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Longitudinal assessment of psychotherapeutic day hospital treatment for neuropsychiatric symptoms in dementia
- Authors:
- WEBER Kerstin, et al
- Journal article citation:
- Aging and Mental Health, 13(1), January 2009, pp.92-98.
- Publisher:
- Taylor and Francis
Behavioural and psychological symptoms (BPSD) of dementia are associated with more rapid cognitive deterioration as well as increased caregiver stress. The effectiveness of psychiatric day hospital care for this condition remains disputed. This study reports on the assessment of a psychotherapeutic day hospital program in a series of elderly people with dementia and concomitant BPSD. The day hospital program combined music, movement, psychodynamic group therapies, sociotherapy as well as individual interviews and family interventions. Participants were 76 individuals with mild to moderate dementia. Outcome measures were the Neuropsychiatric Inventory (NPI), Therapeutic Community Assessment scale including staff (SAS) and client assessments (CAS) and a Group Evaluation Scale (GES) were administrated at admission, 3, 6 and 12 months and discharge. Linear regression analysis showed that SAS (but not CAS) and GES scores significantly increased while the NPI total scores decreased across the different time points. NPI item score modifications were significant for anxiety and apathy. These changes remained significant when demographic variables, drug treatment changes and occurrence of life events were also considered. It is concluded that a psychotherapeutic day hospital program designed for older people with dementia and neuropsychiatric symptoms allows for a significant reduction of anxiety and apathy, better adhesion to therapeutic community treatment and clinical progress in group therapy. Controlled interventional studies are needed to further confirm these data.
Longitudinal assessment of psychotherapeutic day hospital treatment for elderly patients with depression
- Authors:
- CANUTO Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(9), September 2008, pp.949-956.
- Publisher:
- Wiley
Although previous studies suggested that psychiatric day hospital care is a valuable alternative to inpatient treatment, its effectiveness for elderly patients is disputed. Small number of cases, poor definition of the psychotherapeutic setting, and absence of systematic assessment at different time points may explain the observed discrepancies. This study performed an assessment of a psychiatric day hospital treatment combining individual and group psychotherapy in a series of 122 elderly depressed outpatients. The Geriatric Depression Scale, Short Form Survey, as well as a Therapeutic Community Assessment Scale and Group Evaluation Scale were repeated at admission, 3, 6, 12 months and discharge. The day hospital program was based on psychotherapeutic treatment combining individual and group settings. All patients presented with major depression or a depressive episode of bipolar disease. Variables included severity of depressive symptoms, quality of life, adhesion to therapeutic community treatment and progress in groups of psychotherapy, art-therapy, and psychomotricity. There was a significant reduction of depressive symptoms, and improvement in mental quality of life across all time points studied. Adhesion to therapeutic community increased from admission to discharge. This was also the case for the progress in group therapy for all three groups used, yet the evolution of this parameter at intermediate time points was highly variable. Neither demographic characteristics, nor pharmacological treatment or presence of stressful life events predicted the clinical improvement. Psychotherapeutic care program in day hospitals may improve clinical status and quality of life in elderly depressed patients.