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Motivational interviewing and the older population in psychiatry
- Authors:
- BUGELLI Tania, CROWTHER Terrence R.
- Journal article citation:
- Psychiatric Bulletin, 32(1), January 2008, pp.23-25.
- Publisher:
- Royal College of Psychiatrists
Motivational interviewing is a psychological intervention that could potentially give clinical staff working with older people a way of tackling ambivalence and/or resistance to change in therapy. Although it has been shown to be effective in various spheres of mental health, this paper discusses the main principles of this intervention and some adaptations necessary to meet the needs of older people (i.e. those over 65 years old). Patients require the capacity to understand and retain new information in order to make use of this intervention, which hence limits its use to those who retain good cognitive functioning.
Survey of the provision of psychological therapies for older people
- Authors:
- EVANS Ceri, REYNOLDS Paul
- Journal article citation:
- Psychiatric Bulletin, 30(1), January 2006, pp.10-13.
- Publisher:
- Royal College of Psychiatrists
The aim of the present study was to assess the current state of provision of psychological therapies for older people in Wales. A postal questionnaire was sent to all consultant old age psychiatrists in Wales, requesting information regarding the consultant’s community mental health team (CMHT) and access to psychological therapies. A response rate of 85% was achieved: 45% of CMHTs had team members providing psychological therapy; 31% of CMHTs had access to psychological therapy via the team and also generic services. The estimated average wait for generic services was 29 weeks. There was no access to psychological therapies for 17% of CMHTs. In some areas of Wales there is limited or no access to psychological therapies via mental health services for older people. This may represent an important unmet need. Long-term strategies, taking into account recruitment and retention, training and new ways of working, need to be implemented.
White matter lesions on magnetic resonance imaging and their relationship with vascular risk factors in memory clinic attenders
- Authors:
- LAZARUS R., PRETTYMAN R., CHERRYMAN G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.274-279.
- Publisher:
- Wiley
The association between white matter lesions on magnetic resonance imaging (MRI) and the presence of vascular risk factors has been investigated in different populations, and results have varied widely. However, this relationship has not been adequately addressed in memory clinic attenders who have relatively early cognitive impairment. This study was undertaken to determine the relationship between the severity of white matter lesions and vascular risk factors in elderly subjects referred to a Memory Clinic, irrespective of their diagnoses. Patients attending the Memory Clinic had relatively early, mild cognitive impairment and differed, in this respect, from typical unselected community-based samples and from patients with established dementia. The study also investigated whether periventricular and deep white matter lesions differed in their relationship with vascular risk factors. All patients assessed in the Memory Clinic at Leicester General Hospital between April 1998 and October 2000 who had undergone an MRI scan were included in the study. They received a comprehensive clinical and cognitive assessment, a standard dementia laboratory screen and evaluation of vascular risk factors. MRI scans were reviewed by two independent raters and semi-quantitative ratings of the severity of white matter lesions were made using standardised protocols. The relationship between cerebral white matter lesions and vascular risk factor variables was examined by multiple linear regression. One hundred and seventy-seven subjects were included in the study. The mean age was 69.8 and the mean MMSE score was 23.2. Of the risk factors investigated, only age and prior cerebrovascular disease were significantly associated with severe periventricular white matter lesions; age, hypertension and diabetes were significantly associated with severe deep white matter lesions. Periventricular and deep white matter lesions are differentially influenced by vascular risk factors.
The effects of reminiscence on depressive symptoms and mood status of older institutionalized adults in Taiwan
- Author:
- WANG Jing-Yy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.57-62.
- Publisher:
- Wiley
This study examined the effects of reminiscence on depressive symptoms and mood status of elderly people residing in long-term care facilities. A longitudinal quasi-experimental design was conducted, using two equivalent groups for pre-post test and purposive sampling. Each subject was administered pre- and post- tests at a 4 month interval, but subjects in the experimental group underwent weekly individual reminiscence therapy. Geriatric Depression Scale short form (GDS-SF) and Apparent Emotion Rating Scale (AER) were used as study instruments. Forty-eight subjects completed the study, with 25 in the experimental group and 23 in the control group. The experimental findings indicated that the experimental group demonstrated fewer depressive symptoms (p < 0.05) and better mood status (p = 0.05) on the post-test comparing to the control group. These warranted that reminiscence therapy is a recommended therapy for older people who reside in care facilities. It can provide a basis for planning geriatric care in community to promote the well being and quality of life of older people.
A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia
- Authors:
- BAILLON Sarah, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1047-1052.
- Publisher:
- Wiley
Behavioural disturbance, such as agitation, is a common feature of dementia, and causes significant problems and distress for carers. Snoezelen is increasingly used with people who have dementia, but there is limited evidence of its efficacy. This crossover randomised controlled study aimed to evaluate the effect of Snoezelen on the mood and behaviour of patients with dementia, in comparison to the effect of an established and accepted intervention, reminiscence therapy. Twenty patients with dementia and significant agitated behaviour, received three sessions each of Snoezelen and reminiscence. The effects were assessed using measures of observed agitated behaviour and heart rate over the course of the sessions, and mood and behaviour during the sessions. Both interventions had a positive effect. Snoezelen was no more beneficial than reminiscence in terms of effecting a significant reduction in agitated behaviour or heart rate. There was considerable variation in the way individuals responded to each intervention. Snoezelen may have a more positive effect than reminiscence, but due to the observed differences between the interventions being small, and the small number of subjects, this advantage was not demonstrated statistically. Further research, with larger numbers of subjects, and an appropriate control is required to establish the benefits of Snoezelen for people at different stages of dementia, and to identify any benefits additional to those derived from increased staff attention.
A survey of the provision of psychological treatments to older adults in the NHS
- Author:
- EVANS Sandra
- Journal article citation:
- Psychiatric Bulletin, 28(11), November 2004, pp.411-414.
- Publisher:
- Royal College of Psychiatrists
A questionnaire was sent to old age psychiatrists to ascertain their experience, views and clinical practice regarding psychological therapies in their services. The provision of psychological treatments of all modalities to older people is widely varied in Britain. The main difficulty seems to be a lack of resources, but it would appear that inexperience with psychological therapies applied to older adults is also a factor. Most mental health teams (95%) provide anxiety management therapy, and cognitive–behavioural therapy is widely available (76% of teams), but areas such as training and staff supervision appear to be poorly provided. Suggestions are made to increase provision and quality of service within existing resources; improving services to the standards of the National Service Framework would be a bigger challenge.
A counseling intervention for caregivers: effect on neuropsychiatric symptoms
- Authors:
- SENANARONG Vorapun, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.781-788.
- Publisher:
- Wiley
In Thailand, family caregivers have an important role in delivering care to patients with dementia. Most patients with dementia in Thailand and also in Western societies live in the community. Training caregivers may improve care of dementia patients. The authors performed a treatment study of a six-month caregiver intervention with group counseling and support with provision of techniques to cope with non-cognitive symptoms of patients with dementia. They hypothesized that this caregiver intervention with group counseling and support would reduce behavioral and neuropsychiatric symptoms in the demented patients. They conducted a parallel group intervention study. A manual for group counseling and support was developed focusing on education regarding dementia, behavioral analysis and intervention, and environmental adaptation. Fifty nonprofessional caregivers - 25 from the control group and 25 from the study group - of patients with dementia from the memory clinic at Siriraj Hospital were alternately assigned to each group as they presented to the clinic if they met the inclusion criteria and agreed to participate. The Thai Mental State Examination (TMSE) was used to assess dementia severity. Forty-five minute counseling sessions were conducted every 6-8 weeks for 6 months and assessments were conducted at 3 months and 6 months. The primary outcome measure was the Neuropsychiatric Inventory (NPI). A paired samples analysis of the NPI scores demonstrated a significant change of the total NPI scores at the end of six month from baseline in the intervention group (P = 0.045). Change from baseline of the comparison group was not significant. There was a trend towards improvement of the TMSE scores between the two groups at month six (p = 0.061). The result favored the treatment group. This study provided evidence of the utility of a non-pharmacologic intervention using group counseling in an out-patient setting for caregivers of patients with dementia.
The effects of light therapy on depressed elders
- Authors:
- TSAI Yun-Fang, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.516-522.
- Publisher:
- Wiley
Elderly depression has gradually become a severe issue in the health care system. No studies have focused on evaluating the effects of light therapy on the elderly with depression in a subtropical climate area. Experimental design was used. For the experimental group, patients sat in front of a light box, receiving 5000 lux in the morning. The light therapy course was administered for 50 minutes per day and lasted for 5 days. The control group did not receive any treatment. Depressive symptoms were significantly reduced in the experimental group at post-test but no significant decline was found in the control group. Based upon the results of this study, light therapy could be used to decrease depressive symptoms in the elderly.
Bright light treatment improves sleep in institutionalised elderly: an open trial
- Authors:
- FETVEIT Arne, SKJERVE Arvid, BJORRVATIN Bjorn
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.520-526.
- Publisher:
- Wiley
This study evaluates the effects of bright light therapy among demented nursing home patients with sleep disturbances. 11 nursing home patients with actigraphically measured sleep efficiency below 85% took part in an open, non-randomised study where the subjects served as their own control. After two weeks of baseline measurements and two weeks of pretreatment measurements, patients received bright light exposure 2 h/day within the period 08:00-11:00 for two weeks. Sleep-wake patterns during the 24-h day were evaluated by nursing staff ratings and wrist-worn motor activity devices (actigraphs). Sleep improved substantially with bright light exposure. Waking time within nocturnal sleep was reduced by nearly two h, and sleep efficiency improved from 73% to 86%. Corresponding improvements were found in nursing staff ratings. Effects were consistent across subjects. The findings add further evidence of the effectiveness of morning bright light exposure in the treatment of disturbed sleep among demented nursing home patients
Light therapy for behavioural and psychological symptoms of dementia
- Authors:
- SKJERVEArvid, BJORBATN Bjorn, HOLSTEN Fred
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.516-522.
- Publisher:
- Wiley
Reviews the literature concerning the efficacy, clinical practicability and safety of light treatment for behavioural and psychological symptoms of dementia (BPSD). Data collection included computer literature searches (MEDLINE, PsycINFO and Cochrane) and checks of references, covering the period of January 1980-September 2003. Trials were searched for evidence for treatment efficacy and for their consideration of the treatment's clinical practicability and evidence of adverse effects. Results from randomised controlled trials (RCT) indicated some evidence of improvement in aspects of sleep disturbances and circadian activity rhythmicity. One RCT study indicated better response in patients with vascular dementia compared to Alzheimer's disease. By and large, non-RCT studies reported improvement in BPSD including sleep disturbances, agitation and activity rhythm disturbances. Few studies commented on the treatment's practicability and safety. Although there is some evidence for influence of light therapy on sleep and circadian activity rhythmicity, it is not possible to draw any conclusion about efficacy of light therapy for BPSD, or about practicability in clinical settings and safety. There are still too few well designed studies. Suggestions for further research are presented.