Perinatal Planning Guide: Mitigating Perinatal Mood and Anxiety Disorders During the COVID-19 Pandemic.

Women are at high risk for and more vulnerable to perinatal mood and anxiety disorders (PMADs) during the coronavirus disease 2019 (COVID-19) pandemic. While access to specialized perinatal mental health services is limited, clinicians with whom women have ongoing relationships are in a unique position to counsel about prevention of PMADs. These clinicians include primary care, obstetric, and general mental health clinicians. By providing a woman with practical guidance and psychoeducation for perinatal planning (eg, about sleep, exercise, nutrition, and the importance of social supports), clinicians can mitigate a woman's risk of PMADs. This practical guidance must be modified to fit the social context of the COVID-19 pandemic. This guidance can prevent or attenuate unnecessary suffering on the part of the mother and have a long-lasting impact on her child. This review provides a perinatal planning guide that outlines important topics to discuss and problem solve with women in the context of the COVID-19 pandemic.

Caregiver Reward and Burden: Differing Constructs in Family Members Providing Care for Medically Ill Homebound Older Adults.

Objective: This study examined the relationship between caregiver burden and reward and how each relates to factors, such as depression, within the caregiving dyad. Method: A total of 101 older adults and their primary family caregivers were recruited upon enrolling in home health care services. Patients were assessed for sociodemographic information, depression, disability, pain, and caregiver support at baseline and at 8 weeks. Caregivers were assessed at baseline for sociodemographic information, depression, caregiver burden, caregiver reward, and caregiving tasks they provide. Results: Burden and reward were significantly inversely correlated, but differentially associated with distinct patient and caregiver variables. Patients whose caregivers reported higher baseline levels of caregiver reward were more likely to have lower depression scores at follow-up. Discussion: Given that different aspects of patients and caregivers influence reward and burden, assessing caregivers for both burden and reward may better target caregiver interventions at the individual and family levels, particularly for older adult depression.

Ecosystem focused therapy in poststroke depression: a preliminary study.

OBJECTIVE: Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the ecosystem focused therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the "psychosocial storm" of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy. DESIGN: A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks. RESULTS: Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability. CONCLUSION: These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.

Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions.

Less than half of older adults with depression achieve remission with antidepressant medications, and rates of remission are even poorer for those with comorbid conditions. Psychosocial interventions have been effective in treating geriatric depression, either alone or better yet, in combination with antidepressant medications. Traditional strategies for nonpharmacological treatment of late-life depression do not specifically address the co-occurring cognitive impairment and disability that is prevalent in this population. Newer therapies are recognizing the need to simultaneously direct treatment efforts in late-life depression towards the triad of depressive symptoms, cognitive dysfunction, and functional disability that is so often found in geriatric depression, and this comprehensive approach holds promise for improved treatment outcomes.

Assessing families in palliative care: a pilot study of the checklist of family relational abilities.

Although families often play an integral role in palliative care, there are currently few measures to help clinicians gauge families' abilities to participate in this process. The Checklist of Family Relational Abilities was developed as an efficient, clinician-rated method of family assessment. Preliminary results suggest that Checklist ratings of overall family functioning and strength of family attachments were reliable across raters and associated with a well-validated self-report measure of family functioning. However, ratings of family communication and collaborative decision-making were less reliable. Based on these preliminary findings, we propose a revised version of the Checklist for further study in palliative care settings.

Caregiving tasks and training interest of family caregivers of medically ill homebound older adults.

OBJECTIVE: This study assessed the caregiving activities and training interests of family caregivers of medically ill older adults without dementia who receive home health care. METHODS: Participants were 101 family caregivers of patients from the Training in the Assessment of Depression (TRIAD) study. Caregivers were assessed using a sociodemographic questionnaire and measures of caregiver tasks and training interest. RESULTS: Family caregivers provided a variety of caregiving tasks and their interest in training was independent of current provision of tasks. Black caregivers expressed greater overall interest in receiving training than did White caregivers, as did younger caregivers compared to same-generation caregivers. DISCUSSION: Family caregivers in this study evidenced both a range of care provision and clear interest in improving caregiving skills through training. Research efforts should focus on meeting the specific training needs of family caregivers and determining the impact training can have on patient health outcomes.

Uncertain what uncertainty monitoring monitors.

Smith et al. present a model that they suggest may clarify aspects of the phylogenetic distribution of metacognition, based on observation of what they call uncertainty monitoring. Although they suggest that their model is supported by data collected using monkeys and dolphins, their interpretation that nonhuman animal behaviors parallel thought processes in humans may be unwarranted. The model presented by Smith et al. is inconsistent with current theories and empirical findings on the comparative aspects of metacognition. We present three oversights of the model and extend our critique to include a brief discussion of animal self-awareness, as well as current neuropsychological perspectives on metacognitive processing in humans.