negative associations were observed between spirituality and each objective measure of cognitive performance. CONCLUSION: Future longitudinal studies will help elucidate the complex relation between resilience and cognitive functioning in LLD. In addition, randomized controlled trials targeting coping self-efficacy may inform the development of more effective and personalized interventions.


Assuntos
Adaptação Psicológica/fisiologia , Envelhecimento/fisiologia , Disfunção Cognitiva/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Resiliência Psicológica , Autoeficácia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Estudos Transversais , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espiritualidade
9.
Int Psychogeriatr ; 31(2): 193-202, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29335041

RESUMO

ABSTRACTBackground:Traditional perspectives conceptualize resilience as a trait and depression as resulting from resilience deficiency. However, research indicates that resilience varies substantially even among adults who are clinically depressed, as well as across the lifespan of an individual. Few studies have investigated resilience in depression, and even fewer have examined resilience in depressed older adults. METHODS: Three hundred thirty-seven adults ≥60 years with major depressive disorder completed the Connor-Davidson Resilience Scale (CD-RISC) and measures of mental health, quality of life (QOL), and medical comorbidity. Exploratory factor analysis was used to explore the factor structure of the CD-RISC. Correlations and general linear models were used to examine associations between resilience and other variables. RESULTS: The rotated component matrix indicated a four-factor model. Sorting of items by highest factor loading revealed constructs associated with (1) grit, (2) active coping self-efficacy, (3) accommodative coping self-efficacy, and (4) spirituality. Resilience was significantly correlated with increased age, lower cognitive functioning, greater cerebrovascular risk, and greater medical comorbidity. Resilience was negatively associated with mental health symptoms (depression, apathy, and anxiety) and positively associated with QOL. The final optimal model identified less depression, less apathy, greater medical comorbidity, higher QOL, and minority (non-White) race as factors that significantly explained variability in resilience. CONCLUSIONS: Resilience was significantly associated with a range of mental health constructs in a sample of older adults with depression. Future clinical trials and dismantling studies may help determine whether interventions targeting grit, active coping, accommodative coping, and spirituality can increase resilience and help prevent and treat depression in older adults.


Assuntos
Envelhecimento/psicologia , Transtorno Depressivo Maior/psicologia , Qualidade de Vida/psicologia , Resiliência Psicológica , Adaptação Psicológica , Idoso , Análise Fatorial , Feminino , Psiquiatria Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Escalas de Graduação Psiquiátrica , Autoeficácia , Inquéritos e Questionários
10.
Am J Geriatr Psychiatry ; 26(8): 874-883, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29803529

RESUMO

OBJECTIVE: Greater psychological resilience may protect against developing depression in a growing geriatric population. Identifying the neural correlates of resilience in geriatric depression could provide neurobiologic targets to inform clinical interventions. However, most prior neuroimaging studies have only considered the presence or absence of resilience and have not addressed the multifactorial nature of resilience. The current study aimed to establish the neural correlates of four factors of resilience in the depressed elderly. METHODS: White matter integrity was assessed using diffusion-weighted magnetic resonance imaging data collected from 70 older adults with major depressive disorder. We used four resilience factors previously derived in an exploratory factor analysis of the Connor-Davidson Resilience Scale in a large sample of depressed older adults: 1, grit; 2, active coping self-efficacy; 3, accommodative coping self-efficacy; and 4, spirituality. RESULTS: The resilience factor "grit" was positively associated with fractional anisotropy in the callosal region connecting prefrontal cortex and fractional anisotropy in cingulum fibers; however, the latter did not survive correction for multiple comparisons. CONCLUSION: Structural integrity of major white matter pathways implicated in cognitive control and emotion regulation (i.e., connecting prefrontal cortex) was positively associated with the resilience factor "grit" in our sample of older adults with depression. Prospective studies are needed to determine the utility of the structural integrity of these pathways as a biomarker in predicting risk for depression and treatment response.


Assuntos
Transtorno Depressivo Maior/patologia , Córtex Pré-Frontal/patologia , Resiliência Psicológica , Substância Branca/patologia , Idoso , Idoso de 80 Anos ou mais , Anisotropia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem
11.
Curr Psychiatry Rep ; 20(1): 2, 2018 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-29372339

RESUMO

PURPOSE OF REVIEW: A growing body of research supports the use of mind-body therapies (MBTs) as minimally invasive and effective approaches for the management of late-life mood and cognitive disorders. RECENT FINDINGS: Recent randomized controlled trials and meta-analyses indicate that MBTs are effective for enhancing well-being, mood, sleep, and cognition in older adults. Evidence suggests that mindful movement (e.g., yoga, tai chi, walking meditation) may even outperform conventional physical exercise with regard to effects on quality of life, mood, and cognitive functioning. Practitioners may recommend MBTs as holistic, effective approaches for the management of common late-life mood and cognitive disorders. Continued research on MBTs will inform the development of even more effective/targeted interventions and contribute to greater acceptance and integration of these therapies into geriatric medicine and psychiatry.


Assuntos
Transtornos Cognitivos/terapia , Terapias Mente-Corpo , Transtornos do Humor/terapia , Idoso , Cognição/fisiologia , Psiquiatria Geriátrica , Serviços de Saúde para Idosos , Humanos , Qualidade de Vida
12.
Int J Geriatr Psychiatry ; 33(12): 1596-1603, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30035325

RESUMO

OBJECTIVES: With the world population rapidly aging, it is increasingly important to identify sociodemographic, cognitive, and clinical features that predict poor outcome in geriatric depression. Self-report measures of resilience-ie, the ability to adapt and thrive in the face of adversity-may identify those depressed older adults with more favorable prognoses. METHODS: We investigated the utility of baseline variables including 4 factors of resilience (grit, active coping self-efficacy, accommodative coping self-efficacy, and spirituality) for predicting treatment response and remission in a 16-week randomized controlled trial of methylphenidate, citalopram, or their combination in 143 adults over the age of 60 with MDD. RESULTS: Final logistic regression models revealed that greater total baseline resilience (Wald χ2  = 3.8, P = 0.05) significantly predicted both treatment response and remission. Specifically, a 20% increase in total resilience predicted nearly 2 times greater likelihood of remission (OR = 1.98, 95% CI = [1.01, 3.91]). Examining the individual factors of resilience, only accommodative coping self-efficacy (Wald χ2  = 3.7, P = 0.05; OR = 1.41 [1.00-2.01]) was significantly associated with remission. We found no relation between baseline sociodemographic factors (age, sex, race, education level) or measures of cognitive performance and posttreatment depressive symptoms. CONCLUSIONS: Self-reported resilience may predict greater responsivity to antidepressant medication in older adults with MDD. Future research should investigate the potential for resilience training-and in particular, interventions designed to increase accommodative coping-to promote sustained remission of geriatric depression.


Assuntos
Antidepressivos/uso terapêutico , Citalopram/uso terapêutico , Transtorno Depressivo , Psiquiatria Geriátrica , Metilfenidato/uso terapêutico , Resiliência Psicológica , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Resultado do Tratamento
13.
Clin Gastroenterol Hepatol ; 14(7): 937-947.e4, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26721342

RESUMO

BACKGROUND & AIMS: Several meta-analyses have demonstrated the efficacy of psychological therapies for reducing gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). However, no meta-analysis has investigated the duration of these effects. We performed a meta-analysis to assess the immediate, short-term, and long-term efficacy of psychotherapy for reducing GI symptoms in adults with IBS. METHODS: We searched PubMed, PsycINFO, Science Direct, and ProQuest Dissertations and Theses through August 15, 2015 for randomized controlled trials that compared psychological therapy with an active or non-active comparison (control) condition for treatment of GI symptoms in adults with IBS. RESULTS: Forty-one trials were included in our meta-analysis, comprising data from 2290 individuals (1183 assigned to psychotherapy and 1107 assigned to a control condition). Compared with a mixed group of control conditions, psychological therapies had a medium effect on GI symptom severity (d¯ = 0.69) immediately after treatment. On average, individuals who received psychotherapy had a greater reduction in GI symptoms after treatment than 75% of individuals assigned to a control condition. After short-term follow-up periods (1-6 months after treatment) and long-term follow-up periods (6-12 months after treatment), this effect remained significant and medium in magnitude (d¯ = 0.76 and d¯ = 0.73, respectively). CONCLUSIONS: Psychological therapies reduce GI symptoms in adults with IBS. These effects remained significant and medium in magnitude after short-term and long-term follow-up periods.


Assuntos
Síndrome do Intestino Irritável/patologia , Síndrome do Intestino Irritável/terapia , Psicoterapia/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo , Resultado do Tratamento
14.
J Pediatr Psychol ; 40(5): 517-25, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25617048

RESUMO

OBJECTIVE: Evaluate the psychometric properties of child- and parent-report versions of the four-item Abdominal Pain Index (API) in children with functional abdominal pain (FAP) and healthy controls, using a revised scoring method that facilitates comparisons of scores across samples and time. METHODS: Pediatric patients aged 8-18 years with FAP and controls completed the API at baseline (N = 1,967); a subset of their parents (N = 290) completed the API regarding the child's pain. Subsets of patients completed follow-up assessments at 2 weeks (N = 231), 3 months (N = 330), and 6 months (N = 107). Subsets of both patients (N = 389) and healthy controls (N = 172) completed a long-term follow-up assessment (mean age at follow-up = 20.21 years, SD = 3.75). RESULTS: The API demonstrated good concurrent, discriminant, and construct validity, as well as good internal consistency. CONCLUSION: We conclude that the API, using the revised scoring method, is a useful, reliable, and valid measure of abdominal pain severity.


Assuntos
Dor Abdominal/diagnóstico , Exame Físico , Adolescente , Criança , Feminino , Humanos , Masculino , Pais , Pediatria , Psicometria
15.
Int Psychogeriatr ; 31(9): 1237-1240, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34658312
16.
Brain ; 133(Pt 5): 1438-50, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20410144

RESUMO

Fragile X-associated tremor/ataxia syndrome, a neurodegenerative disorder associated with premutation alleles (55-200 CGG repeats) of the FMR1 gene, affects many carriers in late-life. Patients with fragile X-associated tremor/ataxia syndrome typically have cerebellar ataxia, intranuclear inclusions in neurons and astrocytes, as well as cognitive impairment. Dementia can also be present with cognitive deficits that are as severe as in Alzheimer's disease, however frontosubcortical type impairment is more pronounced in fragile X-associated tremor/ataxia syndrome. We sought to characterize the P600 and N400 word repetition effects in patients with fragile X-associated tremor/ataxia syndrome, using an event-related potential word repetition paradigm with demonstrated sensitivity to very early Alzheimer's disease. We hypothesized that the fragile X-associated tremor/ataxia syndrome-affected participants with poor declarative verbal memory would have pronounced abnormalities in the P600 repetition effect. In the event-related potential experiment, subjects performed a category decision task whilst an electroencephalogram was recorded. Auditory category statements were each followed by an associated visual target word (50% 'congruous' category exemplars, 50% 'incongruous' nouns). Two-thirds of the stimuli (category statement-target word pairs) were repeated, either at short-lag (approximately 10-40 s) or long-lag (approximately 100-140 s). The N400 and P600 amplitude data were submitted to split-plot analyses of variance. These analyses of variance showed a highly significant reduction of the N400 repetition effect (F = 22.5, P < 0.001), but not of the P600 repetition effect, in mild fragile X-associated tremor/ataxia syndrome (n = 32, mean age = 68.7, mean Mini-Mental State Examination score = 26.8). Patients with fragile X-associated tremor/ataxia syndrome had significantly smaller late positive amplitude (550-800 ms post-stimulus onset) to congruous words (P = 0.04 for group effect). Reduced P600 repetition effect amplitude was associated with poorer recall within fragile X-associated tremor/ataxia syndrome patients (r = 0.66) and across all subjects (r = 0.52). Larger P600 amplitude to new congruous words also correlated significantly with higher free recall scores (r = 0.37, P < 0.01) across all subjects. We found a correlation between the amplitude of late positivity and CGG repeat length in those with fragile X-associated tremor/ataxia syndrome (r = 0.47, P = 0.006). Higher levels of FMR1 mRNA were associated with smaller N400s to incongruous words and larger positive amplitudes (between 300 and 500 ms) to congruous words. In conclusion, event-related potential word repetition effects appear sensitive to the cognitive dysfunction present in patients with mild fragile X-associated tremor/ataxia syndrome. Their more severe reduction in N400 repetition effect, than P600, is in contrast to the reverse pattern reported in amnestic mild cognitive impairment and incipient Alzheimer's disease (Olichney et al., 2008).


Assuntos
Ataxia/genética , Ataxia/psicologia , Proteína do X Frágil da Deficiência Intelectual/genética , Tremor/genética , Tremor/psicologia , Idoso , Alelos , Análise de Variância , Ataxia/fisiopatologia , Eletroencefalografia , Potenciais Evocados , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , RNA Mensageiro/metabolismo , Sequências Repetitivas de Ácido Nucleico , Síndrome , Tremor/fisiopatologia , Repetições de Trinucleotídeos , Comportamento Verbal
17.
Complement Ther Clin Pract ; 43: 101374, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33826992

RESUMO

BACKGROUND: The benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS). METHODS: Adults (N = 189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n = 67), (2) deepest thoughts and feelings about their IBS (n = 61) or (3) daily activities in an objective manner (control condition; n = 61). Participants completed four 20-min writing sessions over 2-6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion. RESULTS: A significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147) = 6.16, p = 0.014, η2 = 0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92) = 3.89, p = 0.024, η2 = 0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-group differences. CONCLUSION: Writing about one's deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.


Assuntos
Síndrome do Intestino Irritável , Adulto , Revelação , Emoções , Humanos , Síndrome do Intestino Irritável/terapia , Qualidade de Vida , Redação
18.
Complement Ther Clin Pract ; 44: 101440, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34260998

RESUMO

BACKGROUND: Meta-analyses suggest that dance has potential to decrease psychological distress, increase trait mindfulness, and enhance quality of life. Conscious dance can be defined as unchoreographed, intentionally nonevaluative mindful movement commonly practiced in a group setting for purposes of authentic self-expression, self-discovery, interpersonal connectedness, and personal healing or growth. OBJECTIVE: To assess perceived effects of conscious dance practice (e.g., Ecstatic Dance, 5Rhythms) and examine associations between frequency/duration of practice and psychological well-being among participants. METHODS: Self-identifying adult conscious dancers completed a survey (N = 1003; mean age = 47 years; 52% from the U.S; 78% White; 73% female). RESULTS: Conscious dancers with ≥5 years of practice had significantly higher trait mindfulness and life satisfaction compared to newer practitioners. More frequent practice (≥once per week) was associated with higher trait mindfulness. A strong majority of participants endorsed experiences consistent with mindfulness (i.e., feeling "more present in my body"; 99% of the sample) and psychological flow ("I felt like I was 'in the zone' or 'in the flow' of things"; 93% of the sample) during conscious dance. Among participants endorsing any of five stress-related health conditions, the majority reported therapeutic effects (i.e., that conscious dance "helped them cope" with the condition). Therapeutic effects were most consistently reported by individuals with depression or anxiety (96% endorsement), followed by those with a trauma history (95%), chronic pain (89%), and history of substance abuse or addiction (88%). For all conditions except addiction, therapeutic effects were associated with greater experiences of psychological flow during dance, and the magnitude of these effects was large (Cohen's d range: 1.0-2.3). CONCLUSION: Individuals who engage in conscious dance report that these practices help them to cope with stress-related health conditions. Participants reporting longer duration or greater frequency of practice scored higher on measures of psychological well-being. The feasibility and efficacy of conscious dance for improving well-being among individuals naïve to these approaches will be important to determine in future research.


Assuntos
Dança , Atenção Plena , Adaptação Psicológica , Adulto , Ansiedade , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
19.
J Affect Disord ; 274: 464-470, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32663977

RESUMO

BACKGROUND: Geriatric depression with subjective cognitive complaints increases the risk of Alzheimer's Disease (AD). Memantine is a cognitive enhancer used to treat AD. In a 6-month double-blind randomized placebo-controlled trial of escitalopram and memantine (ESC/MEM), ESC/MEM improved cognition at 12 month in geriatric depression (NCT01902004). We now investigated structural neuroplastic changes at 3 months. METHODS: Forty-one older depressed adults (mean age=70.43, SD=7.33, 26 female) were randomized to receive ESC/MEM or ESC/PBO. Mood scores (Hamilton Depression Rating Scale, HAMD) and high-resolution structural T1-weighted images were acquired at baseline and 3 months. Freesurfer 6.0 for image processing and General Linear Models was used to examine group differences in symmetrized percent change gray matter volume (GMV) and cortical thickness, controlling for age and intracranial volume. Nonparametric tests were used to investigate group differences in mood and subcortical volume change. RESULTS: Among 27 completers (ESC/MEM n = 13; ESC/PBO n = 14), 62% achieved remission (HAMD≤6) with ESC/MEM and 43% with ESC/PBO (Fisher's exact p=.45). Change in HAMD did not differ between groups (F(1,23)=0.14, p=.7). GMV and thickness increased more with ESC/MEM than with ESC/PBO in the left middle and inferior temporal lobe, right medial, and lateral orbito-frontal cortex (OFC). LIMITATIONS: included small sample size, dropout, and the lack of cognitive data at 3 months. CONCLUSIONS: Although significant group differences in mood improvement were not observed, ESC/MEM resulted in increased GMV and cortical thickness in several brain regions compared to placebo. Larger longitudinal clinical trials can further examine the neuroprotective effect of memantine in geriatric depression.


Assuntos
Citalopram , Memantina , Adulto , Idoso , Citalopram/uso terapêutico , Depressão , Método Duplo-Cego , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Memantina/uso terapêutico , Projetos Piloto
20.
Neurogastroenterol Motil ; 32(9): e13828, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32266762

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) is a common and often debilitating chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits. Pharmacological treatments are often ineffective, leading to the development of a variety of behavioral interventions. Mindfulness-based stress reduction (MBSR) is one such program that has shown efficacy in reducing gastrointestinal (GI) symptoms and improving quality of life (QOL). This single-arm intervention study examines the association of clinical outcomes with changes in specific aspects of mindfulness. METHODS: Adults with IBS (53 women, 15 men) participated in an 8-week MBSR class. Primary outcomes of GI symptom severity, quality of life, and GI-specific anxiety, as well as specific aspects of mindfulness using the Five Factor Mindfulness Questionnaire (FFMQ), were assessed at baseline, post-treatment, and 6-month follow-up. KEY RESULTS: Gastrointestinal symptom responder rate was 71%, and there was a significant pre-post treatment change for three of the five FFMQ scales. Regression analysis indicated that change in the Act with Awareness (P = .02) facet of mindfulness was the strongest predictor of GI symptom and QOL improvement. CONCLUSIONS & INFERENCES: Mindfulness-based stress reduction training was associated with robust improvements in GI symptoms and associated problems in participants with IBS. Although significant increases in 3 of the 5 measured facets of mindfulness were found, regression analyses suggest that increases in the ability to retain present moment focus and act with awareness may be particularly important for improving outcomes in individuals with IBS. These results may inform the refinement of mindfulness-based protocols specifically for treatment of IBS.


Assuntos
Terapia Comportamental/métodos , Síndrome do Intestino Irritável/terapia , Atenção Plena/métodos , Qualidade de Vida/psicologia , Estresse Psicológico/terapia , Adulto , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/psicologia , Masculino , Índice de Gravidade de Doença , Estresse Psicológico/psicologia
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