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1.
J Psychiatr Res ; 116: 14-18, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176107

RESUMO

BACKGROUND: Ecological momentary assessment (EMA) is increasingly used to characterize patients' daily lives, monitor mood, and test efficacy of treatment interventions. However, few studies have examined patient characteristics impacting adherence with EMA protocols, and to our knowledge, no such study has been conducted in youth with bipolar disorder (BD). METHODS: As part of a larger observational study, 14- to 21-year-olds diagnosed with BD, and who were between episodes of illness (n = 39, 19.0 ±â€¯2.05 Mean ±â€¯Standard Deviation years old, 74.4% female) and psychiatrically healthy controls (n = 47, 18.3 ±â€¯2.40 years old, 66.0% female) completed baseline diagnostic and symptom severity interviews, and were instructed to complete diary assessments of mood, sleep, and behavior electronically three times per day for 21 consecutive days (i.e., in total 5418 (or 63 per person) diary entries). Multiple regression was used to examine effects of BD participants' demographic and clinical characteristics on diary completion rates. RESULTS: 53.8 ±â€¯9.3 diary entries per person were actually completed. Adherence rates were high (87.5% of healthy controls and 80.4% of adolescents with BD), but were still significantly poorer in youth with BD. Adequate adherence (≥80%) rates were also significantly poorer in youth with BD relative to healthy controls (56.4% versus 83.0%). Among youth with BD, more lifetime suicide attempts and higher current mood elevation symptom severity predicted significantly poorer adherence. LIMITATIONS: Limited sample size/generalizability. CONCLUSIONS: Findings highlight the importance of considering the impact of patient characteristics on adherence with EMA protocols among youth with severe mental illness.

2.
Psychiatry Res ; 275: 162-168, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30925304

RESUMO

This paper aims to compare mental and physical health, cognitive functioning, and selected biomarkers of aging reflecting metabolic pathology and inflammation, in outpatients with schizophrenia from two residential settings: residential care facilities (RCFs) and living with someone in a house/apartment. This cross-sectional study examined community-dwelling adults with schizophrenia either in RCFs (N = 100) or in a house/apartment with someone (N = 76), recruited for two NIH-funded studies in San Diego. Assessments included measures of mental/physical health, cognitive function, and metabolic (glycosylated hemoglobin, cholesterol) and inflammatory (C-Reactive Protein, Tumor Necrosis Factor-alpha, Interleukin-6) biomarkers of aging. General logistic models were used to analyze factors associated with residential status. RCF residents had several indicators of worse prognosis (never being married, higher daily antipsychotic dosages, increased comorbidities and higher Framingham risk for coronary heart disease) than individuals living with someone. However, RCF residents had better mental well-being and lower BMI, as well as comparable biomarkers of aging as those living with someone. While the cross-sectional nature of the study does not allow us to infer causality, it is possible that the supportive environment of RCFs may have a positive impact on mental and physical health of persons with schizophrenia. Longitudinal follow-up studies are needed to test this hypothesis.

3.
J Palliat Med ; 22(10): 1196-1201, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30909786

RESUMO

Background: Research on the patterns of use of medical cannabis among cancer patients is lacking. Objective: To describe patterns of medical cannabis use by patients with cancer, and how patterns differ from patients without cancer. Design/Measurements: We performed secondary data analysis using data from a medical cannabis licensee in New York State, analyzing demographic information, qualifying conditions, and symptoms, and the medical cannabis product used, including tetrahydrocannabinol (THC) to cannabidiol (CBD) ratios. Setting/Subjects: Adults age ≥18 who used New York State medical cannabis licensee products between January 2016 and December 2017. Results: There were a total of 11,590 individuals with 1990 (17.2%) having cancer who used at least one cannabis product. Patients with cancer using cannabis were older and more likely to be female. The most common qualifying symptom for both cancer and noncancer patients was severe or chronic pain. Cancer patients were more likely to use the sublingual tincture form of cannabis (n = 1098, 55.2%), while noncancer patients were more likely to use the vaporization form (n = 4222, 44.0%). Over time, across all patients, there was an increase in the THC daily dose by a factor of 0.20 mg/week, yielding a corresponding increase in the THC:CBD daily ratio. Compared with noncancer patients, these trends were not different in the cancer group for THC daily dose, but there were less pronounced increases in the THC:CBD daily ratio over time among cancer patients. Conclusions: Our study found some key differences in demographics and medical cannabis product use between patients with cancer and without cancer.

4.
J Affect Disord ; 250: 226-230, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30870772

RESUMO

BACKGROUND: Sleep disturbances are common in bipolar disorder (BD) and are often assessed by self-report at clinic visits over the course of BD treatment. Self-report may be subject to recall bias based upon current mood/affect states. This study sought to identify the degree of inaccuracy between subjective and objective measures of sleep duration in those with and without BD, and to assess the demographic and clinical correlates of this inaccuracy. METHODS: Thirty-one individuals with BD and 54 healthy control (HC) participants reported on the number of hours slept a night over the past month and subsequently completed up to 14 days/nights of wrist actigraphy which provided an objective measure of sleep duration. We compared the subjective rating to the average of all nights of objective sleep duration, and correlated the magnitude of inaccuracy with demographic and clinical characteristics in the BD and HC groups. RESULTS: On average, both BD and HC groups overestimated their sleep, and there were no differences in inaccuracy between groups. In the BD group, greater inaccuracy was associated with lower functioning, even after controlling individually for objective and subjective sleep measures. LIMITATIONS: Cross-sectional study, only focus on sleep duration, and less severe bipolar symptoms of sample. CONCLUSIONS: Inaccuracy in reports of sleep duration was associated with lower functioning among BD patients. Better identifying discrepancies in reports of sleep duration in clinical practice could help in more efficient monitoring and management of BD symptoms.


Assuntos
Transtorno Bipolar/diagnóstico , Transtornos do Sono-Vigília/diagnóstico , Actigrafia , Adulto , Afeto , Transtorno Bipolar/fisiopatologia , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Transtornos do Sono-Vigília/fisiopatologia , Fatores de Tempo , Adulto Jovem
5.
J Affect Disord ; 241: 586-591, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30172210

RESUMO

BACKGROUND: Bipolar disorder (BD) is associated with later sleep and daily activity (evening rather than morning chronotype). Objective chronotype identification (e.g., based on actigraphs/smartphones) has potential utility, but to date, chronotype has mostly been assessed by questionnaires. Given the ubiquity of accelerometer-based devices (e.g. actigraphs/smartphones) worn/used during daytime and tendency to recharge rather than wear at night, we assessed chronotype using daytime (rather than sleep) interval midpoints. METHODS: Sixty-one participants with BD type I (BD-I) or II (BD-II) and 61 healthy controls completed 25-50 days of continuous actigraphy. The Composite Scale of Morningness (CSM) was completed by a subset of this group. Daytime activity midpoint was calculated for each daytime interval, excluding naps. Evening chronotype was defined as having a daytime interval midpoint at or after 16:15:00 (4:15:00 PM). RESULTS: BD versus controls had delayed daytime midpoint (mean ±â€¯standard deviation) (16:49:07 ±â€¯01:26:19 versus 16:12:51 ±â€¯01:02:14, p < 0.01), and greater midpoint variability (73.3 ±â€¯33.9 min versus 58.1 ±â€¯18.3 min, p < 0.01). Stratifying by gender and age, females and adolescents with BD had delayed and more variable daytime midpoints versus controls. Adults with BD had greater midpoint variability than controls. Within-person mean and standard deviations of daytime midpoints were highly correlated with sleep midpoints (r = 0.99, p < 0.01 and r = 0.86, p < 0.01, respectively). Daytime midpoint mean was also significantly correlated with the CSM (r = -0.56, p < 0.01). LIMITATIONS: Small sample size; analyses not fully accounting for daytime napping. CONCLUSIONS: Wrist actigraphy for determination of daytime midpoints is a potential tool to identify objective chronotype. Exploration of the use of consumer devices (wearables/smartphones) is needed.

6.
JMIR Ment Health ; 5(2): e38, 2018 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-29759960

RESUMO

BACKGROUND: Social isolation is associated with an increased risk for mental and physical health problems, especially among older persons living with HIV (PLWH). Thus, there is a need to better understand real-time temporal associations between social activity and mood- and health-related factors in this population to inform possible future interventions. OBJECTIVE: This study aims to examine real-time relationships between social activity and mood, fatigue, and pain in a sample of older PLWH. METHODS: A total of 20 older PLWH, recruited from the University of California, San Diego HIV Neurobehavioral Research Program in 2016, completed smartphone-based ecological momentary assessment (EMA) surveys 5 times per day for 1 week. Participants reported their current social activity (alone vs not alone and number of social interactions) and levels of mood (sadness, happiness, and stress), fatigue, and pain. Mixed-effects regression models were used to analyze concurrent and lagged associations among social activity, mood, fatigue, and pain. RESULTS: Participants (mean age 58.8, SD 4.3 years) reported being alone 63% of the time, on average, (SD 31.5%) during waking hours. Being alone was related to lower concurrent happiness (beta=-.300; 95% CI -.525 to -.079; P=.008). In lagged analyses, social activity predicted higher levels of fatigue later in the day (beta=-1.089; 95% CI -1.780 to -0.396; P=.002), and higher pain levels predicted being alone in the morning with a reduced likelihood of being alone as the day progressed (odds ratio 0.945, 95% CI 0.901-0.992; P=.02). CONCLUSIONS: The use of EMA elucidated a high rate of time spent alone among older PLWH. Promoting social activity despite the presence of pain or fatigue may improve happiness and psychological well-being in this population.

7.
J Psychiatr Res ; 100: 107-112, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29514121

RESUMO

Deficits in social cognition are present in psychotic disorders; moreover, maladaptive interpersonal beliefs have been posited to underlie risk of suicidal ideation and behavior. However, the association between social cognition and negative appraisals as potential risk factors for suicidal ideation and behavior in psychotic disorders has not been assessed. In a pilot study, we assessed accuracy and error biases in facial emotion recognition (Penn ER-40), maladaptive interpersonal beliefs as measured by the Interpersonal Needs Questionnaire (INQ), and current suicide ideation and history of past attempts in a sample of 101 outpatients with psychotic disorders (75 schizophrenia/schizoaffective; 26 bipolar disorder). INQ scores were positively associated with history of suicide attempts and current ideation. INQ scores were inversely related with emotion recognition accuracy yet positively correlated with bias toward perceiving anger in neutral expressions. The association between biases pertaining to anger and INQ scores persisted after adjusting for global cognitive ability and were more evident in schizophrenia than in bipolar disorder. The present findings suggest that maladaptive beliefs are associated with a tendency to misperceive neutral stimuli as threatening and are associated with suicidal ideation and behavior. Although better cognitive ability is associated with higher rates of suicide attempts in psychotic disorders, biases in misinterpreting anger in others may be a specific deficit related to formation of maladaptive beliefs about others, which, in turn, are associated with history of suicide attempts.

8.
Schizophr Res ; 192: 340-344, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28655480

RESUMO

BACKGROUND: Previous literature suggests that better cognitive ability and insight are associated with greater lifetime risk of suicide attempts in schizophrenia, counter to the direction of association in the general population. However, the conjoint association between distinct cognitive domains, insight, and suicidality has not been assessed. METHOD: In a cross-sectional study, 162 adults with schizophrenia or schizoaffective disorder completed cognitive testing via the MATRICS battery, symptom and cognitive insight assessments, along with the Columbia Suicide Severity Rating Scale. We then contrasted participants based on history of suicidality by cognitive domains and insight measures and conducted multivariate analyses. RESULTS: Although a history of any passive ideation was not associated with cognitive ability or insight, verbal learning was positively associated with a greater history of suicidal attempt and prior ideation with a plan and intent. Higher cognitive insight, and the self-reflectiveness subscale insight, was also associated with history of passive or active suicidal ideation. Cognitive insight and cognitive ability were independent from each other, and there were no moderating influences of insight on the effect of cognitive ability on suicide related history. Exploratory analyses revealed that history of planned attempts were associated with greater verbal learning, whereas histories of aborted attempts were associated with poorer reasoning and problem-solving. IMPLICATIONS: Although cross-sectional and retrospective, this study provides support that greater cognitive ability, specifically verbal learning, along with self-reflectiveness, may confer elevated risk for more severe suicidal ideation and behavior in an independent fashion. Interestingly, poorer problem-solving was associated with aborted suicide attempts.


Assuntos
Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Pacientes Ambulatoriais , Esquizofrenia/complicações , Psicologia do Esquizofrênico , Suicídio/psicologia , Adulto , Idoso , Análise de Variância , Escalas de Graduação Psiquiátrica Breve , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Psicometria , Adulto Jovem
9.
J Gerontol A Biol Sci Med Sci ; 73(3): 367-373, 2018 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-28958012

RESUMO

Background: Napping is associated with both positive and negative health outcomes among older adults. However, the association between particular napping characteristics (eg, frequency, duration, and whether naps were intentional) and daytime function is unclear. Methods: Participants were 2,739 community-dwelling Medicare beneficiaries aged ≥65 years from the nationally representative National Health and Aging Trends Study. Participants reported napping frequency, duration, and whether naps were intentional versus unintentional. Restricted participation in valued activities was measured by self-report. Results: After adjusting for potential confounders and nighttime sleep duration, those who took intentional and unintentional naps had a greater odds of any valued activity restriction (ie, ≥1 valued activity restriction), compared to those who rarely/never napped (unintentional odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.01, 1.79, intentional OR = 1.49, 95% CI 1.09, 2.04). There was no difference between unintentional napping and intentional napping with respect to any valued activity restriction after adjustment for demographics. Compared to participants napping "some days," those napping most days/every day had a greater odds of any valued activity restriction (OR = 1.68, 95% CI 1.30, 2.16). Moreover, each 30-minute increase in average nap duration was associated with a 25% greater odds of any valued activity restriction (OR = 1.25, 95% CI 1.10, 1.43). Conclusion: Older adults who took more frequent or longer naps were more likely to report activity restrictions, as were those who took intentional or unintentional naps. Additional longitudinal studies with objective measures of sleep are needed to further our understanding of associations between napping characteristics and daytime dysfunction.

10.
Psychiatr Serv ; 69(2): 235-238, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29089011

RESUMO

OBJECTIVE: Clinical guidelines suggest that benzodiazepines (BZDs) and non-BZD hypnotics (NBHs) be used on a short-term basis. The authors examined trends in long-term BZD and NBH use from 1999 to 2014. METHODS: Data included 82,091 respondents in the 1999-2014 waves of the National Health and Nutrition Examination Survey (NHANES). NHANES recorded medications used in the past 30 days on the basis of prescription bottles, and participants reported use duration. BZD and NBH use were categorized as short, medium, and long term, and time trends in use were assessed. RESULTS: BZD and NBH use increased from 1999 to 2014, driven by increases in medium- and long-term use, even after adjustment for age and race-ethnicity. In most years, only a fifth of current BZD or NBH users reported short-term use. CONCLUSIONS: Long-term BZD and NBH use has grown independent of U.S. demographic shifts. Monitoring of use is needed to prevent adverse outcomes.

11.
J Affect Disord ; 225: 342-349, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28843917

RESUMO

BACKGROUND: Disturbed sleep timing is common in bipolar disorder (BD). However, most research is based upon self-reports. We examined relationships between subjective versus objective assessments of sleep timing in BD patients versus controls. METHODS: We studied 61 individuals with bipolar I or II disorder and 61 healthy controls. Structured clinical interviews assessed psychiatric diagnoses, and clinician-administered scales assessed current mood symptom severity. For subjective chronotype, we used the Composite Scale of Morningness (CSM) questionnaire, using original and modified (1, ¾, ⅔, and ½ SD below mean CSM score) thresholds to define evening chronotype. Objective chronotype was calculated as the percentage of nights (50%, 66.7%, 75%, or 90% of all nights) with sleep interval midpoints at or before (non-evening chronotype) vs. after (evening chronotype) 04:15:00 (4:15:00a.m.), based on 25-50 days of continuous actigraph data. RESULTS: BD participants and controls differed significantly with respect to CSM mean scores and CSM evening chronotypes using modified, but not original, thresholds. Groups also differed significantly with respect to chronotype based on sleep interval midpoint means, and based on the threshold of 75% of sleep intervals with midpoints after 04:15:00. Subjective and objective chronotypes correlated significantly with one another. Twenty-one consecutive intervals were needed to yield an evening chronotype classification match of ≥ 95% with that made using the 75% of sleep intervals threshold. LIMITATIONS: Limited sample size/generalizability. CONCLUSIONS: Subjective and objective chronotype measurements were correlated with one another in participants with BD. Using population-specific thresholds, participants with BD had a later chronotype than controls.


Assuntos
Transtorno Bipolar/psicologia , Transtornos Cronobiológicos/psicologia , Adolescente , Adulto , Afeto , Ritmo Circadiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Sono/fisiologia , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários , Adulto Jovem
12.
Gerontologist ; 58(2): 270-277, 2018 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-28329814

RESUMO

Purpose of the Study: Clinical studies have demonstrated the health benefits of music listening, especially among older adults; however, this connection has not yet been examined in a nationally representative population based sample. The purpose of this study was to measure the connections between health, listening to music, and engagement with life activities among older Americans. Design and Methods: We used data on 5,797 participants in both the 2012 Health and Retirement Study and 2013 Consumption and Activities Mail Survey. Participants reported their lifetime prevalence of health conditions, number of hours spent per week listening to music, as well as various cognitive, physical, social, and spiritual activities. We categorized participants as non-listeners (those reporting zero hours of music listening), average listeners (between >0 and 28.5 hr), and high listeners (>28.6 hr) and assessed associations between these music listening categories and life activities and the prevalence of health conditions. Results: Approximately 20% of the older Americans were non-listeners, a majority (75%) reported average amounts, and 5% reported high levels of music listening. Older Americans who were average or high music listeners reported a greater number of hours engaged in several cognitive, physical, social, and spiritual activities each week. Music listeners additionally reported fewer problematic health conditions than non-listeners. Implications: Listening to music relates to increased life engagement and better health among older Americans. Given the wide-spread availability of music-based interventions for diverse populations, future studies may investigate the beneficial use of music as a public health initiative for older adults.


Assuntos
Envelhecimento , Cognição , Exercício/psicologia , Envelhecimento Saudável/psicologia , Música/psicologia , Habilidades Sociais , Espiritualidade , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Feminino , Humanos , Masculino , Estados Unidos
13.
Sleep Health ; 3(4): 244-249, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28709510

RESUMO

OBJECTIVE: Sleep apnea has been shown to be associated with mental health conditions. This study examined the association between sleep apnea and psychopathology and mental health service utilization in a US nationally-representative sample. DESIGN: National Survey on Drug Use and Health (NSDUH). SETTING: United States. PARTICIPANTS: We used data on 264,653 individuals who participated in the 2008-2014 waves of the NSDUH, of which 5498 (3.3%) reported having sleep apnea within the past year. INTERVENTION: Not applicable. MEASUREMENTS: Based on NSDUH responses, participants were categorized as having depression, suicidal ideation, anxiety, and serious psychological distress within the past year. Analyses consisted of using logistic regression models with sleep apnea as the main predictor and mental health conditions as the outcomes of interest, controlling for potential confounding variables. RESULTS: Compared with those without sleep apnea, those reporting past-year sleep apnea had 3.11 (95% confidence interval [CI], 2.77-3.50) times increased odds of having depression, 2.75 (95% CI, 2.34-3.23) times increased odds of suicidal ideation, 3.68 (95% CI, 3.30-4.10) times increased odds of anxiety, and 2.88 (95% CI, 2.61-3.17) times increased odds of severe psychological distress, after controlling for confounders. Among those with each psychiatric outcome, individuals with sleep apnea were substantially more likely to report unmet need for mental health care, despite reporting greater mental health service use. CONCLUSIONS: Individuals with sleep apnea have increased risk for psychopathology, including suicidal ideation. Efforts to address the mental health care needs of those with sleep apnea are needed.


Assuntos
Ansiedade , Transtorno Depressivo Maior , Serviços de Saúde Mental/estatística & dados numéricos , Síndromes da Apneia do Sono/psicologia , Ideação Suicida , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
14.
Am J Emerg Med ; 35(10): 1414-1419, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28476551

RESUMO

OBJECTIVE: Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. METHODS: Data came from the 2004-2011 waves of the Drug Abuse Warning Network (DAWN). Visits were categorized as involving: (1) BZDs-only, (2) nBZRAs-only, (3) combination of BZDs and nBZRAs, or (4) any other sedative-hypnotic medication. DAWN also recorded the disposition (i.e., outcome) of the visit. Analyses focused on outcomes indicating a serious disposition defined as hospitalization, patient transfer or death. Using logistic regression, the association of BZD and nBZRA use with visit disposition was assessed after applying sample weights so as to be nationally representative of ED visits in the United States involving medications or illicit substances. RESULTS: Nineteen percent of visits involving other sedative-hypnotics, 28% involving BZDs-only, 20% involving nBZRAs-only and 48% involving a combination of BZDs and nBZRAs resulted in a serious disposition. Compared to visits involving other sedative-hypnotics, visits involving BZDs-only had 66% greater odds (Odds Ratio [OR]=1.66, 95% Confidence Interval [CI]=1.37-2.01), and visits involving a combination of BZDs and nBZRAs had almost four times increased odds of a serious disposition (OR=3.91, 95% CI=2.38-6.41). Results were similar across age groups. CONCLUSIONS: Findings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications.


Assuntos
Benzodiazepinas/efeitos adversos , Serviço Hospitalar de Emergência , Agonistas de Receptores de GABA-A/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
15.
Arch Gerontol Geriatr ; 72: 39-44, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28544945

RESUMO

Type II diabetes mellitus (DM) is associated with increased risk of dementia; however, few studies have examined the longitudinal association between DM and cognitive outcomes in large nationally representative cohorts. We investigated these associations in 7605 participants enrolled in the National Health and Aging Trends Study, a nationally representative prospective study of Medicare beneficiaries ≥65, from 2011 to 2015. Participants or proxy respondents reported DM and dementia diagnosis, and participants completed immediate and delayed recall word list learning tests and the Clock Drawing Test. In multivariable-adjusted generalized linear mixed models, baseline DM diagnosis was associated with decline on immediate and delayed word recall and the Clock Drawing Test. In Cox proportional hazards models, DM also predicted incident dementia in older age groups at baseline. These findings further support the notion that DM is associated with cognitive outcomes, suggesting that treatment and prevention of DM may reduce the risk of these outcomes. However, more studies are needed to better understand whether DM treatments affect this relationship.


Assuntos
Disfunção Cognitiva/etiologia , Demência/etiologia , Diabetes Mellitus Tipo 2/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos
16.
Am J Geriatr Psychiatry ; 25(8): 829-840, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28065496

RESUMO

OBJECTIVE: This study aimed to examine the feasibility, acceptability, and initial validity of using smartphone-based ecological momentary assessment (EMA) to assess daily functioning and other behavioral factors among older HIV+ adults. METHODS: Twenty older HIV+ adults (mean age: 59 years) completed laboratory-based neurobehavioral and functional assessments then completed EMA surveys via smartphones five times per day for one week. RESULTS: Excellent EMA adherence (86.4%) was found, and participants rated their experience with EMA methods positively. Time-use data indicated participants were spending 74% of their waking-sampled time at home, 63% of their time alone, and 32% of their time engaged in passive leisure activities (e.g., watching TV). Better neurocognitive and functional capacity abilities were correlated with less time spent in passive leisure activities. Lastly, mood and cognitive symptom data collected via EMA were significantly associated with scores from laboratory-based assessments of these same constructs. CONCLUSIONS: EMA via smartphones is a feasible and acceptable data collection method among older HIV+ adults and appears to be a promising mobile tool to assess daily functioning behaviors in HIV. These preliminary findings indicate older HIV+ adults are spending a considerable amount of time at home, alone, and engaged in passive leisure activities, primarily watching TV. EMA may contribute to future research examining functional disability among the growing population of older HIV+ adults.


Assuntos
Atividades Cotidianas , Avaliação Momentânea Ecológica , Infecções por HIV , Aplicações da Informática Médica , Aplicativos Móveis , Aceitação pelo Paciente de Cuidados de Saúde , Atividades Cotidianas/psicologia , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Estudos de Viabilidade , Feminino , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone
17.
Behav Sleep Med ; : 1-9, 2017 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-28098495

RESUMO

OBJECTIVE/BACKGROUND: The Insomnia Severity Index (ISI) is a widely used self-report measure of insomnia symptoms. However, to date this measure has not been validated or well-characterized in veterans who have experienced traumatic brain injury (TBI). This study assessed the psychometric properties and convergent, divergent, construct, and discriminate validity of the ISI in veterans with a history of TBI. PARTICIPANTS: Eighty-three veterans with history of TBI were seen in the VA San Diego Healthcare System as part of a research protocol. METHODS: Measures included the ISI, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Neurobehavioral Symptom Inventory, Beck Depression Inventory-II, Beck Anxiety Inventory, and PTSD Checklist-Military Version. RESULTS: The ISI demonstrated moderate to strong or excellent convergent and divergent validity. A principal component analysis indicated a single construct with excellent internal consistency (Cronbach's alpha = 0.92). In exploratory analyses, the ISI discriminated well between those with (73%) and without (27%) sleep disturbance based on the PSQI. CONCLUSIONS: Results from this study indicate validity of the ISI in assessing insomnia in veterans with history of TBI and suggest a cutoff score not dissimilar from non-TBI populations. Findings from this study can help inform clinical applicability of the ISI, as well as future studies of insomnia in TBI.

18.
Am J Public Health ; 106(11): 2019-2025, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27631754

RESUMO

OBJECTIVES: To assess trends in continuing and new prescriptions for sedative-hypnotic medications, including benzodiazepines (BZDs) and non-BZD receptor agonists (nBZRAs). METHODS: Data came from the National Ambulatory Medical Care Survey and comprised 287 288 randomly sampled patient visits. Physicians reported medications prescribed and whether they were "continuing" or "new" prescriptions. We assessed trends in continuing BZD, new BZD, continuing nBZRA, and new nBZRA prescriptions from 2005 to 2012. RESULTS: Proportions of visits with continuing prescriptions increased from 3.4% in 2005 to 4.7% in 2012 (P < .01) for BZDs, and from 1.0% to 1.7% (P < .01) for nBZRAs. We noted no changes in new prescriptions. We observed the same patterns across patient age and physician specialties, except psychiatry. Despite no growth over time, the prevalence of visits involving continuing and new BZD and nBZRA prescriptions was much higher in psychiatry than in primary care and other specialties. CONCLUSIONS: Increased sedative-hypnotic prescribing in recent years may be attributable to long-term growth in continuing prescriptions, rather than new prescriptions. Public Health Implications. Findings call for renewed efforts to limit continuing prescribing of sedative-hypnotics to reduce their use in the population.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Hipnóticos e Sedativos/administração & dosagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos , Adulto Jovem
20.
J Clin Psychiatry ; 77(8): e1019-25, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27561149

RESUMO

OBJECTIVE: Studies of aging usually focus on trajectories of physical and cognitive function, with far less emphasis on overall mental health, despite its impact on general health and mortality. This study examined linear and nonlinear trends of physical, cognitive, and mental health over the entire adult lifespan. METHODS: Cross-sectional data were obtained from 1,546 individuals aged 21-100 years, selected using random digit dialing for the Successful AGing Evaluation (SAGE) study, a structured multicohort investigation that included telephone interviews and in-home surveys of community-based adults without dementia. Data were collected from 1/26/2010 to 10/07/2011 targeting participants aged 50-100 years and from 6/25/2012 to 7/15/2013 targeting participants aged 21-100 years with an emphasis on adding younger individuals. Data included self-report measures of physical health, measures of both positive and negative attributes of mental health, and a phone interview-based measure of cognition. RESULTS: Comparison of age cohorts using polynomial regression suggested a possible accelerated deterioration in physical and cognitive functioning, averaging 1.5 to 2 standard deviations over the adult lifespan. In contrast, there appeared to be a linear improvement of about 1 standard deviation in various attributes of mental health over the same life period. CONCLUSIONS: These cross-sectional findings suggest the possibility of a linear improvement in mental health beginning in young adulthood rather than a U-shaped curve reported in some prior studies. Lifespan research combining psychosocial and biological markers may improve our understanding of resilience to mental disability in older age and lead to broad-based interventions promoting mental health in all age groups.


Assuntos
Envelhecimento , Inquéritos Epidemiológicos/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Resiliência Psicológica , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Autorrelato , Adulto Jovem
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