A positive psychology intervention for patients with bipolar depression: a randomized pilot trial.

Background: There are few effective treatments for bipolar depression, a common and debilitating illness.Aims: We aimed to examine the feasibility and preliminary efficacy of a four-week, telephone-delivered positive psychology (PP) intervention for patients with bipolar depression.Methods: Twenty-five patients hospitalized for bipolar depression were randomized to receive a PP (n = 14) or control condition (CC; n = 11) intervention. Following discharge, participants completed weekly exercises and phone calls with a study trainer. PP intervention feasibility was assessed by the number of exercises completed, and acceptability was examined on five-point Likert-type scales of ease and utility. Between-group differences on psychological constructs at 4 and 8 weeks post-enrollment were assessed using mixed effects regression models.Results: Participants in the PP group completed an average of three out of four PP exercises and found PP exercises to be subjectively helpful, though neither easy nor difficult. Compared to CC, the PP intervention led to trends towards greater improvements in positive affect and optimism at follow-up, with large effect sizes (modified Cohen's d = 0.95-1.24). PP had variable, non-significant effects on negative psychological constructs.Conclusions: Larger, randomized trials are needed to further evaluate the efficacy of this intervention in this high-risk population.

Relationships Between Life Stressors, Health Behaviors, and Chronic Medical Conditions in Mid-Life Adults: A Narrative Review.

OBJECTIVES: (1) To explore stressors affecting midlife adults and understand their impact on health behaviors and the development of chronic medical conditions; (2) To identify midlife-specific interventions that mitigate the impact of stressors on the health of this population. METHODS: We searched the PubMed database from inception to December 2017 using the search terms [mid-life] and [midlife] paired with related behaviors and conditions. Eligible articles provided data on: (1) sources of stress and effects on health behaviors, (2) development of chronic medical conditions, or (3) midlife interventions targeting health-related stressors or behaviors. We also reviewed the references of articles found in the initial search to identify additional articles. We included studies not focused on midlife for comparison. RESULTS: This review revealed that interpersonal stress (e.g., caregiving and loneliness), occupational stress, and financial stress are highly prevalent in midlife and have a substantial impact on the health and health behaviors of this population. Many of these stressors converge, intensifying associated distress and health impact. Although not always targeted specifically to this population, interventions focused on diminishing these stressors have showed promising results, particularly group interventions and those focused on positive psychological well-being and mindfulness. CONCLUSION: Midlife is a large and growing population at high risk for chronic medical conditions. Specific stressors during this period are negatively associated with health outcomes. Further research is needed on midlife-specific interventions focused on mitigating these stressors, as such interventions have the potential to improve quality of life and promote health in this significant and vulnerable segment of society.

A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure: A Proof-of-Concept Trial.

Patients with heart failure (HF) frequently struggle to adhere to health behaviors, and psychological factors may contribute to nonadherence. We examined the feasibility and acceptability of a 10-week, positive psychology (PP)-based intervention to promote health behavior adherence in patients (N = 10) with mild to moderate HF and suboptimal health behavior adherence. Participants engaged in weekly phone sessions, completed PP exercises (e.g., writing a gratitude letter, using a personal strength), and set goals related to diet, medication adherence, and physical activity. Feasibility was assessed by the number of sessions completed, and acceptability by participant ratings of ease and utility. Preliminary efficacy was measured by changes in psychological and adherence outcomes. The intervention was feasible (87% of exercises completed) and acceptable. Furthermore, in exploratory analyses, the intervention was associated with improvements in psychological and health behavior adherence outcomes. Larger, randomized trials are needed to further investigate the utility of this intervention. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02938052.

Magnitude and sources of distress in mid-life adults with chronic medical illness: an exploratory mixed-methods analysis.

Most mid-life adults have at least one chronic medical condition (CMC) and are at risk for developing additional CMCs. Stressors specific to this life stage may contribute to CMC development by hindering healthy behaviors. The goal of this study was to compare sources and intensity of distress, as they relate to health behaviors, between mid-life and non-mid-life adults with CMCs. We utilized a mixed-methods approach by analyzing quantitative self-report measures of psychiatric symptoms and psychological well-being, with in-depth, semi-structured qualitative interviews to identify sources of stress in three cohorts of patients with CMCs (heart failure, type 2 diabetes, and coronary artery disease). Between-group differences on self-report measures were compared via independent samples t-tests and relevant themes from interview transcripts were compared via chi-square analysis. We found that mid-life participants (n = 30) reported greater psychological distress (depression/anxiety) than non-mid-life (n = 62) participants (Hospital Anxiety and Depression Scale scores 13.8 [SD 7.3] vs. 10.6 [SD 6.6]; t(90)=2.13; p = .035), and qualitative analysis revealed several specific sources of stress significantly more common (p < .001) in mid-life adults. Interventions targeting the needs of this population could reduce distress, improve health behaviors, and have a major impact on public health.

Transcranial Direct Current Stimulation to the Left Dorsolateral Prefrontal Cortex Improves Cognitive Control in Patients With Attention-Deficit/Hyperactivity Disorder: A Randomized Behavioral and Neurophysiological Study.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with significant morbidity and mortality that may affect over 5% of children and approximately 2.8% of adults worldwide. Pharmacological and behavioral therapies for ADHD exist, but critical symptoms such as dysexecutive deficits remain unaffected. In a randomized, sham-controlled, double-blind, crossover mechanistic study, we assessed the cognitive and physiological effects of transcranial direct current stimulation (tDCS) in 40 adult patients with ADHD in order to identify diagnostic (cross-sectional) and treatment biomarkers (targets). METHODS: Patients performed three experimental sessions in which they received 30 minutes of 2 mA anodal tDCS targeting the left dorsolateral prefrontal cortex, 30 minutes of 2 mA anodal tDCS targeting the right dorsolateral prefrontal cortex, and 30 minutes of sham. Before and after each session, half the patients completed the Eriksen flanker task and the other half completed the stop signal task while we assessed behavior (reaction time, accuracy) and neurophysiology (event-related potentials). RESULTS: Anodal tDCS to the left dorsolateral prefrontal cortex modulated cognitive (reaction time) and physiological (P300 amplitude) measures in the Eriksen flanker task in a state-dependent manner, but no effects were found in the stop signal reaction time of the stop signal task. CONCLUSIONS: These findings show procognitive effects in ADHD associated with the modulation of event-related potential signatures of cognitive control, linking target engagement with cognitive benefit, proving the value of event-related potentials as cross-sectional biomarkers of executive performance, and mechanistically supporting the state-dependent nature of tDCS. We interpret these results as an improvement in cognitive control but not action cancellation, supporting the existence of different impulsivity constructs with overlapping but distinct anatomical substrates, and highlighting the implications for the development of individualized therapeutics.

Does timeframe adjustment of the Life Orientation Test-Revised assess optimism as a state?: Data from the PEACE-III trial in patients with heart disease.

Optimism is prospectively associated with superior health outcomes in cardiac patients, making it an attractive target for well-being interventions in this population. However, optimism measured by the Life Orientation Test-Revised (LOT-R) has largely been considered a static, dispositional construct. Among 125 patients with a recent acute coronary syndrome who received a positive psychology intervention, we assessed the properties of a modified LOT-R that changed the timeframe of items from general dispositional statements to queries about 'right now.' We aimed to learn whether this modified LOT-R was more dynamic than the original LOT-R via administration of both instruments at three timepoints over the 16-week study period. Contrary to our hypothesis, this modified LOT-R showed no greater change in mean score or intra-individual variance than the original LOT-R over 16 weeks. This suggests that simply changing the timeframe of the LOT-R may not facilitate assessment of more state-like optimism in medical patients.

Alternative treatment strategies for catatonia: A systematic review.

BACKGROUND: Catatonia is a commonly encountered syndrome, affecting 10-20% of various psychiatric populations and carrying significant medical co-morbidities. However, there are few established alternative treatment strategies when benzodiazepines are ineffective and electroconvulsive therapy is unavailable. OBJECTIVE: The authors systematically review evidence for alternative treatment strategies for catatonia using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. METHOD: The authors conducted a search of PubMed database from 1983 to August 2016 to identify articles. Eligible reports presented cases involving treatment of catatonia using modalities other than benzodiazepines or electroconvulsive therapy. RESULTS: The authors identified 72 articles, comprising 98 individual cases. N-methyl-d-aspartate-receptor antagonists, anti-epileptic drugs, and atypical antipsychotic agents appeared to have the largest number of reports supporting their effectiveness and safety in treating catatonia patients. CONCLUSIONS: Based on the case report literature, the authors propose an updated algorithm for catatonia treatment in cases where benzodiazepines fail and electroconvulsive therapy is not available.