MedicalResearch.com Interview with
Helen C. Kales MD
Professor of Psychiatry
Director, Section of Geriatric Psychiatry and The Program for Positive Aging, University of Michigan
Research Scientist, VA Center for Clinical Management Research
and Geriatric Research Education and Clinical Center
VA Ann Arbor Healthcare System
Please note that this paper is the result of the deliberations of a multi-disciplinary national expert panel, not a specific study.
MedicalResearch.com: What were the main findings of the expert panel?
Dr. Kales: Often more than memory loss, behavioral symptoms of dementia are among the most difficult aspects of caring for people with dementia. These symptoms are experienced almost universally, across dementia stages and causes, and are often associated with poor outcomes including early nursing home placement, hospital stays, caregiver stress and depression, and reduced caregiver employment. Doctors often prescribe these patients psychiatric medications like antipsychotics, despite little hard evidence that they work well in this population and despite the risks they pose including hastening death. Meanwhile, studies show promise for non-medication behavioral and environmental approaches (such as providing caregiver education/support, creating meaningful activities and simplifying/enhancing the environment), but too few health providers are trained in their use. The method created by the national multidisciplinary group of experts (DICE which stands for Describe, Investigate, Create and Evaluate) represents a comprehensive approach to assessment and management of behavioral symptoms in dementia. For example, a new report of “agitation” from a caregiver, should be fully understood and described (e.g. who/what/when/where/risk/safety); underlying causes should be investigated (e.g. pain, changes in medications, medical conditions, poor sleep, fear); a treatment plan should be created (e.g. responding to physical problems, working collaboratively with the caregiver and other team members to institute non-pharmacologic interventions); and evaluating whether the interventions tried were effective.
MedicalResearch.com Interview with:
Dr. George Patton
Department of Paediatrics, University of Melbourne
Centre for Adolescent Health, Murdoch Children's Research Institute,
Royal Children's Hospital, Parkville, VIC, Australia
MedicalResearch.com: What are the main findings of the study?
Dr. Patton: Although there has been wide acceptance that the teens are a time when emotional problems are common, views have been polarized about their significance. Some have viewed these problems are usual for this phase of life with little significance for later life mental health; others have argued that early psychiatric intervention was essential given the risks of ongoing disorders.
In this sample almost two thirds of girls and a third of boys had an episode of emotional troubles (anxiety and depression) at a level that would concern a family physician. For those where the episode were brief lasting weeks to months, recovery without further later life episodes was common. In contrast those with persistent (longer than 6 months) or recurrent emotional problems during the teens had a high likelihood of similar problems with depression and anxiety in their twenties. In general these emotional problems persisted more in females than in males.
MedicalResearch.com Interview with:
Brian D'Onofrio, PhD
Associate Professor
Department of Psychological and Brain Sciences
Indiana University Bloomington, IN
MedicalResearch.com: What are the main findings of your study?
Dr. D'Onofrio: The main finding from our study is that the specific associations between advancing paternal age at childbearing and offspring psychiatric and academic problems were much larger than in previous studies. In fact, we found that advancing paternal age was associated with greater risk for several problems, such as Attention Deficit Hyperactivity Disorder, suicide attempts and substance use problems, whereas traditional research designs suggested advancing paternal age may have diminished the rate at which these problems occur.
Gemma Taylor MSc MBPsS
Doctoral Researcher
and
Paul Aveyard and PhD MRCP MRCGP FFPG
Professor of Behavioral Medicine
Fellow of Wolson College
Primary Care Clinical Sciences
The University of Birmingham
Birmingham United Kingdom
MedicalResearch.com: What are the main findings of the study?
Answer: Smoking cessation is associated with improvements in mental health compared with continuing to smoke. The effect sizes seem as large for those with psychiatric disorders as those without and are equal or larger to effect estimates of antidepressant treatment for mood and anxiety disorders.
MedicalResearch.com Interview with:
Carol S. North, MD, MPE
The Nancy and Ray L. Hunt Chair in Crisis Psychiatry
Director, Program in Trauma and Disaster,
VA North Texas Health Care System
4500 S. Lancaster Rd., Dallas, TX 75216
Professor of Psychiatry and Surgery/Division of Emergency Medicine
UT Southwestern Medical Center
6363 Forest Park Rd. Dallas, TX 75390-8828
MedicalResearch.com: What are the main findings of the study?
Answer: In post-disaster settings, a systematic framework of case identification, triage, and mental health interventions can guide overall mental health response and should be integrated into emergency medicine and trauma care responses.
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