4 results
P1: Dosing and treatment outcomes of rTMS for treatment-resistant depressed older adults in a naturalistic outpatient clinic population.
- Amanda Tan, Adriana Patricia, Rachel Hershenberg, Anthony Chatham, Eugenia Giampetruzzi, Valeriya Tsygankova, Gregory Job, Andrea Crowell, Patricia Riva Posse, William McDonald, Brandon Kitay
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 191-192
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Introduction:
Repetitive transcranial magnetic stimulation (rTMS) is an effective, safe, and well-tolerated option for treatment-resistant depression (TRD). The minimal medical and cognitive side effects are advantages of rTMS for all patients. However, the majority of rTMS studies in older adults are notable for underdosing rTMS relative to the corresponding FDA-protocol, as noted by recent international meta-analyses. This study utilizes the standardized rTMS FDA protocol and compares the response rates between older adult and non-older adult patients in a TRD clinic in Atlanta, Georgia with depressive symptoms as the primary outcome and anxiety symptoms as the secondary outcome.
Methods:This retrospective chart review of patients who received rTMS between March 2017 to June 2022 used descriptive statistics to compare treatment parameters and dropout rates between older adult and non-older adult patients. A 2 x 3 repeated-measures analysis of variance (ANOVA) analyzed changes in self-reported depression and anxiety symptom severity throughout treatment course (baseline, treatment midpoint, and final treatment) between the two groups.
Results:Eighty-nine patients were included for analysis: Group 1: >55 years old (n= 42; M= 66.48, sd= 6.16; 71% female), and Group 2: <55 years old (n = 47; M= 37.40, sd= 9.13; 60% female). All patients received at least 3000 pulses per session, with 85.71% of patients completing the FDA protocol in Group 1 and 85.11% of patients completing in Group 2. A >50% improvement in depression scores at the end of treatment were seen in 38.1% of patients in Group 1 and 31.9% of patients in Group 2. Both groups demonstrated significant within-group reductions of depression throughout treatment (ps < .001). A smaller subset of patients completed an anxiety questionnaire. Forty percent in Group 1 (n=24) and 33.3% in Group 2 (n=25) showed a >50% improvement in anxiety scores by end of treatment. Both groups demonstrated significant within-group reductions of anxiety throughout treatment (ps < .001). The between groups’ difference for change in depression and anxiety scores was not statistically significant.
Conclusion:With FDA protocol dosing, older and non-older patients have consistent response and tolerability. While overall response rates were slightly lower than reported standardized clinical trials, our real-world sample highlights the effectiveness of rTMS for patients, including adults over 55, treated in an unselected, naturalistic outpatient sample.
543 - Cultural Considerations for Older LGBTQ Adults During the COVID-19 Pandemic: Case and Review
- M. Alejandra Grullon, Valeriya Tsygankova, Bobbi Woolwine, Amanda Tan, Adriana P. Hermida
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, pp. 85-86
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Introduction
Throughout the COVID-19 pandemic, older adults have been disproportionately impacted by both illness and fatalities. Of the nearly 39 million adults over age 65 in the United States, approximately 2.4 million older adults identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). LGBTQ older adults face unique challenges due to their intersecting identities and histories, including the effects of heterosexism, ageism, and being more likely to live alone, be single, and not have children. As we implement social distancing as a primary COVID-19 prevention method, older adults have faced increased isolation.
MethodsWe presented a case of a lesbian older adult patient who has experienced increased depression during the COVID-19 pandemic. A table will be added featuring culturally competent recommendations for LGBTQ older adults from a literature review.
ResultsA 77-year-old female with history of major depression, attention deficit disorder, hypertension, xerostomia, and polymyalgia rheumatica. The patient has been on multiple trials of medications for depression as well as ECT treatments. She was initially engaged to a man and after some years fell in love with a woman. The patient is currently single and has no children. She typically has a strong support system with her lifelong friend and attends church. She transitioned from independent living to an adult living facility, with the hope of increased social activity and connectedness. However, due to COVID-19, she experienced her move as extremely difficult, and was disappointed that all social activities were canceled. For a period of several months, she was unable to visit her chosen family, was limited to attending church via Zoom, and was restricted from multiple areas of the complex. As a result, she reported increased depression, anxiety, and difficulty sleeping with passive suicidal ideation due to isolation and no direct family support.
ConclusionOlder LGBTQ populations are at disproportionately higher risk for mental health conditions and with the current social distancing measures in place, social isolation and loneliness has been exacerbated.
Connection with accepting family and community are well documented in the literature as key protective factors and sources of resiliency in LGBTQ populations. Culturally competent care is integral to psychiatric treatment of older LGBTQ adults.
Note:This abstract was presented at the American Association of Geriatric Psychiatry 2021 Annual Meeting.
550 - Caregiver Burden and Geriatric Patients Undergoing Electroconvulsive Therapy in the COVID-19 Era
- Valeriya Tsygankova, Maria A. Grullon, Bobbi Woolwine, Ashley Subler, Parker Schwab, Adriana Patricia
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, p. 92
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Introduction
Caregivers are essential in providing valuable patient information to medical providers. With limited available research investigating caregiver burden among those caring for patients receiving ECT and the new life challenges presented by the COVID-19 pandemic, it is more important now than ever to take a closer look at the caregivers’ experiences.
MethodsEmory’s Wesley Woods Geriatric Hospital is one of the busiest ECT services in the country with around 2000 treatments completed every year. In this chart review, researchers are looking at caregivers’ responses to the Zarit Caregiver Burden Interview. This assessment includes 22 questions assessing the caregivers’ current emotional state in order to examine the impact of the patient’s condition on
caregiver wellbeing. The score ranges from 0 (no burden) to 88 (severe burden). Other objective assessments completed with ECT patients are BDI (Beck Depression Inventory), BDI Suicide, Sheehan Disability Scale, ECCA (Electrocompulsive Cognitive Assessment), GAD-7 (Generalized Anxiety Disorder Scale), and CGI (Clinical Global Impression). The purpose of this chart review is to investigate whether the higher severity of depression in patients correlates with higher levels of caregiver burden and whether the pandemic contributed to caregiver burden.
ResultsThe Zarit Caregiver Burden Interview has been administered on twelve caregivers (n=12; 6 male and 6 female), all providing care for patients currently undergoing ECT for depressive symptoms. Out of the twelve caregivers, 66.6% reported little caregiver burden, 16.6% reported mild to moderate burden, and 16.6% reported moderate to severe burden. Additional patients are being interviewed in the ECT suite and further data collected will be presented at the 2021 IPA Virtual International Congress.
ConclusionAs the world adjusts to life in the COVID-19 era, caregivers face new challenges in providing care for vulnerable, at-risk populations. Caregivers of patients receiving ECT facilitate frequent COVID testing and limited visitation policies while continuing to provide care and emotional support to patients with advanced age and a mental illness. Administrating the Zarit Caregiver Burden Interview can help providers look at the degree of burden in caregivers of patients receiving ECT for depressive symptoms and provide better caregiving strategies during and post pandemic.
Preliminary paleoenvironmental analysis of permafrost deposits at Batagaika megaslump, Yana Uplands, northeast Siberia
- Julian B. Murton, Mary E. Edwards, Anatoly V. Lozhkin, Patricia M. Anderson, Grigoriy N. Savvinov, Nadezhda Bakulina, Olesya V. Bondarenko, Marina V. Cherepanova, Petr P. Danilov, Vasiliy Boeskorov, Tomasz Goslar, Semyon Grigoriev, Stanislav V. Gubin, Julia A. Korzun, Alexei V. Lupachev, Alexei Tikhonov, Valeriya I. Tsygankova, Galina V. Vasilieva, Oksana G. Zanina
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- Journal:
- Quaternary Research / Volume 87 / Issue 2 / March 2017
- Published online by Cambridge University Press:
- 16 February 2017, pp. 314-330
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A megaslump at Batagaika, in northern Yakutia, exposes a remarkable stratigraphic sequence of permafrost deposits ~50–80 m thick. To determine their potential for answering key questions about Quaternary environmental and climatic change in northeast Siberia, we carried out a reconnaissance study of their cryostratigraphy and paleoecology, supported by four rangefinder 14C ages. The sequence includes two ice complexes separated by a unit of fine sand containing narrow syngenetic ice wedges and multiple paleosols. Overall, the sequence developed as permafrost grew syngenetically through an eolian sand sheet aggrading on a hillslope. Wood remains occur in two forest beds, each associated with a reddened weathering horizon. The lower bed contains high amounts of Larix pollen (>20%), plus small amounts of Picea and Pinus pumila, and is attributed to interglacial conditions. Pollen from the overlying sequence is dominated by herbaceous taxa (~70%–80%) attributed to an open tundra landscape during interstadial climatic conditions. Of three hypothetical age schemes considered, we tentatively attribute much of the Batagaika sequence to Marine Oxygen Isotope Stage (MIS) 3. The upper and lower forest beds may represent a mid–MIS 3 optimum and MIS 5, respectively, although we cannot discount alternative attributions to MIS 5 and 7.