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Informal carers play an essential role in the care of individuals with Parkinson’s disease (PD). This role, however, is often fraught with difficulties, including emotional, physical, and financial. Coping styles and relationship quality have been hypothesized to influence the impact of stressors. The aim of this study is to examine the relationship between carers’ coping style, relationship quality, and carer burden.
Design:
Cross-sectional.
Participants:
Thirty-nine PD patient carer dyads were included in the study.
Measurements:
Participants completed self-rated questionnaires including the Dyadic Adjustment Scale, Zarit Burden Interview, and Brief Coping Orientation to Problems Experienced Inventory.
Results:
Correlational analyses found significant and positive correlation between carer burden and all three coping styles (problem-focused, emotion-focused, and dysfunctional). There was also a moderate association between carers’ perceived relationship quality and satisfaction and carer burden. Regression analyses found that carer’s gender, severity of PD, relationship quality, emotion-focused, and dysfunctional coping styles did not predict carer burden. Conversely, problem-focused coping style predicted carer burden.
Conclusion:
The results highlight that there is no perfect way to react and care for a loved one and serves as important information for practitioners who design and implement interventions.
Many mental disorders, including depression, bipolar disorder and schizophrenia, are associated with poor dietary quality and nutrient intake. There is, however, a deficit of research looking at the relationship between obsessive–compulsive disorder (OCD) severity, nutrient intake and dietary quality.
Aims
This study aims to explore the relationship between OCD severity, nutrient intake and dietary quality.
Method
A post hoc regression analysis was conducted with data combined from two separate clinical trials that included 85 adults with diagnosed OCD, using the Structured Clinical Interview for DSM-5. Nutrient intakes were calculated from the Dietary Questionnaire for Epidemiological Studies version 3.2, and dietary quality was scored with the Healthy Eating Index for Australian Adults – 2013.
Results
Nutrient intake in the sample largely aligned with Australian dietary guidelines. Linear regression models adjusted for gender, age and total energy intake showed no significant associations between OCD severity, nutrient intake and dietary quality (all P > 0.05). However, OCD severity was inversely associated with caffeine (β = −15.50, 95% CI −28.88 to −2.11, P = 0.024) and magnesium (β = −6.63, 95% CI −12.72 to −0.53, P = 0.034) intake after adjusting for OCD treatment resistance.
Conclusions
This study showed OCD severity had little effect on nutrient intake and dietary quality. Dietary quality scores were higher than prior studies with healthy samples, but limitations must be noted regarding comparability. Future studies employing larger sample sizes, control groups and more accurate dietary intake measures will further elucidate the relationship between nutrient intake and dietary quality in patients with OCD.
Obsessive–compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach.
Objective
To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5′ phosphate, and selenium.
Methods
A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive–Compulsive Scale (YBOCS), administered every 4 weeks.
Results
An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of −7.13 (95% confidence interval = −9.24, −5.01), with a mean reduction of −1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered “responders” (YBOCS ≥35% reduction and “very much” or “much improved” on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD.
Conclusions
While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.
The literature on late-life anxiety has grown exponentially in the last two decades, and a wide array of research questions are being explored by an ever-growing cadre of clinicians and scientists internationally. In fact, in the last decade, there have been several special journal issues devoted to aspects of anxiety in later life – for example, American Journal of Geriatric Psychiatry (2011, vol. 19, issue 4), Journal of Anxiety Disorders (2013, vol. 27, issue 6), International Psychogeriatrics (2015, vol. 27, issue 7), and Clinical Gerontologist (2017, vol. 40, issue 3). All have made the point that while our understanding of the etiology, diagnosis, assessment, and treatment of such disorders has grown and continues to increase, there are still many areas requiring further research attention. In addition, experimental techniques to study the biological mechanisms underpinning anxiety continue to grow in sophistication and access.
Historically, clinicians and researchers interested in the mental health of older people have focused on depression and dementia and have given little attention to anxiety except as a complication of depression or dementia. Over recent years, however, research into anxiety in older people has increased substantially, leading to both a burgeoning scientific literature and increasing clinical interest in the field.
Anxiety disorders in later life have historically been overshadowed by strong clinical and epidemiological interest in mood disorders and cognitive disorders. This chapter reviews the key scientific literature on the epidemiology of anxiety disorders in older people and putative risk and protective factors.
Although behavioural and psychological interventions are considered first-line treatments for anxiety disorders in older people (National Institute for Health and Care Excellence, 2014), psychotropic medications are also widely prescribed (Hollingworth & Siskind, 2010). Drugs from a range of psychotropic classes have been used to treat anxiety disorders, including benzodiazepines, antidepressants, anticonvulsants, and antipsychotics (Reinhold et al., 2011). While there is clinical trial evidence for the short-term efficacy of drugs from each of these classes, particularly for generalized anxiety disorder (GAD), there is scant evidence for long-term effectiveness. Psychotropic drugs exhibit a wide range of adverse effects, including some that pose particular hazards in later life.
Historically, clinicians and researchers have focused on depression and dementia in older people, paying little attention to anxiety except as a complication of these disorders. However, increased research into late-life anxiety has seen a growth in scientific literature and clinical interest. This important book brings together international experts to provide a comprehensive overview of current knowledge in relation to anxiety in older people, highlighting gaps in both theory and practice, and pointing towards the future. Early chapters cover the broader aspects of anxiety disorders, including epidemiology, risk factors, diagnostic issues, association with insomnia, impaired daily functioning, suicidality, and increased use of healthcare services. The book then explores cross-cultural issues, clinical assessment, and pharmacological and psychological interventions across a variety of settings. An invaluable resource for mental health professionals caring for older people including researchers, psychiatrists, psychologists, specialist geriatric nurses and social workers.
Symptoms of anxiety relating to Parkinson's disease (PD) occur commonly and include symptomatology associated with motor disability and complications arising from PD medication. However, there have been relatively few attempts to profile such disease-specific anxiety symptoms in PD. Consequently, anxiety in PD is underdiagnosed and undertreated. The present study characterizes PD-related anxiety symptoms to assist with the more accurate assessment and treatment of anxiety in PD.
Methods:
Ninety non-demented PD patients underwent a semi-structured diagnostic assessment targeting anxiety symptoms using relevant sections of the Mini International Neuropsychiatric Interview (MINI-plus). In addition, they were assessed for the presence of 30 PD-related anxiety symptoms derived from the literature, the clinical experience of an expert panel and the PD Anxiety-Motor Complications Questionnaire (PDAMCQ). The onset of anxiety in relation to the diagnosis of PD was determined.
Results:
Frequent (>25%) PD-specific anxiety symptoms included distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and PD medication complications, and were experienced more commonly in patients meeting DSM-IV criteria for an anxiety disorder. The onset of common anxiety disorders was observed equally before and after a diagnosis of PD. Patients in a residual group of Anxiety Not Otherwise Specified had an onset of anxiety after a diagnosis of PD.
Conclusion:
Careful characterization of PD-specific anxiety symptomatology provides a basis for conceptualizing anxiety and assists with the development of a new PD-specific measure to accurately assess anxiety in PD.
The current study investigated the ability of CogniScreen to differentiate older adults with mild cognitive impairment (MCI) from those reporting symptoms of depression. Participants included 140 community-based adults (30 MCI, 15 self-rated depressed, and 95 typical older adults) aged 50–89 years. Intergroup comparisons performed using receiver operating characteristic (ROC) analyses suggest tasks within CogniScreen are sensitive to clinically significant memory loss. Data provided partial support for some CogniScreen tasks to also differentiate individuals with MCI from those who are depressed. Results suggest CogniScreen may be potentially useful in screening older adults for early cognitive decline.