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Predictors of comprehensive stimulation program efficacy in patients with cognitive impairment. Clinical practice recommendations
- Authors:
- BINETTI Giuliano, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(1), 2013, pp.26-33.
- Publisher:
- Wiley
This longitudinal study examined which factors best predict response to a comprehensive stimulation programme offered to patients with dementia and mild cognitive impairment (MCI) and their caregivers. A total of 145 Italian patients (55 with MCI and 90 with dementia), participating to a cognitive motor rehabilitation program, and their 131 caregivers, attending informational/psychoeducational interventions were followed for six months. Three alternative cognitive stimulation interventions were used: Reality Orientation Therapy, Global Reactivation Therapy, and Memory Training. Mini mental state examination, Alzheimer’s Disease Assessment Scale-Cognition, and Clinician’s Interview-Based Impression of Change-plus were the primary outcome measures. Sixty-eight (46.9%) of the 145 subjects were classified as clinical responders. At baseline, responders had a significantly less insight into impairment, greater functional capacity as well as fewer delusions, euphoria, and aberrant motor behaviours than the non-responder. After 6 months, along with an improvement in cognition, responders also showed decreased behavioural disturbances and severity of disturbances. During the analysis the caregiver's burden of distress remained stable; however after 6 months the burden of the caregivers of MCI responders was reduced. The authors conclude that a high level of insight, preserved functional abilities as well as the lack of severe delusions, euphoria, and aberrant motor behaviours are significant predictors of responsiveness to stimulation programmes.
Open trial on crisis psychotherapy in Padova, Italy
- Authors:
- PAVAN I., et al
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(1), Spring 2003, pp.37-46.
- Publisher:
- Oxford University Press
Crisis psychotherapy is addressed to patients with feelings of impotence: a precise psychological correlate characteristic of the crisis situation. Associated with this picture are anxious-depressive and personality disorders. Prevention focuses on recovering previous level of functioning in order to forestall the evolution of maladaptive behaviors that may in turn lead to chronic pathology or suicide. The aim of this study was to preliminarily assess symptom outcome in 42 cases treated with the model adopted in Padua, Italy. Assessment was based on various instruments to explore depression (Beck Depression Inventory [BDI], Hamilton Depression Rating Scale [HRSD]), anxiety (State-Trait Anxiety Expression Inventory [STAI]), anger (State-Trait Anger Expression Inventory [STAXI]), global functioning (Global Assessment Scale [GAS]), social adjustment (Social Adaption Self Evaluation Scale [SASS]), stressful events, and personality (Structured Clinical Interview for DSM-IV [SCID II]). Depression and anxiety levels displayed a significant decrease at the end of treatment. There was also a significant reduction in levels of trait anxiety and anger, probably indicating a "return to baseline" after a destabilizing experience. These effects mark a "traumatic" impasse resulting from stressful life events that may be either real external events or subjectively traumatic psychological events. Other positive effects of the therapy were improvement in global functioning and renewed interest in social relations. Some degree of comorbidity with personality disorders emerged, especially from DSM-IV clusters C and B. Further controlled studies are warranted to assess the effect of spontaneous remission on this intervention technique.