Lifestyle and mental health.

Mental health professionals have significantly underestimated the importance of lifestyle factors (a) as contributors to and treatments for multiple psychopathologies, (b) for fostering individual and social well-being, and (c) for preserving and optimizing cognitive function. Consequently, therapeutic lifestyle changes (TLCs) are underutilized despite considerable evidence of their effectiveness in both clinical and normal populations. TLCs are sometimes as effective as either psychotherapy or pharmacotherapy and can offer significant therapeutic advantages. Important TLCs include exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others. This article reviews research on their effects and effectiveness; the principles, advantages, and challenges involved in implementing them; and the forces (economic, institutional, and professional) hindering their use. Where possible, therapeutic recommendations are distilled into easily communicable principles, because such ease of communication strongly influences whether therapists recommend and patients adopt interventions. Finally, the article explores the many implications of contemporary lifestyles and TLCs for individuals, society, and health professionals. In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical, and public health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Herbal medicine for the treatment of cardiovascular disease: clinical considerations

Herbs have been used as medical treatments since the beginning of civilization and some derivatives (eg, aspirin, reserpine, and digitalis) have become mainstays of human pharmacotherapy. For cardiovascular diseases, herbal treatments have been used in patients with congestive heart failure, systolic hypertension, angina pectoris, atherosclerosis, cerebral insufficiency, venous insufficiency, and arrhythmia. However, many herbal remedies used today have not undergone careful scientific assessment, and some have the potential to cause serious toxic effects and major drug-to-drug interactions. With the high prevalence of herbal use in the United States today, clinicians must inquire about such health practices for cardiac disease and be informed about the potential for benefit and harm. Continuing research is necessary to elucidate the pharmacological activities of the many herbal remedies now being used to treat cardiovascular diseases.     

Polysomnographie, chronobiologie et approche cognitive dans le traitement de la dépression majeure.

Apart from pharmacotherapy and biological conceptualisations, the cognitive theory and its therapeutic approach are likely the most used in the conceptualization and the treatment of major depression. The cognitive model attempts to explain how certain factors activate a dysfunctional cognitive structure. As such, the cognitive therapy focuses on the modification of negative and depressive cognitive distortions. Despite a success rate of approximately 66%, a significant proportion of patients (30%) suffer a relapse within one year of treatment. This suggests that the cognitive approach is not sufficient to explain the development, maintenance, remission and relapse of a major depressive episode. It is proposed here that sleep and chronobiological factors should be taken into consideration in order to improve the understanding of major depression and to maximize the chances of complete remission in those who suffer from this disorder. Indeed, both research and clinical reports have revealed that major depression is accompanied by sleep disruptions. More specifically, three types of problems have been identified: (1) Sleep discontinuity (reduced total sleep time, increased sleep latency, increased awakenings, reduced sleep efficiency); (2) decreases in slow wave sleep (SWS); (3) changes in rapid eye movement (REM) sleep characteristics (decreased REM latency, increased REM density, increase in the length of the first REM period and in the quantity of REM sleep). Of particular interest is the observation that, when the depressive symptoms disappear, sleep improves. Recent research, however reveals that certain sleep abnormalities, namely short REM latency and reduced SWS, are more robust or trait-like and are indicators of an increased risk of relapse. Furthermore, other studies suggest that the presence of these sleep abnormalities may facilitate the onset of depression. Models of sleep-wake regulation which have attempted to explain the sleep characteristics of depression are reviewed. These point to underlying chronobiological factors such as phase advances of circadian rhythms and suggest that such factors are responsible for the manifestation of the sleep disturbances observed in major depression. Fortunately, techniques that improve sleep quality and resynchronize the biological rhythms are available. Sleep hygiene maximizes sleep habits that facilitate normal sleep, particularly sleep initiation, sleep continuity and length of sleep. On the chronobiological side, bright light exposure and sleep schedule manipulations can resynchronize sleep periods with the appropriate circadian phase. It is thus proposed that sleep recordings, namely polysomnography, which have recently become more readily available (particularly with ambulatory devices), be used to select adequate treatment, and to support decisions regarding treatment duration. Similarly, sleep hygiene and chronobiological treatments should be integrated in the treatment of major depression. This article concludes by proposing a hierarchical model of interventions that combine polysomnography and chronobiological techniques with the classic cognitive approach to major depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How psychology can improve effectiveness and reduce costs of health services.

Contends that psychology can be used to prevent heart disease, cancer, accidents and violence, and respiratory disease through programs such as those designed to eliminate smoking, control obesity, reduce stress, and intervene when multiple risk factors are present. Psychological techniques—as useful and cost-saving companions to traditional medical treatments—can increase checkup visits and participation in health screening, improve adherence to medication schedules, aid recovery from surgery, and facilitate outpatient medical service delivery. Since 40–60% of physician visits are for nonmedical reasons that are psychological and behavioral in nature, psychologists can reduce medical care overutilization and unnecessary medical expenditures by offering less costly and more appropriate alternatives. Psychological interventions for health disorders include treatment for pain, asthma attacks not responsive to medical treatment, heart rate variability, gastrointestinal problems, skin disorders, and self-destructive behaviors. It is concluded that psychological procedures offer a means of reducing health care expenditures reliably. (4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive function as an emerging treatment target for marijuana addiction.

Cannabis is the most widely used illicit substance in the world, and demand for effective treatment is increasing. However, abstinence rates following behavioral therapies have been modest, and there are no effective pharmacotherapies for the treatment of cannabis addiction. We propose a novel research agenda and a potential treatment strategy, based on observations that both acute and chronic exposure to cannabis are associated with dose-related cognitive impairments, most consistently in attention, working memory, verbal learning, and memory functions. These impairments are not completely reversible upon cessation of marijuana use, and moreover may interfere with the treatment of marijuana addiction. Therefore, targeting cognitive impairment associated with chronic marijuana use may be a promising novel strategy for the treatment of marijuana addiction. Preclinical studies suggest that medications enhancing the cholinergic transmission may attenuate cannabis-induced cognitive impairments, but these cognitive enhancing medications have not been examined in controlled human studies. Preliminary evidence from individuals addicted to other drugs suggests that computerized cognitive rehabilitation may also have utility to improve cognitive function in marijuana users. Future clinical studies optimally designed to measure cognitive function as well as drug use behavior would be needed to test the efficacy of these treatments for marijuana addiction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common peripheral vascular diseases

Among the most common causes of morbidity and mortality in elderly individuals are the manifestations of the various peripheral vascular diseases. Many chronic degenerative diseases, which begin in middle age, are associated with peripheral vascular disease. Heart disease, hypertension, hyperlipidemia and diabetes are all risk factors for peripheral vascular diseases and also common degenerative conditions in our society. Other risk factors, such as diet, smoking, stress, lack of exercise, and obesity, are also closely associated with peripheral vascular disease. Aging itself is also a risk factor. Appropriate treatment for disease processes such as diabetes and hypertension and control of other preventable risk factors have been shown to reduce the morbidity and mortality seen in peripheral vascular disorders. Our rapidly aging population requires increasing amounts of medical resources, placing an enormous burden on society because the aged population are generally more dependent upon government-sponsored health care services. The podiatric practitioner is in a position as a primary care provider to influence the health practices of our aging population. The implementation of a health practice that stresses prevention and wellness as well as the appropriate management and a referral of patients with peripheral vascular disorders will limit the morbid results of peripheral vascular diseases.     

Integrating health care: The clear advantage for underserved diverse populations.

Integrating health care into primary and specialty physician practices and clinics has potential benefits for women; racial/ethnic minorities; and lesbian, gay, bisexual, transgendered populations, thus making a major contribution to the health disparities in America. Mounting evidence suggests that physical illnesses are accompanied and exacerbated by emotional, social, and cultural factors. Many of the chronic diseases, cardiovascular disease, HIV-AIDS, diabetes, and some cancers can be prevented and altered by behavioral changes and are thus considered behavioral diseases. In addition, nonadherence to medication is a significant factor in less-than-optimal treatment of any illness. Thus, medical treatment without coordinated attempts to also treat the behavioral and social factors compromises its effectiveness. Treatment is often complicated by the lack of timely diagnoses of issues such as domestic violence, substance abuse, and eating disorders. Furthermore, helping patients negotiate medical visits, treatment options, and disease prevention and management can be effectively addressed within an integrated primary care system of health delivery with better outcomes for minorities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Different cognitive profiles for single compared with recurrent fallers without dementia.

Relationships between self-reported retrospective falls and cognitive measures (executive function, reaction time [RT], processing speed, working memory, visual attention) were examined in a population based sample of older adults (n = 658). Two of the choice RT tests involved inhibiting responses to either targets of a specific color or location with hand and foot responses. Potentially confounding demographic variables, medical conditions, and postural sway were controlled for in logistic regression models, excluding participants with possible cognitive impairment. A factor analysis of cognitive measures extracted factors measuring RT, accuracy and inhibition, and visual search. Single fallers did not differ from nonfallers in terms of health, sway or cognitive function, except that they performed worse on accuracy and inhibition. In contrast, recurrent fallers performed worse than nonfallers on all measures. Results suggest that occasional falls in late life may be associated with subtle age-related changes in the prefrontal cortex leading to failures of executive control, whereas recurrent falling may result from more advanced brain ageing that is associated with generalized cognitive decline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive, psychosocial, and educational issues in neuromuscular disease

There is a broad range of cognitive function in persons with neuromuscular disease, both between and within the various types. Those groups exhibiting little or no cognitive impairment included FSHD, LGS, BMD, SMA, and HMSN. DMD and MD--particularly C-MD-groups did show deficits. The data on HSCA are too minimal to reach any firm conclusion at this time. Specific patterns of deficits in DMD have been proposed, but need further research. No specific correlates with diminished intellectual function have yet been found, and the search for a cause of the intellectual deficit has as yet been unsuccessful. Nevertheless, the impact of NMD on psychosocial and educational function of both children and adults is significant. It is recommended that supportive services be provided by medical professionals specifically trained in such helping professions as psychology to lessen the impact of these chronic progressive diseases and thus to improve the quality of life of persons with NMD.     

Aging, vascular risk, and cognition: Blood glucose, pulse pressure, and cognitive performance in healthy adults.

Advanced age is associated with decline in many areas of cognition as well as increased frequency of vascular disease. Well-described risk factors for vascular disease, such as diabetes and arterial hypertension, have been linked to cognitive deficits beyond those associated with aging. To examine whether vascular health indices such as fasting blood glucose levels and arterial pulse pressure can predict subtle deficits in age-sensitive abilities, the authors studied 104 healthy adults (ages 18 to 78) without diagnoses of diabetes or hypertension. Whereas results revealed a classic pattern of age-related differences in cognition, preprandial blood glucose level and pulse pressure independently and differentially affected cognitive performance. High-normal blood glucose levels were associated with decreased delayed associative memory, reduced accuracy of working memory processing among women, and slower working memory processing among men. Elevated pulse pressure was associated with slower perceptual–motor processing. Results suggest that blood glucose levels and pulse pressure may be sensitive indicators of cognitive status in healthy adults; however, longitudinal research is needed to determine whether such relatively mild elevations in this select group predict age-related cognitive declines. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond Medical Risk: Investigating the Psychological Factors Underlying Women's Perceptions of Susceptibility to Breast Cancer, Heart Disease, and Osteoporosis.

The relationships of epidemiological (objective) risk indices, perceived disease characteristics, and cognitive heuristics to women's perceived susceptibility to breast cancer, heart disease, and osteoporosis in a community sample of 312 women ages 40-86 were examined. Epidemiological indices accounted for a small to moderate proportion of the variance in perceived susceptibility. Psychological factors (perceived similarity to women who contract the target disease and perceived disease prevalence) predicted perceived susceptibility above and beyond medical risk factors. Opposite to actual risk, age correlated negatively with perceived susceptibility to all 3 diseases. Exploratory analyses suggested that perceived similarity, perceived prevalence, and absent/exempt beliefs might mediate this relationship. Confirmatory factor analyses verified that measures of absolute and direct comparative risk assess the same underlying construct of perceived susceptibility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of cardiovascular risk factors in the urban population of Soussa in Tunisia

BACKGROUND: With the epidemiological transition phenomenon, Tunisia is now facing the growing prevalence of chronic diseases. Environmental and behavioural changes such as the adoption of new dietary habits and a sedentary lifestyle, and the stress of urbanization and of working conditions all lead to the rise in cardiovascular disease (CVD) risk factors. METHODS: The aim of this study is to estimate the prevalence of the main CVD risk factors in an urban context. For this, we have undertaken a household epidemiological survey of a representative sample of the adult urban population of Soussa, Tunisia (n = 957). RESULTS: This study shows high prevalences of hypertension (blood pressure >160/95 mmHg) of 18.8 per cent with an adjusted rate of 15.6 per cent, history of diabetes of 10.2 per cent, and obesity (body mass index > 30) of 27.7 per cent [significantly higher in women (34.4 per cent)], android obesity 36 per cent, smoking habits 21.5 per cent [significantly higher in men (61.4 per cent)]. CONCLUSION: With this profile of CVD risk factors, Tunisia must implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic diseases such as hypertension and diabetes.     

Smoking habits and changes in smoking habits as they relate to chronic conditions and respiratory symptoms

The relation of smoking to chronic lung disease has been documented in several studies. Several conclusions have been drawn about the type of smoking associated withdisease, including inhalation, filter tip use, and reduction in smoking. These factors were examined in a community epidemiologic study of chronic obstructive lung diseases. It was found that the community population exhibited greater filter tip use and higher rates of exsmoking than often seen elsewhere. Smoking habits and the changes in smoking habits over time were related to physician-diagnosed emphysema and/or chronic bronchitis, but not asthma. Some relation was seen also with present heart trouble. There was dose-relationship to pack-years of smoking in both present and ex-smokers. There were more ex-smokers among males. Most male ex-smokers quit due to symptoms. Ex-smokers were found to have high rates of diagnosed disease but reduced rates of symptoms. The incidence of diagnosed disease was found to be associated with smoking, both in intensity and duration. Changes in smoking over time were found to be correlated with symptomatology.     

Background and prospects of the Community Health Act

Japan was defeated in World War II and almost all of the nation was demoralized by the destruction and damage to much of the nation. The medical and health care system during and before World War II needed to be reformed radically and fundamentally since almost all medical and health institutes were destroyed. On the other hand, many health personnel came back from overseas after the war. Japanese modern medicine had developed on the basis of German medicine; however, many aspects of American medicine, including public health and democracy, were rapidly introduced following the end of World War II. The American type of health center was established and many laws concerning medical and health care were enacted in 1947-1948. One of them was "The Health Center Law." The National Health Insurance Act was enacted in 1958 and the total population has been covered by health insurance plans since 1961. Many physicians quit the health centers and they have worked as clinicians under the National Health Insurance scheme, because health centers were introduced before adequate education and research existed in the field of public health. On the other hand, the health insurance scheme was in its golden age during the high economic growth period of the 1960s. Japan has succeeded in all forms of modern technology and economy for the past 30 years and is now one of the top nations in the field of medical and health care, such as the numbers of clinics and hospitals and beds, the frequency of consulting with a doctor, length of hospital stay, examinee rates in mass health examinations in the community and workplace and so on. Health conditions have changed drastically from the 1950s to the present. Therefore, health centers do not fit current health needs. For example, mortality from tuberculosis, acute infections diseases and also stomach and uterus cancers and apoplexy have decreased rapidly while mortality from chronic diseases, especially lung, breast and rectal cancers, and myocardial infarction have increased gradually. Changes of life style resulting from rapid economic growth are suspected to be important causes of the change in the prevalence of these diseases. Mass health examination was important and effective as a preventive measure against tuberculosis, especially as a means of early detection and early treatment. However, it is not now effective against chronic diseases. The screening examination has resulted in identifying many patients suspected of being ill. Every examiner must be able to distinguish pathologic findings from physiologic changes of aging. Every patient must, therefore, understand his/her individuality and evaluate the result of his/her efforts to improve life style by receiving a health examination. Accordingly, the aim of health examination has changed from early detection to health support for the examinee. During the decades when life expectancy was less than 50 years of age, it was not necessary for people to plan for retirement. Moreover, there was little burden on younger generations to provide care for the aged people because there were few old people more than 70 years of age and the birth rate was high. Nowadays, elderly people face many years of life after retirement and there are too many aged people in relation to the number of younger persons. As for medical care services, many new medical needs have emerged in recent years, including "quality of life," "palliative medicine in terminal care," "establishment of a primary care system" and "comprehensive care connecting health and medical care with welfare" etc. Improved living standards resulting from economic growth, called the "economic miracle" internationally, have helped to bring about a rapid and wide range of change in daily lifestyle, such as eating habits, working conditions and environment. The Ministry of Health and Welfare has made every effort to revise the laws in relation to health and medical care systems, in order to adjust to recent     

Streamlining assessments and treatments for geriatric mental health in medical rehabilitation.

The past decade has seen dramatic health care changes that profoundly affect the way rehabilitation psychologists are able to provide care for older adults. Increased medical comorbidities and decreased lengths of stay have made it necessary for rehabilitation psychologists to streamline their services. This commentary shares the authors' experience in creating new tools to increase efficiency while retaining effectiveness. The four areas the authors discuss include (a) a tool for triaging cases, (b) a brief battery for cognitive evaluations, (c) a treatment approach for depression that can be delivered in the hospital or outpatient clinic setting, and (d) increased interdisciplinary team communication and function. Each of these approaches has been researched, validated, and cross-validated in geriatric settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Recent advances in the assessment and treatment of insomnia.

Persistent insomnia has multiple potential causes such as medical, pharmacological, lifestyle, personality, and behavioral factors. Although many poor sleepers use hypnotic medications, a wide array of cognitive-behavioral interventions are available that target somatic and cognitive arousal, dysfunctional thoughts, and learned maladaptive sleep habits. Outcome research conducted over the past decade reveals that the single treatments of stimulus control and sleep restriction produced the best results, reducing self-reported target complaints by 50–60%. Approximately half of insomniacs show reliable change, although only about one third become good sleepers. Multicomponent methods offer considerable promise but on the whole have not surpassed results achieved with the simpler stimulus control. Recommended new directions of pursuit include (1) examination of a broader range of insomnia sufferers, (2) use of multimodal assessment and more objective verification of self-reported benefits, (3) research on treatments tailored to individual causal and maintaining factors, and (4) further scrutiny of newer interventions (e.g., sleep restriction and more comprehensive multifaceted strategies). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive profiles of mild cognitive impairment with and without vascular disease.

This study examined whether the cognitive profile of subjects with mild cognitive impairment (MCI) with vascular disease differs from that of MCI subjects with no vascular disease. Consecutive MCI subjects with vascular disease (n=60) and matched MCI subjects with no vascular disease (n=60) were included in the study and were compared with healthy control subjects (n=60). The neuropsychological assessment comprised tests of speed and attention, episodic memory, visuospatial function, language, and executive function. Control subjects performed significantly better than did both MCI groups on the neuropsychological battery. MCI subjects with no vascular disease performed better overall than did MCI subjects with vascular disease, most clearly on tests of speed and attention, visuospatial function, and executive function. MCI subjects with and without vascular disease exhibited differences, both in terms of overall performance and of cognitive profiles. These differences can be largely explained by deficits in speed and attention and in executive function of the MCI subjects with vascular disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress-related cognitive interference predicts cognitive function in old age.

Both subjective distress and cognitive interference have been proposed as mechanisms underlying the negative effects of stress on cognition. Studies of aging have shown that distress is associated with lower cognitive performance, but none have examined the effects of cognitive interference. One hundred eleven older adults (Mage=80) completed measures of working memory, processing speed, and episodic memory as well as self-report measures of subjective distress and cognitive interference. Cognitive interference was strongly associated with poorer performance on all 3 cognitive constructs, whereas distress was only modestly associated with lower working memory. The results suggest that cognitive process related to stress is an important predictor of cognitive function in advanced age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive decline from estimated premorbid status predicts neurodegeneration in Alzheimer's disease.

This study investigated the relationship between premorbid and current cognitive function with respect to the clinical features of patients with various types of neurodegeneration in the form of Alzheimer's disease (AD), mild cognitive impairment (MCI), and subjective cognitive impairment (SCI), as compared with a healthy control group (C). Clinical features (MMSE, cognitive and depressive symptoms), genetics (apolipoprotein E; APOE) and measures of neurodegeneration (Aβ42, t-tau, and p-tau) were examined, as well as present cognitive function. Various methods of assessing premorbid cognitive function were compared, including a Swedish NART-analogous test (Irregularly Spelled Words; ISW), a Swedish lexical decision test (SLDT), a Hold test (Information in WAIS-R), Best current performance test, and combined demographic characteristics. Results showed that cognitive decline (premorbid minus current cognitive function) based on SLDT and ISW was a significant predictor for MMSE and Aβ42, whereas corresponding associations for present cognitive function and decline measures based on other methods were less powerful. Results also showed that specific verbal abilities (e.g., SLDT and ISW) were insensitive to AD and that these abilities indicated premorbid cognitive function in retrospect. In conclusion, cognitive decline from premorbid status reflects the disease processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Latent Growth Curve Analysis of Late-Life Sensory and Cognitive Function Over 8 Years: Evidence for Specific and Common Factors Underlying Change.

Correlations among rates of change in sensory and cognitive functioning in adulthood were evaluated. Measures of Vision, Hearing, Memory, Speed and Verbal ability were obtained in 1992, 1994, and 2000 in the Australian Longitudinal Study of Aging (N=2,087 at baseline). Data from 1,823 participants who undertook at least 1 clinical assessment were analyzed using latent growth curve models. A significant moderate-sized association between rates of change in Memory and Vision was found. This remained after statistically controlling for the effects of age, gender, education, self-rated health, medical conditions, and depressive symptoms. Rate of change in Hearing was weakly associated with rate of change in Memory. The results support a theory incorporating a major role for unique factors in addition to common factors underlying sensory and cognitive change in old age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)