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Sorg SF, Squeglia LM, Taylor MJ, Alhassoon OM, Delano-Wood LM, Grant I. Effects of aging on frontal white matter microstructure in alcohol use disorder and associations with processing speed. J Stud Alcohol Drugs 2016; 76:296-306. [PMID: 25785805 DOI: 10.15288/jsad.2015.76.296] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The number of older adults with alcohol use disorder (AUD) is expected to significantly increase in the coming years. Both aging and AUD have been associated with compromised white matter microstructure, although the extent of combined AUD and aging effects is unclear. This study investigated interactions between aging and AUD in cerebral white matter integrity using diffusion tensor imaging (DTI). METHOD All participants (44 recently detoxified participants with AUD and 28 healthy controls; ages 31-64 years) completed neurocognitive testing and a DTI scan. Regions of interests were identified on Tract-Based Spatial Statistics images. Hierarchical multiple regression was used to examine interactions between age and AUD status on DTI values [e.g., fractional anisotropy (FA)]. RESULTS Significant Age × AUD interactions were found across several prefrontal white matter regions (R(2)Δ = 5%-9%). Regional FA was negatively associated with age in the AUD group (rs = -.33 - -.53) but not in the control group (rs = .18 - -.32). This pattern remained after adjusting for lifetime history of drinking and recent drinking. Lifetime alcohol consumption negatively correlated with frontal white matter integrity in the AUD group (rs = -.33 - -.40). Finally, processing speed was significantly slower in the AUD group versus controls (p = .001) and was positively correlated with FA values in frontal white matter regions (rs = .34-.53). CONCLUSIONS Cumulative alcohol consumption may affect frontal white matter integrity, and persons with AUD may be more prone to reductions in frontal white matter integrity with advancing age. These reductions in frontal white matter integrity may contribute to reductions in processing speed.
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Affiliation(s)
- Scott F Sorg
- Veterans Affairs San Diego Healthcare System, La Jolla, California, Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michael J Taylor
- Veterans Affairs San Diego Healthcare System, La Jolla, California, Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Omar M Alhassoon
- Department of Psychiatry, University of California, San Diego, La Jolla, California, California School of Professional Psychology, San Diego, California
| | - Lisa M Delano-Wood
- Veterans Affairs San Diego Healthcare System, La Jolla, California, Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Igor Grant
- Veterans Affairs San Diego Healthcare System, La Jolla, California, Department of Psychiatry, University of California, San Diego, La Jolla, California
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Affiliation(s)
- Mary Zagari K. MacLeod
- The Margaret Warner Graduate School of Education and Human Development; University of Rochester
| | - Kathryn Z. Douthit
- The Margaret Warner Graduate School of Education and Human Development; University of Rochester
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Developing zebrafish models relevant to PTSD and other trauma- and stressor-related disorders. Prog Neuropsychopharmacol Biol Psychiatry 2014; 55:67-79. [PMID: 25138994 DOI: 10.1016/j.pnpbp.2014.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/01/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022]
Abstract
While post-traumatic stress disorder (PTSD) and other trauma- and stress-related disorders (TSRDs) represent a serious societal and public health concern, their pathogenesis is largely unknown. Given the clinical complexity of TSRD development and susceptibility, greater investigation into candidate biomarkers and specific genetic pathways implicated in both risk and resilience to trauma becomes critical. In line with this, numerous animal models have been extensively used to better understand the pathogenic mechanisms of PTSD and related TSRD. Here, we discuss the rapidly increasing potential of zebrafish as models of these disorders, and how their use may aid researchers in uncovering novel treatments and therapies in this field.
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Stewart AM, Braubach O, Spitsbergen J, Gerlai R, Kalueff AV. Zebrafish models for translational neuroscience research: from tank to bedside. Trends Neurosci 2014; 37:264-78. [PMID: 24726051 DOI: 10.1016/j.tins.2014.02.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 01/23/2023]
Abstract
The zebrafish (Danio rerio) is emerging as a new important species for studying mechanisms of brain function and dysfunction. Focusing on selected central nervous system (CNS) disorders (brain cancer, epilepsy, and anxiety) and using them as examples, we discuss the value of zebrafish models in translational neuroscience. We further evaluate the contribution of zebrafish to neuroimaging, circuit level, and drug discovery research. Outlining the role of zebrafish in modeling a wide range of human brain disorders, we also summarize recent applications and existing challenges in this field. Finally, we emphasize the potential of zebrafish models in behavioral phenomics and high-throughput genetic/small molecule screening, which is critical for CNS drug discovery and identifying novel candidate genes.
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Affiliation(s)
- Adam Michael Stewart
- ZENEREI Institute and the International Zebrafish Neuroscience Research Consortium (ZNRC), 309 Palmer Court, Slidell, LA 70458, USA; Department of Neuroscience, University of Pittsburgh, A210 Langley Hall, Pittsburgh, PA 15260, USA
| | - Oliver Braubach
- Center for Functional Connectomics, Korea Institute of Science and Technology, Hwarangno 14-gil 5, Seoul, 136791, Republic of Korea
| | - Jan Spitsbergen
- Department of Microbiology, Oregon State University, Nash Hall 220 Corvallis, OR 97331, USA
| | - Robert Gerlai
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, N Mississauga, Ontario L5L 1C6, Canada
| | - Allan V Kalueff
- ZENEREI Institute and the International Zebrafish Neuroscience Research Consortium (ZNRC), 309 Palmer Court, Slidell, LA 70458, USA.
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Kalueff AV, Nguyen M. Testing anxiolytic drugs in the C57BL/6J mouse strain. J Pharmacol Toxicol Methods 2014; 69:205-7. [DOI: 10.1016/j.vascn.2014.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Stewart AM, Kalueff AV. Anxiolytic drug discovery: what are the novel approaches and how can we improve them? Expert Opin Drug Discov 2013; 9:15-26. [PMID: 24206163 DOI: 10.1517/17460441.2014.857309] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Contemporary biological psychiatry uses experimental (animal) models to increase our understanding of affective disorder pathogenesis. Despite the well-recognized spectrum nature of affective disorders, modern anxiolytic drug discovery mainly targets specific pathways and molecular determinants within a single phenotypic domain. However, greater understanding of the integrative mechanisms and pathogenesis is essential in order to develop new effective therapies. AREAS COVERED In this review, the authors emphasize the importance of a 'domain interplay-oriented' approach to experimental affective research. They also highlight the need to expand the scope of anxiolytic drug targets to better understand the pathogenesis of anxiety-spectrum disorders. EXPERT OPINION There is the potential to markedly improve the utility of animal models for affective disorders. First, the authors suggest that one such way would be by analyzing the systems of several domains and their interplay to better understand disease pathogenesis. Further, it could also be improved by expanding the range of model species and by extending the spectrum of anxiolytic drug targets; this would help to focus on emerging and unconventional systems to better develop new therapies.
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Affiliation(s)
- Adam Michael Stewart
- ZENEREI Institute , 309 Palmer Court, Slidell, LA 70458 , USA +1 240 328 2275 ; +1 240 328 2275 ;
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Nogueira EL, Cataldo Neto A, Cauduro MHF, Ulrich LEF, Spanemberg L, DeCarli GA, Gomes I. Prevalence and Patterns of Alcohol Misuse in a Community-Dwelling Elderly Sample in Brazil. J Aging Health 2013; 25:1340-57. [PMID: 24179052 DOI: 10.1177/0898264313506461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: The aim of this study was to estimate prevalence and patterns of lifetime alcohol misuse. Method: This was a cross-sectional study of a representative sample of 1,078 individuals aged 60 or more. Structured interview included sociodemographic, lifestyle, health data, and the five alcohol misuse screening questions of the Self-Reporting Questionnaire. Results: Prevalence of misuse was 6.5%. Men, aged 60 to 69, low educational level, separated/divorced, and tobacco smoking were independently associated with lifetime alcohol misuse. Odds ratios show increasing association with levels of alcohol misuse groups in males, low-educated, and tobacco users. Persons aged 60 to 69, 4 to 7 education years, and non-White ethnicity were significantly associated with the major alcohol misuse score. Discussion: Younger elderly were more exposed to alcohol than previous cohorts. Thus, problems with alcohol in old age will possibly increase as they grow older. The results of this study call attention to a field of lacking evidence in alcohol-related problems of older persons.
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Affiliation(s)
| | | | | | | | - Lucas Spanemberg
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Geraldo A. DeCarli
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Irenio Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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McHugh JE, Lawlor BA. Social support differentially moderates the impact of neuroticism and extraversion on mental wellbeing among community-dwelling older adults. J Ment Health 2013; 21:448-58. [PMID: 22978500 DOI: 10.3109/09638237.2012.689436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Personality affects psychological wellbeing, and social support networks may mediate this effect. This may be particularly pertinent in later life, when social structures change significantly, and can lead to a decline in psychological wellbeing. AIM To examine, in an older population, whether the relationships between neuroticism and extraversion and mental wellbeing are moderated by available social support networks. METHOD We gathered information from 536 community-dwelling older adults, regarding personality, social support networks, depressive symptomatology, anxiety and perceived stress, as well as controlling for age and gender. RESULTS Neuroticism and extraversion interacted with social support networks to determine psychological wellbeing (depression, stress and anxiety). High scores on the social support networks measure appear to be protective against the deleterious effects of high scores on the neuroticism scale on psychological wellbeing. Meanwhile, individuals high in extraversion appear to require large social support networks in order to maintain psychological wellbeing. CONCLUSION Large familial and friendship social support networks are associated with good psychological wellbeing. To optimise psychological wellbeing in older adults, improving social support networks may be differentially effective for different personality types.
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Affiliation(s)
- J E McHugh
- TRIL (Technology Research for Independent Living) Centre, St James's Hospital, Dublin, Ireland.
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Panek PE, Jenkins SR, Hayslip B, Moske AK. Verbal expressive personality testing with older adults: 25+ years later. J Pers Assess 2013; 95:366-76. [PMID: 23441570 DOI: 10.1080/00223891.2013.767821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This review builds on those conducted over 25 years ago by Panek and Hayslip in examining the literature dealing with the use of verbal expressive techniques with older adults. Such findings based on the Rorschach Ink Blot Test, Holtzman Inkblot Technique, Hand Test, Sentence Completion methods, and the Thematic Apperception Test and kindred thematic apperceptive techniques are presented and evaluated regarding the evidence for age differences, differential diagnosis, extraneous individual differences in performance, and adequacy of normative data. Although available evidence appears to warrant the continued use of verbal expressive techniques with older adults, more adequately designed studies are necessary to fully support the potential of these assessment tools for decision making with this population: assisting in diagnosis, recommending the appropriateness of various living arrangements, facilitating supportive care choices, and aiding in treatment planning.
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Affiliation(s)
- Paul E Panek
- Department of Psychology, The Ohio State University-Newark, OH, USA
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Javadpour A, Sehatpour M, Mani A, Sahraian A. Assessing Diagnosis and Symptoms Profiles of Late-Life Psychosis. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2013. [DOI: 10.1024/1662-9647/a000090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: There are many controversies with regard to the nosology and conditions causing psychosis in old age people. This study defines a symptom profile and differential diagnosis of late-onset psychosis. Method: 201 elderly persons with psychotic symptoms were recruited. All patients were interviewed based on SCID-1 to confirm the possible diagnosis. Results: The most delusional symptom reported by the subjects was persecutory delusion, and visual hallucinations were the most common hallucination. The most repeated diagnosis was dementia, followed by psychosis due to mood disorders, primary psychotic disorders, delirium, and psychosis due to medical conditions. Conclusions: Results from the current study indicate that late-life psychoses form a heterogeneous group of disorders with varying symptom profiles and etiologies.
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Affiliation(s)
- Ali Javadpour
- Research Centre for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sehatpour
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Sahraian
- Research Centre for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Futeran S, Draper BM. An examination of the needs of older patients with chronic mental illness in public mental health services. Aging Ment Health 2012; 16:327-34. [PMID: 22128796 DOI: 10.1080/13607863.2011.628978] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To describe the needs of patients aged 50 years and over with chronic mental illness being case managed within a public mental health service, and to determine factors that influence these needs. METHOD Patients were recruited from community-based Adult Mental Health (AMH) teams and Specialist Mental Health Services for Older People (SMHSOP) teams. Eligibility criteria included a diagnosis of schizophrenia or mood disorder. Patient, carer and key worker interviews were carried out using the Camberwell Assessment of Need for the Elderly (CANE). RESULTS Of 183 eligible patients, 97 (mean age of 66.4 years) participated, of whom 63 were managed by AMH teams and 34 by SMHSOP teams. The majority (52%) had a diagnosis of schizophrenia, particularly those managed by AMH (71%). Patients self-rated fewer needs overall on the CANE than their key workers or the researcher, and also rated a higher proportion of their needs being met (83%) than the key worker (77%) or researcher (76%). From each perspective, over 80% of psychiatric and around 95% of identified medical needs were being met. The majority of social needs were unmet, with patients reporting only 42%, and key workers only 33%, met needs. The key unmet social needs were company, daily activities and having a close confidant. Key workers, patients and researchers rated SMHSOP service delivery to have significantly less unmet needs. CONCLUSIONS The social needs of older patients with chronic mental illness require greater attention by public mental health services.
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Affiliation(s)
- Shuli Futeran
- Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Randwick, NSW, Sydney, Australia
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Abstract
Despite the effectiveness of exposure therapy to alleviate trauma-related distress, many older adults are unable or unwilling to enter therapy. Mild forms of exposure therapy, such as completing memory questionnaires about a stressful event, have been shown to reduce distress in younger adults. This study attempted to examine the impact of a mild form of exposure therapy in an older adult population. A community-living sample of 263 older adults nominated a stressful event from their lives, and were randomly assigned to either complete questionnaires concerning their memory of the stressful event, or a control task. Results indicated that those who had completed the memory questionnaires about a nominated stressful event evidenced lower levels of distress two weeks later. This effect was stronger for events that were either more recent or had elevated initial levels of distress. These findings suggest an alternative treatment for older adults who have experienced a stressful or traumatic event.
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Affiliation(s)
- Adriel Boals
- Department of Psychology, University of North Texas, Denton, TX, USA.
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Currin JB, Hayslip B, Temple JR. The relationship between age, gender, historical change, and adults' perceptions of mental health and mental health services. Int J Aging Hum Dev 2011; 72:317-41. [PMID: 21977677 DOI: 10.2190/ag.72.4.c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to explore the impact of age, historical change, and gender on perceptions of mental health and mental health services. Using multidimensional measures to assess such perceptions among older adults (1977, 1991, 2000), and younger adults (1991, 2000), we expected that older adults would have less positive mental health perceptions than would younger adults, that more recently born cohorts of older persons would evidence more positive perceptions, and that women, especially those more recently assessed, would also evidence more positive perceptions. To an extent, we found positive historical shifts in mental health perceptions, though data also indicated that such views may have stabilized over the last decade for older persons, and interacted with age and gender in this respect. Age differences favoring younger persons were, in part, replicated across historical time, and women held more positive mental health perceptions than did men. Over historical time, older persons' mental health perceptions are, for the most part, increasingly positive, significant in light of the increasing proportion of older persons and changes in the mental health system itself. Our data suggest that efforts to reach older men should be given high priority.
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Stewart A, Gaikwad S, Hart P, Kyzar E, Roth A, Kalueff AV. Experimental models for anxiolytic drug discovery in the era of omes and omics. Expert Opin Drug Discov 2011; 6:755-69. [PMID: 22650981 DOI: 10.1517/17460441.2011.586028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Animal behavioral models have become an indispensable tool for studying anxiety disorders and testing anxiety-modulating drugs. However, significant methodological and conceptual challenges affect the translational validity and accurate behavioral dissection in such models. They are also often limited to individual behavioral domains and fail to target the disorder's real clinical picture (its spectrum or overlap with other disorders), which hinder screening and development of novel anxiolytic drugs. AREAS COVERED In this article, the authors discuss and emphasize the importance of high-throughput multi-domain neurophenotyping based on the latest developments in video-tracking and bioinformatics. Additionally, the authors also explain how bioinformatics can provide new insight into the neural substrates of brain disorders and its benefit for drug discovery. EXPERT OPINION The throughput and utility of animal models of anxiety and other brain disorders can be markedly increased by a number of ways: i) analyzing systems of several domains and their interplay in a wider spectrum of model species; ii) using a larger number of end points generated by video-tracking tools; iii) correlating behavioral data with genomic, proteomic and other physiologically relevant markers using online databases and iv) creating molecular network-based models of anxiety to identify new targets for drug design and discovery. Experimental models utilizing bioinformatics tools and online databases will not only improve our understanding of both gene-behavior interactions and complex trait interconnectivity but also highlight new targets for novel anxiolytic drugs.
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Affiliation(s)
- Adam Stewart
- Tulane University Medical School, Department of Pharmacology and Neuroscience Program , Tulane Neurophenotyping Platform, SL-83, 1430 Tulane Ave, New Orleans, LA 70112 , USA +1 504 988 3354 ;
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Abstract
OBJECTIVES This purpose of this study was to explore the following question: Are there gender differences among older individuals with a history of heroin addiction with regard to social and family relationships and health problems? METHODS Eight gender-specific focus groups were conducted with 38 (19 women, 19 men) older (50+ years) individuals with long-term histories of heroin dependence. Four groups were conducted in a methadone maintenance (MM) clinic and four groups were derived from the Los Angeles community. RESULTS Modest gender differences were observed, but mainly in the focus-group dynamics. Women typically described the impact of their addiction on their families, while men typically described their surprise at still being alive. Hepatitis C was the primary health concern in all groups; mental health issues were also discussed. DISCUSSION Remarkable gender differences were not apparent in the qualitative experiences of these participants. Instead, we found overriding similarities related to the interactive effects of drug use and aging. Longitudinal studies of this population as they age and interact with the health-care system and other social systems will help to untangle the complicated relationship between aging, drug addiction, gender, and health.
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Affiliation(s)
- Alison B Hamilton
- UCLA Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, University of Los Angeles, Los Angeles, CA, USA.
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Abstract
AIMS This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. DESIGN Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002-06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. SETTING Non-institutionalized US residences. PARTICIPANTS Representative sample of the US civilian, non-institutionalized population. MEASUREMENTS Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. FINDINGS Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. CONCLUSIONS Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.
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Affiliation(s)
- Beth Han
- Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, MD, USA.
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Khouzam HR, Emes R. Late life psychosis: assessment and general treatment strategies. ACTA ACUST UNITED AC 2008; 33:127-43. [PMID: 18004028 DOI: 10.1007/s12019-007-0016-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 11/30/1999] [Accepted: 04/27/2007] [Indexed: 10/22/2022]
Abstract
With the increased number of elderly patients suffering from mental illness, an increased incidence of psychiatric conditions including psychotic disorders is also expected. When psychosis occurs in the elderly, its assessment and treatment may pose a challenge for primary care clinicians and caregivers. This article will review the assessment and treatment of late life psychosis.
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Affiliation(s)
- Hani Raoul Khouzam
- Chemical Dependency Treatment Program, VA Central California Health Care System, Fresno, CA 93703, USA.
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Abstract
This article reviews the most common behavioral emergencies in the geriatric population. Psychiatric emergencies are seen frequently by emergency physicians who face the challenge of assessing and managing patients presenting with psychosis, severe depression, agitation, suicidal intent, and substance abuse in the emergency department. The evaluation is frequently complicated by the necessity to investigate numerous domains such as underlying medical conditions, prior psychiatric disorders and substance abuse, as well as psychosocial factors. It is crucial to rule out organic causes for what appears to be psychiatric disease in the elderly. The assessment might be further complicated by the patient's limited ability to recall pertinent aspects of the history due to either cognitive impairment or acute distress. Emergency department personnel might have inadequate expertise in assessing emergencies in elderly persons, further impeding the ability to appropriately manage behavioral complications in geriatric patients. Availability of high-quality emergency care and tight collaboration with primary care providers, psychiatric consultants, and social services is crucial to optimal outcomes from acute psychiatric decompensations in the elderly.
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Affiliation(s)
- Joanna Piechniczek-Buczek
- Division of Psychiatry, Boston University School of Medicine, Robinson Building B-410, 88 East Newton Street, Boston, MA 02118, USA.
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Sivis R, McCrae CS, Demir A. Availability of mental health services for older adults: a cross-cultural comparison of the United States and Turkey. Aging Ment Health 2005; 9:223-34. [PMID: 16019276 DOI: 10.1080/13607860500113896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Researchers conducted a cross-cultural study using qualitative methods (based on a phenomenological approach) to explore the availability of mental health services (MHS) for older adults in the United States and Turkey. Using purposive sampling, semi-structured in-depth interviews were conducted with administrators (n=24) from a wide-range of sites (nursing homes, hospice, senior centers) in a rural area of North Central Florida, United States and Ankara, Turkey. Interview questions focused on types of staff employed; integration of MHS with other services provided; community promotion of services; coordination, cooperation and communication with other service providers; and administrators' perceptions of barriers in the provision of MHS for older adults. Interestingly, employing on-site mental health staff was a much more popular practice in Turkey compared to the United States with three times as many Turkish sites having on-site mental health professionals. As anticipated, administrators in both countries cited inadequate funding as the most common barrier to MHS provision. Potential solutions to MHS barriers in both countries are discussed.
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Affiliation(s)
- R Sivis
- Middle East Technical University, Ankara, Turkey.
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Wetherell JL, Kaplan RM, Kallenberg G, Dresselhaus TR, Sieber WJ, Lang AJ. Mental health treatment preferences of older and younger primary care patients. Int J Psychiatry Med 2005; 34:219-33. [PMID: 15666957 DOI: 10.2190/qa7y-tx1y-wm45-kgv7] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare mental health treatment history and preferences in older and younger primary care patients. METHOD We surveyed 77 older (60+) and 312 younger adult primary care patients from four outpatient medical clinics about their mental health treatment history and preferences. RESULTS Older adults were less likely than younger adults to report a history of mental health treatment (29% vs. 51%) or to be currently receiving treatment (11% vs. 23%). They were also less likely to indicate that they currently desire help with emotional problems (25% vs. 50%). Older adults were more likely to hold a belief in self-reliance that could limit their willingness to accept treatment for mental health problems, although they were less likely than younger adults to identify other barriers to treatment. Older adults reported that they were less likely to attend programs in primary care targeting mental health issues (counseling, stress management) than younger adults, although they were as willing as younger adults to attend programs targeting physical health issues (healthy living class, fitness program). Age remained a significant predictor of mental health treatment history and preferences even after controlling for other demographic variables. CONCLUSION These results suggest that older adults in the primary care setting may be less willing to accept mental health services than younger adults. Results further suggest that perceived barriers may differ for older and younger patients, which may indicate the need for age-specific educational messages and services targeted to older adults in primary care.
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Laganà L, Shanks S. Mutual biases underlying the problematic relationship between older adults and mental health providers: any solution in sight? Int J Aging Hum Dev 2003; 55:271-95. [PMID: 12693548 DOI: 10.2190/1lte-f1q1-v7hg-6bc9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As the size and diversity of the older population increases, mental health providers will be called upon to deliver high-quality services to the elderly. However, many of these professionals hold negative attitudes toward the elderly; psychotherapy conducted with older adults by clinicians with such biases could represent a waste of time and energy, as well as money, for these clients. This article reviews studies conducted within the past three decades on the biases held by mental health professionals (primarily psychiatrists and psychologists) toward older patients and vice versa. It also discusses possible solutions to the conflicts within the elderly-mental health provider relationship, based on the contributions made by professionals from various health care disciplines on this topic. Moreover, this article takes into account various ethnicity-related issues that are often at play in the relationship in question, and provides research and clinical recommendations for the enhancement of the quality of this relationship. It is time to find successful and interdisciplinary ways to improve how older adults and mental health professionals deal with one another. These efforts should creatively enhance the quality of the mental health services offered to older patients, in addition to dispelling age-related myths and corresponding obstacles to the utilization of these needed services by older adults.
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Affiliation(s)
- Luciana Laganà
- Department of Psychology, California State University, Northridge 91330-8255, USA
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Toward JI, Ostwald SK. Exploring mental health service needs for the elderly: results of a modified Delphi study. Community Ment Health J 2002; 38:141-9. [PMID: 11944791 DOI: 10.1023/a:1014595121309] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Identified key informants with professional experience in the broad domain of mental health services reported current and future mental health service needs of elderly Harris County residents as part of a three-round modified Delphi study. Forty-one professionals from various housing, psychosocial, medical, and protective service provider groups were surveyed during three consecutive rounds. The consensus achieved through the Delphi process served to describe the gaps in the mental health services currently available to elderly Harris County residents as well as identify the service needs of this population into the future, thereby providing direction for future service development.
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Affiliation(s)
- Jeffrey I Toward
- Center on Aging, The University of Texas Health Science Center at Houston, 77030, USA
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Kaplan MS, Adamek ME, Martin JL. Confidence of primary care physicians in assessing the suicidality of geriatric patients. Int J Geriatr Psychiatry 2001; 16:728-34. [PMID: 11466753 DOI: 10.1002/gps.420] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examined the confidence levels of physicians in assessing the risk of suicide among older adults in clinical settings. Of the 300 physicians who were selected from a population of 4980 family practice, internal medicine, and geriatric physicians in Illinois, 63% responded to the mail survey. Several categorical items inquired about specific assessment and treatment approaches, referral resources used, barriers to meeting the mental health needs of older patients, and sources of training in suicide risk assessment. All the training items (suicide assessment in medical school, residency, and CME courses; rating of medical school training; and insufficient training in geriatric mental health) were significantly (p < 0.01) associated with confidence in assessing suicidality. The overall model consisting of six variables explained 57% of the variation in confidence scores [F (6, 130) = 28.48, p < 0.001]. Three variables accounted for 50% of the explained variance: confidence in diagnosing depression, residency training in the assessment of suicide risk, and assessment of the intentional misuse of medication. Confidence in diagnosing depression (beta = 0.38, p < 0.001) was the strongest predictor. More effective mental health care will require specific preparation in treating geriatric patients through the full spectrum of medical training, including medical school, residency, and CME courses. Improved prevention of elderly suicide hinges on the enhancement of clinical skills in diagnosing and treating geriatric depression.
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Affiliation(s)
- M S Kaplan
- School of Community Health, Portland State University, P.O. Box 751, Portland, OR 97207-0751, USA.
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Kaskie B, Knight BG, Liebig PS. State legislation concerning individuals with dementia: an evaluation of three theoretical models of policy formation. THE GERONTOLOGIST 2001; 41:383-93. [PMID: 11405436 DOI: 10.1093/geront/41.3.383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study examined the formation of state government policies concerning persons with dementia. In particular, we identified variables associated with the passage of pertinent state laws by testing three theoretical models of policy formation: the iron triangle, the policy system, and an integrated model. METHODS We sampled 44 states and counted the number of laws concerning individuals with dementia that passed during the 1998 legislative sessions. We constructed nine independent variables to represent the three theoretical models of state policy formation. Then the number of legislative actions were regressed onto each model. RESULTS The integrated model that consisted of political actors, legislative features, and environmental inputs met goodness-of-fit criteria for a maximum likelihood regression analysis (chi2/df = 1.55). The advocacy effort of the Alzheimer's Association, number of legislative champions, supply of special care beds for persons with dementia, and recent policy activity were related significantly with increased legislative activity concerning individuals with dementia. IMPLICATIONS Policy responses concerning persons with dementia increasingly have been created within state governments, and we identified variables associated with the passage of pertinent state laws. This research also contributed to the advancement of comparative state policy research by contrasting the three theoretical models of policy formation.
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Affiliation(s)
- B Kaskie
- Department of Health Management and Policy, University of Iowa, Iowa City 52242-1008, USA.
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Brennan PL, Kagay CR, Geppert JJ, Moos RH. Predictors and outcomes of outpatient mental health care: a 4-year prospective study of elderly Medicare patients with substance use disorders. Med Care 2001; 39:39-49. [PMID: 11176542 DOI: 10.1097/00005650-200101000-00006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many elderly inpatients have substance use disorders; recent treatment guidelines suggest that they should receive regular outpatient mental health care after discharge from hospital. OBJECTIVE The prevalence, predictors, and outcomes of outpatient mental health care obtained by elderly Medicare patients with substance use disorders were examined. RESEARCH DESIGN A longitudinal prospective follow-up was performed. SUBJECTS Data from Medicare Provider Analysis and Review Record and Part B Medicare Annual Data were used to identify elderly inpatients with substance use disorders (n = 4,961) and determine their outpatient mental health care 4 years following hospital discharge. RESULTS Only 12% to 17% of surviving elderly substance abuse patients received outpatient mental health care in each of 4 years after discharge. Cumulatively over 4 years, approximately 18% of surviving patients obtained diagnostic/evaluative mental health services, 22% obtained psychotherapy, and 9% received medication management. Of patients who obtained outpatient mental health care, 57% made 10 or fewer outpatient mental health visits over the entire 4 years. Younger, non-black, and female patients were more likely to obtain mental health outpatient care, as were patients with prior substance-related hospitalizations, dual diagnoses, and fewer medical conditions. Prompt outpatient mental health care was predictively associated with higher likelihood of mental health readmissions and, among patients with drug disorders, lower mortality. CONCLUSION Very few elderly Medicare substance abuse patients obtain outpatient mental health care, perhaps because of health or economic barriers.
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Affiliation(s)
- P L Brennan
- Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University Medical Center, California 94304, USA.
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Shea DG, Russo PA, Smyer MA. Use of mental health services by persons with a mental illness in nursing facilities: initial impacts of OBRA87. J Aging Health 2000; 12:560-78. [PMID: 11503732 DOI: 10.1177/089826430001200406] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify mental health service use patterns in nursing facilities subsequent to nursing home reforms in the Omnibus Budget Reconciliation Act of 1987. METHODS The study involves a retrospective analysis of Medicare Part B claims for mental health care for persons in a nursing facility in 1992 (N = 692) using the Medicare Current Beneficiary Survey. Mental health service use was described and analyzed using logistic regression. RESULTS Only 26% of nursing facility residents and 36% of residents with a mental illness had a mental health visit in 1992. Logistic regression confirms analyses prior to 1987 showing older residents and those in rural areas remain less likely to receive mental health visits. DISCUSSION Claims data collected after the passage of The Nursing Home Reform Act (NHRA) of 1987 indicate continued low levels of mental health treatment in nursing homes.
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Affiliation(s)
- D G Shea
- Department of Health Policy and Administration, Pennsylvania State University, USA
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Abstract
This paper presents estimates of the number of people who will need treatment for illicit drug abuse problems for the years 2000 through 2020. The methodology employs logistic regression models, with treatment need as a dependent variable, using data from lifetime marijuana users included in the National Household Survey on Drug Abuse. Age at first use of marijuana was found to be the most important predictor in these models. Other variables included in the models were age, gender, and race/ethnicity. By generating estimates under alternative assumptions about future rates of initiation, it was projected that if current rates of initiation continue, treatment need will increase by 57% by 2020, and that the need for treatment will remain high even if initiation rates decrease dramatically, because of the aging baby boom cohort.
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Affiliation(s)
- J C Gfroerer
- Office of Applied Studies, Substance Abuse and Mental Health, Services Administration, Rockville, MD 20857, USA
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Bartels SJ, Colenda CC. Mental health services for Alzheimer's disease. Current trends in reimbursement and public policy, and the future under managed care. Am J Geriatr Psychiatry 1998; 6:S85-100. [PMID: 9581225 DOI: 10.1097/00019442-199821001-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Behavioral or psychiatric symptoms in Alzheimer's disease are strongly related to the use of health care services and result in a significant emotional and financial burden for families. This paper is an overview of major trends in the organization and funding of mental health services for people with Alzheimer's disease, emphasizing specific public policy and reimbursement initiatives that have affected acute and long-term care. Recent trends reflecting increased federal scrutiny of Medicare-reimbursed services and the current and future challenges in providing mental health services to people with Alzheimer's disease within managed care and capitated health plans are also addressed.
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Affiliation(s)
- S J Bartels
- NH-Dartmouth Psychiatric Research Center, Department of Psychiatry, Michigan State University, USA
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Bartels SJ, Mueser KT, Miles KM. A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophr Res 1997; 27:181-90. [PMID: 9416647 DOI: 10.1016/s0920-9964(97)00080-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study compared the functioning of 188 elderly schizophrenic and bipolar disorder patients living in nursing homes and the community. Residential status and diagnostic groups were compared on measures of symptomatology, cognitive impairment, functional impairment, and behavior problems. In general, the diagnostic groups differed in symptoms, while most differences in living setting were related to cognition, functioning, and behavior. Nursing home status was significantly associated with more severe overall symptom ratings, worse cognitive impairment, greater functional impairment, more aggressive behaviors, and marital status of having never married. Self-care skills, community living skills, and marital status were most uniquely predictive of nursing home residence. However, cognitive deficits were strongly predictive of both self-care and community living skills, explaining approximately half of the variance in these variables. The implications of these findings for the treatment of elderly patients with schizophrenia and other severe mental illnesses are discussed.
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Affiliation(s)
- S J Bartels
- New Hampshire-Dartmouth Psychiatric Research Center, Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USA
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Collins CE, Butler FR, Gueldner SH, Palmer MH. Models for community-based long-term care for the elderly in a changing health system. Nurs Outlook 1997; 45:59-63. [PMID: 9127344 DOI: 10.1016/s0029-6554(97)90080-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C E Collins
- College of Nursing, Michigan State University, USA
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