Families under stress: Interventions for caregivers of senile dementia patients.

The senile dementias are progressive brain disorders that result in severe intellectual and behavioral decline. The present paper notes that although these illnesses cannot be treated medically, interventions with dementia patients and their families can be useful. Interventions include education about the disease, problem solving, and support. Treatment modalities that have been helpful are counseling the primary caregivers, family meetings, and support groups for caregivers. A case example illustrates aspects of intervention. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms of psychological distress among caregivers of dementia patients.

Nine subscales of the Brief Symptom Inventory (BSI) were examined for caregivers of dementia patients. Caregivers (N?=?184) were divided into groups on the basis of age (≤59 and 60+) and gender. Their scores were compared with age-matched norms. All of the caregiving groups were significantly elevated on the Hostility subscale. Both younger and older women scored higher than the norms on the Anxiety subscale, and the older women were significantly elevated on three other subscales as well. The Anxiety and Hostility subscales of the BSI were most strongly correlated with the Burden Interview, a measure of the demands imposed by caregiving activities. This relation between burden and symptomatology highlights the stressful nature of caregiving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior rehearsal and social competence: A pilot study.

Investigated the effects on socially incompetent college students of a group program that used social-learning theory and behavior-rehearsal techniques. 20 students referred from a university mental health clinic were assigned to 1 of 2 treatment groups (Groups 1 and 2) or a control group (Group 3). Groups 1 and 2 participated in 8, 2-hr sessions involving behavior-rehearsal and modeling procedures, whereas Group 3 was given readings on social skills and assertiveness training. All groups were given pretests, posttests, and follow-up tests on Forms A and B of the 16 PF. Data were analyzed with a repeated measures analysis of variance. Significant gains in social competence were shown by Groups 1 and 2 on the posttest and the follow-up test. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The four-factor model of depressive symptoms in dementia caregivers: A structural equation model of ethnic differences.

Previous studies have suggested that 4 latent constructs (depressed affect, well-being, interpersonal problems, somatic symptoms) underlie the item responses on the Center for Epidemiological Studies Depression (CES-D) Scale. This instrument has been widely used in dementia caregiving research, but the fit of this multifactor model and the explanatory contributions of multifactor models have not been sufficiently examined for caregiving samples. The authors subjected CES-D data (N = 1,183) from the initial Resources for Enhancing Alzheimer's Caregiver Health Study to confirmatory factor analysis methods and found that the 4-factor model provided excellent fit to the observed data. Invariance analyses suggested only minimal item-loading differences across race subgroups and supported the validity of race comparisons on the latent factors. Significant race differences were found on 3 of the 4 latent factors both before and after controlling for demographic covariates. African Americans reported less depressed affect and better well-being than White caregivers, who reported better well-being and fewer interpersonal problems than Hispanic caregivers. These findings clarify and extend previous studies of race differences in depression among diverse samples of dementia caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of respite care on dementia and nondementia patients and their caregivers.

The impact of a respite program on the cognitive and physical functioning of dementia and nondementia patients, and on the burden perceived by their caregivers, was assessed in a pretest–posttest design. A total of 55 caregivers were interviewed twice, 5 weeks apart. In the respite group, the caregiver's patient experienced a 2-week respite stay in a nursing home during the 5-week interval, whereas in the waiting-list comparison group, the patient experienced ongoing in-home care during the interval. We hypothesized that patient diagnosis (dementia vs. nondementia) would interact with respite exposure, with nondementia patients showing more improvement from respite than dementia patients. Regardless of diagnosis, however, positive effects from respite exposure were found for caregiver reports of the patient's memory and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and distress predict time to cardiovascular disease in dementia caregivers.

Objective: This study assessed the impact of depressive symptoms and distress from patient problem behaviors on time to developing a diagnosis of cardiovascular disease (CVD) in a sample of 643 dementia family caregivers. Design: A longitudinal, prospective design was used. Over an 18-month period, caregivers free from a CVD diagnosis at baseline were assessed at 6, 12, and 18-month follow-ups for the onset of CVD. Main Outcome Measures: Days to the onset of CVD was the primary outcome. Results: Over the length of the study, 32 participants (5%) reported a diagnosis of CVD. After adjusting for sociodemographic and health factors (e.g., high blood pressure, age, smoking history), greater depressive symptoms (p = .040) and distress from patient problem behaviors (p = .034) were significant predictors of time to CVD diagnosis. Conclusion: This study suggests that increased depressive symptoms and reaction to patient problem behaviors (i.e., distress) may increase caregivers' risk for experiencing negative health outcomes, specifically CVD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological, social, and health impact of caregiving: A comparison of Black and White dementia family caregivers and noncaregivers.

Psychological, social, and health variables were compared in 175 Black and White family caregivers of patients with dementia and 175 Black and White noncaregivers. Caregivers and noncaregivers did not differ within race on demographic variables. Caregiving was associated with increased depression and decreased life satisfaction only in White families. However, caregiving appears to have similar social consequences for Black and White families, including restriction of social activity and increased visits and support by family from outside of the home. Race, but not caregiving, was associated with physical health variables. Methodological issues in comparing well-being in Black and White caregivers, in particular the importance of including noncaregiving comparison subjects, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent growth models of the longitudinal effects of dementia caregiving: A comparison of African American and White family caregivers.

Self-report measures of depression, physical health symptoms, and life satisfaction were collected over a 2-yr period from 197 family caregivers of dementia patients and 218 noncaregivers (controls). Latent growth models were used to compare changes across time for African American and White caregivers, with gender, age, and socioeconomic status serving as covariates. Results indicated that White caregivers sustained higher levels of elevated depression and decreasing life satisfaction over time compared with African American caregivers. Both groups of caregivers reported increases in physical symptoms over time. These results indicate worsening difficulties over time for many White caregivers. African American caregivers show more resilience on measures of depression and life satisfaction but are still vulnerable to increases in physical symptoms over time. Implications for additional research and clinical intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among caregivers of the elderly in need of care and their service utilization: a pilot study

This is the first reported case of a spontaneous migration of an embolized catheter fragment from the left side of the pulmonary arterial system to the right side.     

Motivational interviewing with cocaine-dependent patients: A pilot study.

A brief motivational interviewing (MI) intervention was evaluated within the context of an outpatient, cocaine-detoxification program. MI was hypothesized to assist patients in completing the detoxification program and to improve outcomes during subsequent treatment. Participants (N = 105) were randomly assigned to MI or to detox-only conditions. Results indicated that although participants completed the detoxification program at equal rates, completers who received MI increased use of behavioral coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment. MI patients with lower initial motivation were more likely to complete detoxification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-directed program for weight control: A pilot study.

Designed a treatment program to enable 16 undergraduates to lose weight through the use of self-monitored techniques for changing their eating behaviors. All Ss achieved a stable loss in weight, and their mean loss was significantly greater than the change shown by a group of similarly motivated controls. No additional effects due to a few sessions of aversive counterconditioning were demonstrated, and no general mood changes accompanied the weight loss. The Ss reported a decreased temptation to overeat. It was suggested that similar programs of gradual habit change through self-control of stimulus conditions and reinforcement contingencies might be applied to the treatment of other addictive behaviors, which are also refractory to change. (26 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Successful behavioral treatment for reported sleep problems in elderly caregivers of dementia patients: a controlled study

Although sleep problems are common among dementia caregivers, there has been no research thus far describing treatment of such problems using behavioral techniques. In this study, 36 elderly dementia caregivers with disturbed sleep were randomly assigned to either a brief behavioral intervention or a wait list control. The active treatment consisted of standard sleep hygiene, stimulus control, and sleep compression strategies as well as education about community resources, stress management, and techniques to reduce patient disruptive behaviors. Caregivers in active treatment showed significant improvements in sleep at post-treatment and 3-month follow up. No significant differences between groups were observed for caregiver mood, burden, or patient behavior problems, suggesting that sleep improvements were not an artifact of depression treatment. Treatment responders tended to be younger and more compliant with treatment recommendations than non-responders. Results suggest that behavioral techniques may well be a viable alternative to medication for sleep problems in aging caregivers.     

Sexual behavior and nonsexual deviance: A sibling study of their relationship.

Analyzed the correlation of nonsexual deviance and physical, sexual behavior using a sibling design. Hypothesized that both types of behavior are partly determined by a latent trait of deviance proneness, d. In two separate studies—one based on an Oklahoma dataset of college students and their siblings, and the other, on the Adolescent Sexuality Project ({adsex}) dataset of high-school students and their siblings in Tallahassee, Florida—found a strong relationship between relatively early sexual intimacy and nonsexual forms of deviance. Siblings were more alike than chance in deviance and in physical sexual behavior. Most critical for the model, there was also an association between one sibling's sexual intimacy with a partner and the other's deviance. Using {lisrel}, tested the latent-trait model statistically and accepted it as consistent with the obtained correlations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telecommunication interventions for caregivers of elders with dementia

Caregiver Interventions via Telecommunications (CIT) is designed for family caregivers of elders with dementia. Building on Riegel's dialectical theory of human development, the authors argue that psychotherapeutic interventions, made highly accessible by telecommunication technology, assist caregivers to achieve positive developmental outcomes. Specific components of CIT are described, and an outline for a structured protocol is provided. Advantages, disadvantages, and future directions of telecommunications therapy are discussed.     

Sexual behavior in young adulthood: A population-based twin study.

Objective: With behavior genetic analyses of data from young adult twins, we evaluated theoretical perspectives that differentially emphasize biological dispositions, social/cultural factors, or universal pathways to explain individual differences in sexual behaviors. Design: We fit biometric sex limitation models to three aspects of sexual behavior reported by 4,925 Finnish twins ages 23-27. Main Outcome Measure: From a postal questionnaire, we obtained self-report information on initiation/abstinence of sexual intercourse, onset age, and number of sexual partners. Results: Genetic and non-shared environmental influences were significant for all three measures. There were trends for common environmental influences on initiation and, in females, age at first intercourse. Some differential effects in males and females were found. Results comparing onset age and number of partners among experienced twins from pairs concordant and discordant for initiation found genetic and environmental influences on initiation/abstinence overlapped those found for the other aspects of sexual behavior. Conclusions: These results document genetic variation in individual differences in sexual behavior of young adults. Incorporating genetic dispositions into integrated models of sexual behavior will facilitate more effective health promotion and risk taking intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual functioning in chronically depressed patients treated with SSRI antidepressants: a pilot study

OBJECTIVE: This prospective study assessed changes in depression and sexual functioning in chronically depressed men and women during treatment with selective serotonin reuptake inhibitors (SSRIs). METHOD: Twenty-five subjects (14 women, 11 men) with DSM-III-R dysthymia, chronic major depression, or double depression were administered the Arizona Sexual Experience Scale and the Hamilton Depression Rating Scale before and after 6 weeks of treatment with sertraline or paroxetine. RESULTS: As measured by scores on the Arizona Sexual Experience Scale, desire, psychological arousal, and overall sexual functioning significantly improved in women; orgasm delay, orgasm satisfaction, and overall sexual functioning significantly worsened in men. CONCLUSIONS: This study suggests that after SSRI treatment, difficulties with desire and psychological arousal in depressed women tend to remit, whereas in men orgasmic dysfunction appears to be a side effect to medication.     

Dancing in the sky: Enhancing quality of life for people with AIDS-related dementia and their caregivers.

Among the many feared consequences of contracting AIDS is the possibility of HIV or AIDS dementia complex (ADC). As the individual with dementia becomes progressively unable to communicate with his or her caregivers (therapists, loved ones, and medical professionals), the quality of life for both the individual and the caregiver can deteriorate. The person with ADC, faced with a foreshortened future as well as confronted with impending death, must suddenly attend to developmental tasks of dying when he or she may have been in the prime of life. As dementia takes hold, caregivers may disengage because communication becomes disjointed and nonsensical. One of the authors found that, by entering the metaphorical world of the person with ADC, communication could be not only prolonged but deepened, enhancing the relationship between the caregiver and the individual with dementia. Using case examples, this article describes the process of communicating in metaphor with people with ADC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)