SLEEP problems are a common complaint of the elderly

Size: px
Start display at page:

Download "SLEEP problems are a common complaint of the elderly"

Transcription

1 Journal of Gerontology: PSYCHOLOGICAL SCIENCES 1998, Vol. 53B, No. 2, P122-P129 Copyright 1998 by The Gerontological Society of America Successful Behavioral Treatment for Reported Sleep Problems in Elderly Caregivers of Dementia Patients: A Controlled Study Susan M. McCurry, Rebecca G. Logsdon, Michael V. Vitiello, and Linda Teri University of Washington, Seattle, Washington. 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. The treatment consisted of standard sleep hygiene, stimulus, and sleep compression strategies as well as education about community resources, stress management, and techniques to reduce patient disruptive behaviors. Caregivers in 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. SLEEP problems are a common complaint of the elderly (Bliwise, 1993; Foley et al., 1995). A number of nonpharmacological strategies, such as sleep hygiene, sleep compression, relaxation training, and stimulus instructions, have proven effective in reducing sleep disturbances in older adults (Engle-Friedman, Bootzin, Hazlewood, & Tsao, 1992; Lichstein & Johnson, 1993; Murtagh & Greenwood, 1995; Riedel, Lichstein, & Dwyer, 1995). However, sleep studies commonly exclude subjects with special problems and complications, such as depression and chronic illnesses. Because of these exclusions, many older adults who are in need of treatment may be eliminated. For example, it has been reported that sleep problems are common among dementia caregivers (McCurry & Teri, 1995; Pruchno & Potashnik, 1989), and that inability to sleep is correlated with caregiver stress and patient institutionalization (Chenier, 1997; Pollak & Perlick, 1991). Nevertheless, there has been no research to demonstrate whether elderly caregivers can benefit from psychological interventions that are efficacious with non-caregiving older adults. There are several reasons why elderly caregivers may need a specialized approach and may not benefit from the same treatments as non-caregivers. First, the behavioral approaches that have proven most effective, stimulus and sleep restriction (Morin, Culbeert, & Schwartz, 1994), require adherence to a structured routine that may not be feasible for caregivers who must match their sleep schedules to a demented patient. Second, depression and physical health problems are prevalent among caregivers (Baumgarten et al., 1992; Gallagher, Rose, Rivera, Lovett, & Thompson, 1989; Kiecolt-Glaser, Dura, Speicher, Trask, & Glaser, 1991), and psychological treatments designed for persons without these conditions may be less effective with caregivers. Further, caregivers are relatively high users of psychotropic medications (Clipp & George, 1990), and there is evidence that persons who regularly use sleep medications benefit less from psychological treatments for insomnia (Murtagh & Greenwood, 1995). Nevertheless, given the potential problems associated with pharmacological treatments for older adults, and the consequences of caregiver sleep disturbance for both the caregiver and the care recipient, it is important to determine whether behavioral interventions provide a viable alternative to medications in alleviating the sleep problems caregivers report. This article describes the effectiveness of a brief, multicomponent behavioral treatment designed to reduce sleep problems in elderly dementia caregivers. The treatment combined training in standard sleep hygiene, stimulus, and sleep compression strategies with education about caregiver stress management, community resources, and behavioral techniques to reduce patient behavior problems. This inclusion of caregiver-specific education with a systematic sleep training program offers a unique approach to working with elderly caregivers. It was hypothesized that treatment would decrease sleep disturbance in caregivers. Because sleep problems are correlated with depressed mood, it was also hypothesized that caregiver ratings of depression would improve as a result of treatment. Treatment was not hypothesized to affect patient behavior because caregivers were not recruited on the basis of patient behavior problems, and the focus of treatment was on changing caregiver behaviors that contribute to sleep disturbance. However, patient behavior problems and caregiver burden were assessed, because they could interfere with caregiver sleep, and caregivers were taught and encouraged to use behavior management strategies if disruptive patient nighttime behaviors occurred during the intervention period. P122

2 BEHAVIORAL TREATMENT OF CAREGIVER SLEEP P123 METHODS Subjects Subjects were recruited through articles in caregiver and senior newsletters, presentations at senior organizations and day centers, telephone contacts to caregivers enrolled in epidemiological studies of dementia in the community, and mailings to University retirees. In an initial telephone interview, potential recruits were given a brief description of the study and were screened for interest in participation and eligibility using a sleep problems questionnaire (Jenkins, Stanton, Niemcryk, & Rose, 1988). To be eligible, caregivers had to endorse one or more sleep problems, an average of 3+ nights per week during the past month, which were severe enough to be interfering with their caregiving role. Caregiver self-perceptions of impaired sleep were considered very important for eligibility because caregiver sleep problems have been linked to patient institutionalization (Chenier, 1997), and although sleep deterioration is common in older adults, not all poor sleepers are distressed by their sleep disturbance (Fichten et al., 1995). In addition, participants were required to be (a) at least 50 years of age; (b) a caregiver for a family member diagnosed with a senile dementia; (c) taking no medication for sleep or stabilized on current medication for at least 6 weeks; and (d) living with their demented patient or ly involved in the patient's care on a daily basis for a minimum of 4 hours/day. Potential subjects were excluded if they reported a prior diagnosis of primary sleep disorder (e.g., sleep apnea), or a severe chronic illness that could be causing their sleep problems (e.g., emphysema). In addition, one caregiver suspected to be at risk for undiagnosed sleep apnea was referred to his physician for evaluation in a sleep lab prior to acceptance into the study. Diagnostic information on the demented patients was confirmed in writing by their primary care physicians. Of 70 individuals who expressed interest in the study, 36 subjects were eligible and scheduled for a pre-treatment assessment interview, where additional information about their sleep, mood, and patient behavior problems was obtained. Following the initial assessment interview, subjects were randomly assigned into either an treatment (individual or group format) or a wait list condition. Participating caregivers ranged in age from 50 to 86 years old. Eighty-one percent (29 out of 36) endorsed at least one sleep problem on the screening questionnaire at a frequency of days in the past month. The vast majority of caregivers (94%) were living with their demented patient (one caregiver in treatment and one in the wait list condition lived away), 47% stated that their patient had never awakened them at night in the past month, and 36% reported awakenings on an almost nightly basis. Six caregivers were taking medication for sleep at the time of enrollment, and they agreed after consultation with their physicians to stay at a stable dose throughout the treatment period (until posttest). Of these, two caregivers were in treatment (1 benzodiazepine, 1 hypnotic), and four caregivers were in the wait list condition (1 tricyclic antidepressant, 2 benzodiazepine, 1 melatonin). Additional information about participant characteristics is shown on Table 1. Study Procedures The study was conducted in two phases. In the first phase, 12 caregivers (7, 5 ) were recruited to participate in a 6-week group intervention. Subjects in the condition met in one of two small groups (3 and 4 caregivers, respectively) for 6 weekly sessions with the senior author. The intervention consisted of a combination of sleep hygiene, stimulus, sleep compression, and relaxation techniques, as well as education about the behavioral impact of dementing illnesses and related caregiver issues. Post-treatment assessments were done following completion of the group treatment or after a 6-week wait list period by an interviewer who was unaware of the caregiver's treatment condition. Caregivers in the condition also completed a daily sleep diary during the intervention period (6 weeks), and a 3-month follow-up assessment interview. They were contacted after this assessment and asked for feedback regarding non-treatment-related aspects of the intervention (including length, duration of sessions, availability of respite care, group location). Table 1. Participant Demographic and Clinical Characteristics Variable Caregiver gender Male Female Caregiver age (years) Caregiver education (years) Caregiver ethnicity White Asian Relationship to patient Spouse Adult child Other Live with patient Yes Use of sleeping aids No Caregiver PSQI Patient gender Male Female Patient age (years) Patient diagnosis Alzheimer's disease Vascular dementia Parkinson's disease Dementia, other Group Treatment (W =7) 2 (29%) 5 (71%) 68.0 ± ±1.9 7 (100%) 7 (100%) 7 (100%) 7 (100%) 11.7 ±4.7 5(71%) 2 (29%) 71.3 ±5.8 5(71%) 1 (14%) 1 (14%) Individual Treatment (M= 14) 3(21%) 11 (79%) 64.9 ± ± (100%) 7 (50%) 5 (36%) 2 (14%) 13 (93%) 12 (86%) 10.4 ±2.7 6 (43%) 8 (57%) 81.9 ±6.9 6 (43%) 3(21%) 4 (7%) 4 (29%) Wait list (N=15) 3 (20%) 12 (80%) 72.6 ± ± (93%) 1 (7%) 13 (87%) 2(13%) 13 (87%) 11 (73%) 11.9 ±4.5 9 (60%) 6 (40%) 78.3 ±7.0 6 (40%) 3 (20%) 6 (40%) Total {N = 36) 8 (22%) 28 (78%) 68.7 ± ± (97%) 1 (3%) 27 (75%) 7(19%) 2 (6%) 33 (92%) 30 (83%) 11.2 ± (56%) 16(44%) 78.3 ± (47%) 4(11%) 4(11%) 11 (31%)

3 P124 McCURRYETAL. In the second phase, the behavioral treatment was condensed to 4 weeks in duration, and caregivers were treated individually rather than in small groups. These modifications were developed in response to participant feedback after the first phase and were designed to maximize study accessibility and facilitate recruitment. Treatment content and other aspects of the intervention (including outcome measures, daily diary reporting, use of a "blinded" interviewer and single therapist) remained the same except for minor differences described elsewhere (see Treatment section below). All caregivers ( and wait list) completed post-treatment and 3-month follow up assessments; after the final follow up interview, caregivers were paid a small sum ($5.00) for each assessment and treatment session. A total of 24 caregivers (14, 10 ) were enrolled for this second study phase. Two caregivers withdrew from the study prior to completion because their demented patients were institutionalized. Both were from the second phase of the study; one caregiver assigned to individual treatment withdrew within the first week of baseline diary monitoring, and one in the wait list condition withdrew prior to 3-month follow up. Caregivers in the wait list condition were offered an opportunity to receive treatment following the 3-month assessment. Treatment The first treatment session included a description of normal age-related sleep changes, and a rationale for the behavioral intervention. Caregivers were given the opportunity to discuss their caregiving situation, the nature of sleep problems they had been experiencing, what they would consider an "ideal" night's sleep, and any questions they had about the daily reporting procedures. Caregivers also received graphs showing their nightly bedtimes, waketimes, and estimated hours of nightly sleep during the baseline period. Using these graphs, an individualized sleep compression schedule analogous to that used by Riedel et al. (Riedel et al., 1995) was developed for each caregiver, whereby caregivers' time in bed was limited to a duration that was less than the average number of nightly hours in bed each had reported during the baseline week, but not in excess of 8 hours (M = 7.4 hours, range hours). At this session, sleep hygiene rules were also introduced, and caregivers were given stimulus instructions to follow during the remainder of the treatment period (Lacks, 1987). In the next session, caregivers reviewed any difficulty they were experiencing complying with their treatment programs, and strategies for overcoming these problems were discussed. Caregivers who reported severe fatigue from the sleep compression were permitted to add a daily nap before 1:00, not to exceed 30 minutes in duration. This accommodation was made in deference to caregivers' age and nocturnal caregiving responsibilities. To address sleep problems that were potentially related to patient behavioral disturbance, all caregivers were given basic information about behavior problems in dementia and their management. For example, information about sundowning and other sleep changes associated with Alzheimer's disease was provided (Teri & Schmidt, 1993). For caregivers who reported that patient behavior problems contributed to their sleep disturbance, time was spent in this and subsequent sessions teaching caregivers to identify the antecedents and consequences of these behavior problems, to monitor them throughout the week and to problem-solve strategies for changing them (Teri & Logsdon, 1990). The subsequent session focused on techniques for coping with caregiver stress. Caregivers were provided with information about communication with their dementia patient and maintaining realistic expectations about their patient's abilities and behaviors. Relevant topics were discussed, including access to community services, the value of respite, and participation in pleasant activities for both patients and caregivers. Ongoing caregiver compliance problems with sleep hygiene, stimulus, and sleep compression recommendations were reviewed, as well as any problems with patient nighttime behaviors. In the first study phase, an additional session was devoted to the topic of systematic relaxation as a tool for coping with the stresses of caregiving. Caregivers were taught a brief (10-min) relaxation exercise (Benson, 1975) and encouraged to practice daily. In the subsequent, abbreviated intervention, the value of daily relaxation was discussed, but caregivers were not given specific instructions regarding its use. In the final session, each caregiver received a summary graph that showed changes in his or her sleep (based upon daily sleep data) during the treatment period. Plans for maintaining or modifying caregiver sleep schedules, patient behavior management plans, and coping strategies were reviewed. A detailed treatment manual for the intervention is available from S. M. McCurry upon request. Dependent Measures Caregiver sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI; Buysse, Reynolds, Monk, Berman, & Kupfer, 1989). The PSQI is a self-report questionnaire that yields a global subjective sleep quality score ranging from 0 to 21; scores greater than 5 are considered indicative of disturbed sleep. All participating caregivers except one had PSQI total scores greater than 5 at enrollment (range = 4^19). Caregiver mood was assessed using the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a 20-item self-report measure that assesses frequency of depressive symptomatology during the past 2 weeks; scores of 16 or higher are considered indicative of depression. In the current study, caregiver CES-D scores ranged from 4-47 at enrollment. In addition, modified CES-D total scores were calculated after eliminating the item that specifically refers to sleep. After this modification, caregiver mces-d scores at enrollment ranged from Caregivers reported on patient behaviors and their reactions to those behaviors using the Screen for Caregiver Burden (SCB; Vitaliano, Russo, Young, Becker, & Maiuro, 1991) and the Revised Memory and Behavior Problem Checklist (RMBPC; Teri et al., 1992). The SCB is a 25- item questionnaire designed to measure objective (OB) and subjective burden (SB) among spousal caregivers of AD patients; average OB scores of 10 (± 4.5) and SB scores of 38 (± 10.7) have been reported for caregivers, with SB scores

4 BEHAVIORAL TREATMENT OF CAREGIVER SLEEP P125 in excess of 42 considered "quite high" (Vitaliano et al., 1991). In this sample, OB scores ranged from 1-39, and SB scores ranged from 1-73 at enrollment. The RMBPC contains 24 items covering a range of memory, depression, and disruptive behavior problems. Each item is rated from 0-4 for frequency of occurrence during the past week and caregiver reaction (degree to which each rated behavior "bothers or upsets" the caregiver). Memory, depression, and disruptive behavior subscale reliabilities range from.67 to.89 (Teri et al., 1992). In this sample, frequency summary scores ranged from 3-28 for the memory subscale, 0-28 for the disruptive behavior subscale, and 0-31 for the depression subscale. Finally, in order to evaluate specific dimensions of caregiver sleep, caregivers in the treatment were instructed to call a telephone voice mail line every morning with a sleep diary report from the previous 24 hours. Daily sleep diary reporting began one week before the first treatment session (baseline) and continued throughout the treatment period (6 or 4 weeks, depending on study phase). Daily diary reports provided information on bedtime, sleep onset latency, number and duration of nocturnal awakenings, cause of nocturnal awakenings (due to patient behaviors or not), rising time, number and duration of daily naps, and 5-point subjective ratings of the previous night's sleep quality (1 = very restless; 5 = very sound) and how rested the caregiver felt upon rising (1 = exhausted; 5 = refreshed). In addition, caregivers were asked (yes/no) whether they had taken any medication the night before to help them sleep. Five sleep variables that have been previously used in sleep studies with community-dwelling older adults (Friedman, Bliwise, Yesavage, & Salom, 1991) were computed from caregivers' daily diaries: (a) Time in Bed, calculated by subtracting the time caregivers reported getting into bed at night from the time they reported getting out of bed for the final time in the morning; (b) Sleep Latency, derived from caregivers' reports of the number of minutes needed to fall asleep after initially going to bed; (c) Wake Time After Sleep Onset (WASO), calculated by summing the estimated number of minutes caregivers were awake between sleep onset and final awakening; (d) Total Sleep Time, calculated by subtracting WASO and sleep latency from time in bed; and (e) Sleep Efficiency (SE), calculated by dividing total sleep time by time in bed. Statistical Analysis Because of the small sample size, a conservative approach was taken with all statistical analyses to minimize the risk that observed treatment effects would be due to Type 1 error. In both phases of the study, subjects were randomly assigned into either a treatment or wait list condition. Fisher's exact test and analysis of variance (ANOVA) were used to compare baseline assessment data and demographic characteristics of treatment and wait list subjects within each study phase as a randomization check. In addition, because differences in recruitment procedures between the two study phases could impact the sample of subjects who were enrolled, the pre-treatment characteristics of all subjects (wait list and treatment combined) in each of the two study phases were compared. Separate ANOVAs were conducted for groups of demographic information (patient and caregiver age, patient and caregiver education), caregiver sleep status (PSQI score), caregiver mood (CES-D, SCB-subjective subscale), and patient behavior scores (SCB-objective, RMBPC memory, depression, and disruption subscales). Accordingly, a Bonferoni correction for multiple comparisons was utilized, with alphas set at p -.05 for caregiver sleep,.025 for caregiver mood, and.013 for demographic information and patient behavior. Post-treatment outcome data were subsequently analyzed using a series of planned orthogonal contrasts (Mead, 1988) to test the following hypotheses: (a) caregivers who received group treatment (Phase 1) were expected to be no different from caregivers who received individual treatment (Phase 2) at post-treatment and 3-month follow up; and (b) caregivers who received either individual or group treatment were expected to have better sleep and lower depression scores than caregivers in the wait list condition at post-treatment and 3-month follow up. As was done with the pre-treatment variables, outcome data were analyzed in groups by caregiver sleep, caregiver mood, and patient behavior variables, and alpha levels were corrected accordingly. Daily diary data provided by subjects in either intervention were examined for the first four weeks of data collection. Weekly averages for the diary sleep variables at baseline (Week 1) and during the final week of sampling (Week 4) were compared using paired t tests set at p =.007 to for multiple comparisons. Fisher's exact test and t tests for independent samples were also used to compare caregiver "responders" with "non-responders" in the intervention. RESULTS Between-Group Comparisons In both Phase 1 and Phase 2 of the study, there were no significant differences between and wait list subjects in pre-treatment demographic characteristics, caregiver sleep, caregiver mood, or reports of patient behavior problems, indicating that randomization had been effective. Table 1 summarizes the descriptive characteristics of subjects in the two treatment and combined wait list groups. When subjects from Phase 1 and Phase 2 were compared, the demented patients in Phase 1 were significantly younger, F(l,34) = 14.49, p <.013, and their caregivers were significantly more depressed, F(l,33) = 7.86, p <.025, and higher in objective burden, F(l,34) = 23.02, p <.013, than those in Phase 2. To ensure that any post-treatment differences found would be due to treatment effect rather than study phase, a dichotomous variable for study phase was entered as a covariate into subsequent analyses, but it had no effect on analytical results. Post-treatment and follow up outcome data were analyzed using a series of planned orthogonal contrasts, as described earlier. The first analyses tested the hypothesis that caregivers who received group treatment would be no different from caregivers who received individual treatment. As predicted, no significant differences in caregiver sleep, caregiver mood, or patient behaviors were observed be-

5 P126 McCURRYETAL tween subjects in the two conditions (individual vs group treatment) at either post-treatment and 3-month follow up. Therefore, data for subjects from the two conditions were combined for subsequent comparisons with the wait list condition subjects. The next stage of analysis tested the hypothesis that caregivers who received treatment would have better sleep and lower depression scores than caregivers in the wait list condition at post-treatment and follow up. Table 2 summarizes outcome data at pre-treatment, posttreatment, and 3-month follow up for the wait list and intervention subjects. Overall sleep quality, as measured on the PSQI, was significantly better for subjects in the condition at post-treatment, F(l,33) = 4.23, p <.05, and follow up, F(l,27) = 5.98, p <.05, than for caregivers in the wait list. There were no significant differences in caregiver mood or patient behaviors at either post-treatment or follow up, but there was a tendency for depression scores to decline at post-treatment in both conditions; 35% of caregivers in treatment had CES-D scores of 16 or higher at pre-treatment, compared to 15% at Table 2. Pre-, Post-, and Three-Month Follow Up Scores (Af ± SD) for Combined Active Intervention Subjects Versus Wait List Controls 0 Variable Pre-Treatment Post-Treatment 3-Month PSQI CES-D SCB - Subjective SCB - Objective RMBPC - Memory RMBPC - Depression RMBPC - Disruption 10.8 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.3* 6.2 ±3.6* 10.6 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± 3.4 Note: PSQI = Pittsburgh Sleep Quality Index; CES-D = Center for Epidemiological Studies Depression Scale; SCB = Screen for Caregiver Burden (subjective and objective subscales); RMBPC = Revised Memory and Behavior Problems Checklist (memory, depression, and disruption subscales summary scores). W = 21 at pre-treatment, and N = 20 at post-treatment and follow up for treatment group due to withdrawal of one caregiver. For wait list group, N = 15 at baseline and post-treatment, N = 9 at follow up due to withdrawal of one caregiver, and lack of 3-month data on wait list subjects in the first phase of the study. Significant difference between and groups, p <.05. post-treatment and 35% at follow up. Similarly, 40% of caregivers in wait list had CES-D scores of 16 or higher at pre-treatment, compared to 15% at post-treatment and 22% at follow up. Within-Group Comparisons: Daily Diary Reports Table 3 shows weekly average scores for daily diary data provided by caregivers during the intervention (to be consistent between both study phases, only the middle 4 weeks of diary data were included in the analysis). Significant (p <.007) improvements between Week 1 (baseline) and Week 4 occurred in caregiver sleep efficiency (t = -4.31). No significant differences occurred in the other diary variables although sleep latency, WASO, sleep quality, and restfulness all showed improvement trends with moderate effect sizes (Cohen, 1965) in the expected direction (effect = -.45, -.54,.43,.33, respectively). "Responders" versus "Non-responders" To determine the extent to which statistically significant group findings reflected changes that were meaningful to caregivers' lives, the clinical significance of change in test scores was also examined. In this study, subjects were considered "responders" if they improved in two or more of the following criteria: (a) total PSQI scores dropped into normal range (<5); (b) total PSQI scores dropped more than 5 points (representing the top quartile of improvers on PSQI change scores in this sample); (c) sleep efficiency moved into normal range for older persons (>.85) (Glovinsky & Spielman, 1991); (d) sleep latency less than 30 minutes with a change of at least 10 minutes from baseline (Riedel et al., 1995); or (e) WASO less than 40 minutes Table 3. Summary of Sleep Diary Data for Caregivers in the Active Intervention (N = 20) During the First Four Weeks of Data Collection Variable Weekl (Baseline) Week 2 Week 3 Week 4 Sleep latency (minutes) 39.6 ± ± ± ±13.7 Sleep efficiency*.73 ± ± ± ±.09 Wake time after sleep onset (minutes) 65.0 ± ± ± ±45.3 Hours nightly sleep 6.1 ± ± ± ±0.9 Number of night awakenings 2.2 ± ± ± ±1.2 Sleep quality 3.0 ± ± ± ±0.7 Felt upon awakening 3.0 ± ± ± ±0.7 *Mean paired differences between Week 1 and Week 4 significant at p <.007.

6 BEHAVIORAL TREATMENT OF CAREGIVER SLEEP P127 with a change of at least 10 minutes from baseline (Riedel etal., 1995). In this sample, 60% of caregivers who completed the intervention condition (12 out of 20) met criteria for "responders.'' Ten caregivers (50%) had clinically significant improvement in sleep latency, eight (40%) caregivers had improvements in sleep efficiency or a drop of 5 to 9 points in total PSQI score, six (30%) showed clinical improvement in nighttime WASO, and five (25%) dropped into the normal PSQI range. A study of baseline characteristics of responders and non-responders in the intervention revealed that caregivers with a good clinical response to treatment were younger (t = -3.74; p =.001) than treatment non-responders. There were no significant differences between the two groups in other baseline characteristics, including relationship to patient, sleep and mood variables, residential status, or patient behavior problems. Two caregivers assigned to the intervention were taking a medication for sleep which remained stable throughout the study; both were classified as treatment non-responders. In an attempt to examine the relationship between treatment compliance and outcome, caregivers' daily diary reports of total time in bed (computed from reported bed hour minus reported rising hour) were compared to the recommended sleep compression schedule they were placed on after the baseline sampling period. For all caregivers, the amount of time in bed they were "allowed" on the compressed schedule was less than their mean reported time in bed for the baseline period (Week 1). Among responders, 75% of caregivers during Week 2, 83% during Week 3, and 67% during Week 4 reported mean nightly times in bed that were within 30 minutes of the recommended schedule (allowing for 15 minutes of bed- or rising-time flexibility at either end of the night). Among non-responders, 25% of caregivers during Week 2, 38% during Week 3, and 38% during Week 4 reported mean nightly times in bed that were within 30 minutes of the recommended schedule, suggesting that failure to comply with the sleep compression program contributed to at least part of the observed outcome differences among treatment participants. A significantly (p =.05) greater number of responders (42%) than non-responders (0%) kept to the recommended sleep compression program all three weeks of treatment. It should be noted that although sleep diary information (including sleep latency, efficiency, and WASO scores) was not available for caregivers in the wait list condition, no wait list subjects dropped into the normal PSQI range, and only one had a PSQI change score greater than 5 between pre- and post-treatment assessments. This is in contrast to 10 caregivers in treatment who had improvements in at least one of the two PSQI response categories (significantly different at/? =.009). DISCUSSION This article described findings from a brief, multi-component behavioral treatment designed to reduce sleep problems in elderly dementia caregivers. The treatment combined training in standard sleep hygiene, stimulus, and sleep compression strategies with education about caregiver stress management, community resources, and behavioral techniques to reduce patient behavior problems. This inclusion of caregiver-specific education with a systematic sleep training program offers a unique approach to working with elderly caregivers. As hypothesized, caregiver sleep improved significantly as a result of treatment. Subjects in the intervention had significantly lower total PSQI scores at post-test and 3- month follow up than did subjects in the wait list. For caregivers in the intervention, significant improvements in sleep efficiency were observed: sleep latency, WASO, hours of nightly sleep, sleep quality, and restfulness also showed improvement trends with moderate effect sizes in the expected direction, although with the small sample size statistical significance could not be detected. It was also hypothesized that caregiver ratings of depression would improve as a result of treatment, but this was not observed, nor were significant changes in patient behavior problems reported. These findings suggest that improvements in sleep among subjects in the condition were not byproducts of decreased caregiver depression, burden, or patient nighttime behavior problems. Younger caregivers were more likely to respond to the treatment than older caregivers. Studies with noncaregiving older adults have shown that increased age is associated with decreases in sleep quality and efficiency, as well as increases in sleep latency and frequency of night awakenings, particularly among women (Bliwise, 1993; Middlekoop, Smilde-van den Doel, Neven, Kamphuisen, & Springer, 1996). In the current study, 30% of caregivers were in the "old-old" age group (age 75+), and 82% of these were women. All reported themselves to be in good health, with no diseases or medications known to impact sleep. Nevertheless, none of these very old, female caregivers who were in the intervention were treatment "responders," and none were in the group of caregivers who complied with the sleep compression schedule all 3 weeks of treatment. One might wonder whether this apparent age effect is an artifact of caregiver relationship, as spouses would be more likely to be disturbed at night because they share a bedroom with the demented patient. However, in this sample, although more non-responders than responders were spouses (88% vs. 58%, respectively), there was no difference between the groups in terms of sleeping arrangements (50% of non-responders and 58% of responders slept in the same bedroom as their demented patient). Further study is needed to see if these findings would be repeated with a larger number of caregivers. They suggest, however, that treatment may be more efficacious when it targets a younger subset of the aging caregiver population, and that older women may need either different forms of assistance or longer treatment duration to improve their sleep. In this study, treatments were compared to a wait list condition. The absence of an (such as a dementia education group) makes it difficult to evaluate whether observed treatment effects in this study were due to the sleep intervention or to nonspecific therapeutic factors. This is of particular concern as only caregivers in the condition kept a daily sleep diary, and

7 P128 McCURRYETAL the therapeutic reactivity of self-monitoring is well-known (Kazdin, 1974). Further, without the diary, we cannot evaluate whether subjects in the wait list condition also experienced improvements in specific sleep domains (e.g., sleep efficiency or WASO). Nevertheless, several considerations weigh against a placebo-only interpretation of treatment improvement. The first is that treatment responders were found to be more compliant with at least one portion of the intervention (the sleep compression schedule) than were treatment non-responders. Second, caregivers in both the and conditions showed small, but nonsignificant, reductions in depression and burden scores at post-test that were not maintained at follow up, indicating the presence of some mild treatment contact effect. However, sleep changes were only noted for the treatment group, providing evidence that sleep improvements were more likely due to the sleep intervention rather than nonspecific treatment factors. Finally, incidental findings from an unrelated investigation (Teri, Logsdon, Uomoto, & McCurry, 1997; Teri et al., 1992) lend additional support for the efficacy of the sleep intervention. In that study, caregivers were taught strategies designed to reduce depression in their demented patients. Caregiver depression and sleep problems were not targeted by the intervention; nevertheless, caregivers in a behavioral problem-solving condition that had some of the same elements as the current study (e.g., education about communication strategies, realistic expectations, community services, and respite care) did show improvements in both total depression and ratings of sleep. Caregivers in a behavioral activation condition showed no improvements in either depression or sleep, although patient depression ratings significantly improved, suggesting that although significant reduction of caregiver depression may lead to improved caregiver sleep, therapeutic contact with caregivers is not itself sufficient to reduce insomnia. One potential concern about study results is whether or not caregiver use of sleep medications could be influencing treatment outcome. As noted earlier, six caregivers reported they were taking sleep medication at the time of study enrollment, and they agreed to stay on a stable dose throughout the treatment period. Daily diary reports for the two caregivers in treatment, and responses for all six caregivers to a question on the PSQI (at pre- and post-test) about the frequency of sleeping medication use in the past month, indicate that these caregivers did indeed continue to take their medication nightly. The same PSQI item responses and diary data (when available) were also examined for the remaining caregivers. No caregiver indicated that he or she began taking a medication to enhance sleep. Future studies should more carefully monitor all caregiver medication consumption to address this important potential confound more directly. Given the established relationship between depressed mood and impaired sleep, it may be surprising that in the current study no significant improvements in caregiver depression were observed as a result of an intervention that improved caregiver self-reported sleep. This may reflect the fact that caregivers were, on the whole, not significantly depressed when they entered treatment (median CES-D score at baseline was 14), and reduction of caregiver depression was not a specific treatment goal. Another possibility is that a subset of caregivers in the wait list condition received outside supportive services during the treatment period, resulting in nonsignificant differences between the and group subjects (although data were not collected in this study to evaluate service utilization). Regardless, because significant improvements were also not observed in caregiver burden or patient behavior problems, one might ask whether the caregiver education and support components of the intervention were essential to treatment success. It may be that caregiver-specific education was important to the intervention in other ways, such as successful recruitment, low drop-out rates, and treatment compliance. However, given the time burdens and responsibilities caregivers face, additional research is needed to evaluate whether the treatment could be further abbreviated and yet remain effective for improving sleep. The present findings may be limited in that they are based solely upon self-report sleep diary data. It is known that patients with insomnia tend to overestimate sleep latency and underestimate sleep time (Lacks & Morin, 1992). However, studies with older adults that have both diary reports and electroencephalographic data have also shown that improvements in sleep reports are mirrored by improvements on objective measures (Morin, Kowatch, Barry, & Walton, 1993). Moreover, diary self-reports also show good agreement with collateral reports from significant others and with ambulatory polysomnographic recordings (Morin & Azrin, 1988; Rogers, Caruso, & Aldrich, 1993). In this study, caregivers were instructed in use of the sleep diary and were contacted by telephone follow up if they missed a daily report or snowed any confusion in their responding. Although not an exact substitute for objective sleep measures, diaries are probably an adequate measure of sleep quality and treatment response for already burdened elderly caregivers who may be unable to spend time in a sleep laboratory or unwilling to wear home monitoring devices. In conclusion, this study provides the first evidence that elderly caregivers of dementia patients who are experiencing sleep problems can benefit from behavioral techniques (specifically, sleep hygiene, stimulus, and sleep compression strategies) that are known to improve sleep in non-caregiving older adults. Treatment can be brief; in this study, improvements were detected within 3 weeks following an initial training session. It should be noted, however, that the demands of a behavioral sleep program are rigorous; caregivers in this study often complained that their sleep initially became worse as they adjusted to new sleep habits and patterns. Caregivers with significant health problems, acute care-related stresses, or mild cognitive impairments, particularly those who are in the old-old group, may not be appropriate candidates for such an intervention or may need an intervention more tailored to their unique needs. However, for many elderly caregivers of dementia patients, behavioral sleep techniques should be viewed as a viable alternative to pharmacotherapy, particularly those for whom medication side effect risks or long-term cost, chronic caregiving stress, and social isolation are important treatment considerations.

8 BEHAVIORAL TREATMENT OF CAREGIVER SLEEP P129 ACKNOWLEDGMENTS We acknowledge Laura Hemmy, Laura Anderson, and Francie Zumwalt for their assistance in data collection; and Laura Gibbons, M.S., and Steve Edland, M.S., for their statistical consultation on this article. We also wish to thank the anonymous reviewers who provided numerous thoughtful comments about earlier versions of this article. This study was supported in part by NIA Grants P50-AG , AG , and the Alzheimer's Association/Albert and Lois Schwartz Memorial Pilot Research Grant PRG Address correspondence to Dr. Susan M. McCurry, Department of Psychiatry & Behavioral Sciences, University of Washington, Box , Seattle, WA REFERENCES Baumgarten, M., Battista, R. N., Infante-Rivard, C, Battista, R. N., Becker, R., & Gauthier, S. (1992). The psychological and physical health of family members caring for an elderly person with dementia. Journal of Clinical Epidemiology, 45, Benson, H. (1975). The relaxation response. New York: William Morrow and Company. Bliwise, D. L. (1993). Sleep in normal aging and dementia. Sleep, 16, Buysse, D. J., Reynolds, C. E, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, Chenier, M. C. (1997). Review and analysis of caregiver burden and nursing home placement. Geriatric Nursing, 18, Clipp, E. C, & George, L. K. (1990). Psychotropic drug use among caregivers of patients with dementia. Journal of the American Geriatrics Society, 38, Cohen, J. (1965). Some statistical issues in psychological research. In B. B. Wolman (Ed.), Handbook of clinical psychology (pp ). New York: McGraw-Hill. Engle-Friedman, M., Bootzin, R. R., Hazlewood, L., & Tsao, C. (1992). An evaluation of behavioral treatments for insomnia in the older adult. Journal of Clinical Psychology, 48, Fichten, C. S., Creti, L., Amsel, R., Brender, W., Weinstein, N., & Libman, E. (1995). Poor sleepers who do not complain of insomnia: Myths and realities about psychological and lifestyle characteristics of older good and poor sleepers. Journal of Behavioral Medicine, 18, Foley, D. J., Monjan, A. A., Brown, S. L., Simonsick, E. M., Wallace, R. B., & Blazer, D. G. (1995). Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep, 18, Friedman, L., Bliwise, D. L., Yesavage, J. A., & Salom, S. R. (1991). A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. Journal of Gerontology: Psychological Sciences, 46, P1-P8. Gallagher, D., Rose, J., Rivera, P., Lovett, S., & Thompson, L. W. (1989). Prevalence of depression in family caregivers. The Gerontologist, 29, Glovinsky, P. B., & Spielman, A. J. (1991). Sleep restriction therapy. In P. J. Hauri (Ed.), Case studies in insomnia (pp ). New York: Plenum Publishing Company. Jenkins, C. D., Stanton, B., Niemcryk, S. J., & Rose, R. M. (1988). A scale for the estimation of sleep problems in clinical research. Journal of Clinical Epidemiology, 41, Kazdin, A. E. (1974). Re self-monitoring: The effects of response desirability, goal setting, and feedback. Journal of Consulting and Clinical Psychology, 42, Kiecolt-Glaser, J. K., Dura, J. R., Speicher, C. E., Trask, J., & Glaser, R. (1991). Spousal caregivers of dementia victims: Longitudinal changes in immunity and health. Psychosomatic Medicine, 53, Lacks, P. (1987). Behavioral treatment for persistent insomnia. New York: Pergamon Press. Lacks, P., & Morin, C. M. (1992). Recent advances in the assessment and treatment of insomnia. Journal of Consulting and Clinical Psychology, 60, Lichstein, K. L., & Johnson, R. S. (1993). Relaxation for insomnia and hypnotic medication use in older women. Psychology and Aging, 8, McCurry, S. M., & Ten, L. (1995). Sleep disturbance in elderly caregivers of dementia patients. Clinical Gerontologist, 16, Mead, R. (1988). The design of experiments. New York: Cambridge University Press. Middlekoop, H. A. M., Smilde-van den Doel, D. A., Neven, A. K., Kamphuisen, H. A. C, & Springer, C. P. (1996). Subjective sleep characteristics of 1,485 males and females aged 50-93: Effects of sex and age, and factors related to self-evaluated quality of sleep. Journal of Gerontology: Medical Sciences, 51 A, M108-M115. Morin, C. M., & Azrin, N. H. (1988). Behavioral and cognitive treatments of geriatric insomnia. Journal of Consulting and Clinical Psychology, 56, Morin, C. M., Culbeert, J. P., & Schwartz, S. M. (1994). Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. American Journal of Psychiatry, 151, Morin, C. M., Kowatch, R. A., Barry, T, & Walton, E. (1993). Cognitivebehavior therapy for late-life insomnia. Journal of Consulting and Clinical Psychology, 61, Murtagh, D. R. R., & Greenwood, K. M. (1995). Identifying effective psychological treatments for insomnia: A meta-analysis. Journal of Consulting and Clinical Psychology, 63, Pollak, C. P., & Perlick, D. (1991). Sleep problems and institutionalization of the elderly. Journal of Geriatric Psychiatry and Neurology, 4, Pruchno, R., & Potashnik, S. (1989). Caregiving spouses: Physical and mental health in perspective. Journal of the American Geriatrics Society, 37, Radloff, L. (1977). The CES-D Scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 3, 385^01. Riedel, B. W., Lichstein, K. L., & Dwyer, W. O. (1995). Sleep compression and sleep education for older insomniacs: Self-help versus therapist guidance. Psychology and Aging, 10, Rogers, A. E., Caruso, C. C, & Aldrich, M. S. (1993). Reliability of sleep diaries for assessment of sleep/wake patterns. Nursing Research, 42, Teri, L., & Logsdon, R. (1990). Assessment and management of behavioral disturbances in Alzheimer's disease patients. Comprehensive Therapy, 16, Teri, L., Logsdon, R. G., Uomoto, J., & McCurry, S. (1997). Behavioral treatment of depression in dementia patients: A led clinical trial. Journal of Gerontology: Psychological Sciences, 52B, P159-P166. Teri, L., & Schmidt, A. (1993). Understanding Alzheimer's: A guide for families, friends, and health care providers. Seattle: University of Washington. Teri, L., Truax, P., Logsdon, R. G., Uomoto, J., Zarit, S., & Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: The Revised Memory and Behavior Problems Checklist. Psychology and Aging, 7, Vitaliano, P. P., Russo, J., Young, H. M., Becker, J., & Maiuro, R. D. (1991). The Screen for Caregiver Burden. The Gerontologist, 31, Received January 14, 1997 Accepted September 19, 1997

Sleep Deprivation and Post-Treatment (CBD)

Sleep Deprivation and Post-Treatment (CBD) Population Authors & year Design Intervention (I) and Comparison (C) Mean age (SD) 1 Gender (%) Delivered to Dosage (total number of sessions) Primary Outcome domain (Measure(s)) Secondary Outcome domain

More information

SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS

SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS E-Resource December, 2013 SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep

More information

Written Example for Research Question: How is caffeine consumption associated with memory?

Written Example for Research Question: How is caffeine consumption associated with memory? Guide to Writing Your Primary Research Paper Your Research Report should be divided into sections with these headings: Abstract, Introduction, Methods, Results, Discussion, and References. Introduction:

More information

Cognitive behavioural interventions for sleep problems in adults aged 60+ (Review)

Cognitive behavioural interventions for sleep problems in adults aged 60+ (Review) Cognitive behavioural interventions for sleep problems in adults aged 60+ (Review) Montgomery P, Dennis JA This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration

More information

The NYU Caregiver Intervention

The NYU Caregiver Intervention The NYU Caregiver Intervention Translating an Evidence-based Intervention for Spouse-Caregivers into Community Settings Mary S. Mittelman, DrPH Center of Excellence for Brain Aging and Dementia NYU Langone

More information

Tara Leigh Taylor, MD, FCCP Intensivist, Wyoming Medical Center

Tara Leigh Taylor, MD, FCCP Intensivist, Wyoming Medical Center Tara Leigh Taylor, MD, FCCP Intensivist, Wyoming Medical Center Objectives Define the magnitude of the problem Define diagnostic criteria of insomnia Understand the risk factors and consequences of insomnia

More information

A Healthy Life RETT SYNDROME AND SLEEP. Exercise. Sleep. Diet 1. WHY SLEEP? 4. ARE SLEEP PROBLEMS A COMMON PARENT COMPLAINT?

A Healthy Life RETT SYNDROME AND SLEEP. Exercise. Sleep. Diet 1. WHY SLEEP? 4. ARE SLEEP PROBLEMS A COMMON PARENT COMPLAINT? Diet Sleep Exercise RETT SYNDROME AND SLEEP DR. DANIEL GLAZE, MEDICAL DIRECTOR THE BLUE BIRD CIRCLE RETT CENTER A good night s sleep promotes learning, improved mood, general good health, and a better

More information

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults Professional Reference Series Depression and Anxiety, Volume 1 Depression and Anxiety Prevention for Older Adults TA C M I S S I O N The mission of the Older Americans Substance Abuse and Mental Health

More information

Insomnia affects 1 in 3 adults every year in the U.S. and Canada.

Insomnia affects 1 in 3 adults every year in the U.S. and Canada. Insomnia What is insomnia? Having insomnia means you often have trouble falling or staying asleep or going back to sleep if you awaken. Insomnia can be either a short-term or a long-term problem. Insomnia

More information

Primary Care Management of Sleep Complaints in Adults

Primary Care Management of Sleep Complaints in Adults Scope Primary Care Management of Sleep Complaints in Adults (Revised 2004) This guideline is for the primary care management of non-respiratory sleep disorders in adults and follows the DSM-IV-TR classification

More information

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE 1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff

More information

MINISTERIO DE SALUD PUBLICA DIRECCION PROVINCIAL DE SALUD DEL GUAYAS HOSPITAL DE INFECTOLOGIA DR. JOSE DANIEL RODRIGUEZ MARIDUEÑA Guayaquil - Ecuador

MINISTERIO DE SALUD PUBLICA DIRECCION PROVINCIAL DE SALUD DEL GUAYAS HOSPITAL DE INFECTOLOGIA DR. JOSE DANIEL RODRIGUEZ MARIDUEÑA Guayaquil - Ecuador EVALUATION OF THE EFFECTIVENESS OF THE PRODUCT BABUNA IN THE TREATMENT OF INSOMNIA, IN PATIENTS OF THE MALE WING OF THE ECUADORIAN HEALTH MINISTRY S HOSPITAL OF INFECTIOUS DISEASE PILLASAGUA Diana, ANDINO

More information

Oncology Nursing Society Annual Progress Report: 2008 Formula Grant

Oncology Nursing Society Annual Progress Report: 2008 Formula Grant Oncology Nursing Society Annual Progress Report: 2008 Formula Grant Reporting Period July 1, 2011 June 30, 2012 Formula Grant Overview The Oncology Nursing Society received $12,473 in formula funds for

More information

The Environmental Skill-building Program: A Proven Home-based Occupational Therapy Intervention for Families and Individuals with Dementia

The Environmental Skill-building Program: A Proven Home-based Occupational Therapy Intervention for Families and Individuals with Dementia The Environmental Skill-building Program: A Proven Home-based Occupational Therapy Intervention for Families and Individuals with Dementia Laura N. Gitlin, Ph.D. Director, Jefferson Center for Applied

More information

CRITICALLY APPRAISED PAPER (CAP)

CRITICALLY APPRAISED PAPER (CAP) CRITICALLY APPRAISED PAPER (CAP) FOCUSED QUESTION What is the effect of life review through writing on depressive symptoms in older adults residing in senior residences? Chippendale, T., & Bear-Lehman,

More information

Telehealth interventions for mood disorders: What? Who? How?

Telehealth interventions for mood disorders: What? Who? How? Telehealth interventions for mood disorders: What? Who? How? Gregory Simon MD MPH Group Health Center for Health Studies, Seattle, WA Public Health Impact Depression: Lifetime prevalence of 16%, One-year

More information

# Slots/Average. Type/Name of Waiver Eligibility Services. Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 1 of 6

# Slots/Average. Type/Name of Waiver Eligibility Services. Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 1 of 6 Elderly or Disabled with Consumer Direction (EDCD) Elderly or Disabled with Consumer Direction (EDCD) Waiver became effective February 1, 2005. It is the combination of two waivers, the Elderly and Disabled

More information

Caregiving Impact on Depressive Symptoms for Family Caregivers of Terminally Ill Cancer Patients in Taiwan

Caregiving Impact on Depressive Symptoms for Family Caregivers of Terminally Ill Cancer Patients in Taiwan Caregiving Impact on Depressive Symptoms for Family Caregivers of Terminally Ill Cancer Patients in Taiwan Siew Tzuh Tang, RN, DNSc Associate Professor, School of Nursing Chang Gung University, Taiwan

More information

Critical Review: Does music therapy have a positive impact on language functioning in adults with dementia?

Critical Review: Does music therapy have a positive impact on language functioning in adults with dementia? Critical Review: Does music therapy have a positive impact on language functioning in adults with dementia? Ingram, A. M.Cl.Sc (SLP) Candidate University of Western Ontario: School of Communication Sciences

More information

SLEEP DIFFICULTIES AND PARKINSON S DISEASE Julie H. Carter, R.N., M.S., A.N.P.

SLEEP DIFFICULTIES AND PARKINSON S DISEASE Julie H. Carter, R.N., M.S., A.N.P. SLEEP DIFFICULTIES AND PARKINSON S DISEASE Julie H. Carter, R.N., M.S., A.N.P. Problems with sleep are common in Parkinson s disease. They can sometimes interfere with quality of life. It is helpful to

More information

1.0 Abstract. Title: Real Life Evaluation of Rheumatoid Arthritis in Canadians taking HUMIRA. Keywords. Rationale and Background:

1.0 Abstract. Title: Real Life Evaluation of Rheumatoid Arthritis in Canadians taking HUMIRA. Keywords. Rationale and Background: 1.0 Abstract Title: Real Life Evaluation of Rheumatoid Arthritis in Canadians taking HUMIRA Keywords Rationale and Background: This abbreviated clinical study report is based on a clinical surveillance

More information

Running head: GENDER EFFECT 1. Gender Effect of Parent-Child Relationships on Parental Health. Jazmine V. Powell

Running head: GENDER EFFECT 1. Gender Effect of Parent-Child Relationships on Parental Health. Jazmine V. Powell Running head: GENDER EFFECT 1 Gender Effect of Parent-Child Relationships on Parental Health by Jazmine V. Powell A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Bachelor

More information

Medical Necessity Criteria

Medical Necessity Criteria Medical Necessity Criteria 2015 Updated 03/04/2015 Appendix B Medical Necessity Criteria Purpose: In order to promote consistent utilization management decisions, all utilization and care management staff

More information

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

More information

ARTICLE IN PRESS. Addictive Behaviors xx (2005) xxx xxx. Short communication. Decreased depression in marijuana users

ARTICLE IN PRESS. Addictive Behaviors xx (2005) xxx xxx. Short communication. Decreased depression in marijuana users DTD 5 ARTICLE IN PRESS Addictive Behaviors xx (2005) xxx xxx Short communication Decreased depression in marijuana users Thomas F. Denson a, T, Mitchell Earleywine b a University of Southern California,

More information

Depression & Multiple Sclerosis

Depression & Multiple Sclerosis Depression & Multiple Sclerosis Managing specific issues Aaron, diagnosed in 1995. The words depressed and depression are used so casually in everyday conversation that their meaning has become murky.

More information

Treating Depression to Remission in the Primary Care Setting. James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health

Treating Depression to Remission in the Primary Care Setting. James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health Treating Depression to Remission in the Primary Care Setting James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health 2007 United Behavioral Health 1 2007 United Behavioral Health Goals

More information

Multisystemic Therapy With Juvenile Sexual Offenders: Clinical and Cost Effectiveness

Multisystemic Therapy With Juvenile Sexual Offenders: Clinical and Cost Effectiveness Multisystemic Therapy With Juvenile Sexual Offenders: Clinical and Cost Effectiveness Charles M. Borduin Missouri Delinquency Project Department of Psychological Sciences University of Missouri-Columbia

More information

Managing depression after stroke. Presented by Maree Hackett

Managing depression after stroke. Presented by Maree Hackett Managing depression after stroke Presented by Maree Hackett After stroke Physical changes We can see these Depression Emotionalism Anxiety Confusion Communication problems What is depression? Category

More information

LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult

LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders of the American

More information

adaptations whenever possible, to prevent or reduce the occurrence of challenging behaviours.

adaptations whenever possible, to prevent or reduce the occurrence of challenging behaviours. POSITION STATEMENT on Management of Challenging Behaviours in People with Dementia 1. AIM OF THE POSITION STATEMENT This position statement applies to people living in supported accommodation and those

More information

CHRONIC PAIN AND RECOVERY CENTER

CHRONIC PAIN AND RECOVERY CENTER CHRONIC PAIN AND RECOVERY CENTER Exceptional Care in an Exceptional Setting Silver Hill Hospital is an academic affiliate of Yale University School of Medicine, Department of Psychiatry. SILVER HILL HOSPITAL

More information

Psychology and Aging. Psychologists Make a Significant Contribution. Contents. Addressing Mental Health Needs of Older Adults... What Is Psychology?

Psychology and Aging. Psychologists Make a Significant Contribution. Contents. Addressing Mental Health Needs of Older Adults... What Is Psychology? AMERICAN PSYCHOLOGICAL ASSOCIATION Psychologists Make a Significant Contribution Psychology and Aging Addressing Mental Health Needs of Older Adults... People 65 years of age and older are the fastest

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

Examination Content Blueprint

Examination Content Blueprint Examination Content Blueprint Overview The material on NCCPA s certification and recertification exams can be organized in two dimensions: (1) organ systems and the diseases, disorders and medical assessments

More information

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015 The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least

More information

IBADAN STUDY OF AGEING (ISA): RATIONALE AND METHODS. Oye Gureje Professor of Psychiatry University of Ibadan Nigeria

IBADAN STUDY OF AGEING (ISA): RATIONALE AND METHODS. Oye Gureje Professor of Psychiatry University of Ibadan Nigeria IBADAN STUDY OF AGEING (ISA): RATIONALE AND METHODS Oye Gureje Professor of Psychiatry University of Ibadan Nigeria Introduction The Ibadan Study of Ageing consists of two components: Baseline cross sectional

More information

DEMENTIA EDUCATION & TRAINING PROGRAM

DEMENTIA EDUCATION & TRAINING PROGRAM The pharmacological management of aggression in the nursing home requires careful assessment and methodical treatment to assure maximum safety for patients, nursing home residents and staff. Aggressive

More information

Alcohol Disorders in Older Adults: Common but Unrecognised. Amanda Quealy Chief Executive Officer The Hobart Clinic Association

Alcohol Disorders in Older Adults: Common but Unrecognised. Amanda Quealy Chief Executive Officer The Hobart Clinic Association Alcohol Disorders in Older Adults: Common but Unrecognised Amanda Quealy Chief Executive Officer The Hobart Clinic Association The Hobart Clinic Association Not-for-profit private Mental Health Service

More information

GUIDELINES FOR USE OF PSYCHOTHERAPEUTIC MEDICATIONS IN OLDER ADULTS

GUIDELINES FOR USE OF PSYCHOTHERAPEUTIC MEDICATIONS IN OLDER ADULTS GUIDELINES GUIDELINES FOR USE OF PSYCHOTHERAPEUTIC MEDICATIONS IN OLDER ADULTS Preamble The American Society of Consultant Pharmacists has developed these guidelines for use of psychotherapeutic medications

More information

MEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27

MEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27 POLICY TITLE: RESIDENTIAL TREATMENT CRITERIA POLICY STATEMENT: Provide consistent criteria when determining coverage for Residential Mental Health and Substance Abuse Treatment. NOTE: This policy applies

More information

Suicide Assessment in the Elderly Geriatric Psychiatric for the Primary Care Provider 2008

Suicide Assessment in the Elderly Geriatric Psychiatric for the Primary Care Provider 2008 Suicide Assessment in the Elderly Geriatric Psychiatric for the Primary Care Provider 2008 Lisa M. Brown, Ph.D. Aging and Mental Health Louis de la Parte Florida Mental Health Institute University of South

More information

Sleep Difficulties. Insomnia. By Thomas Freedom, MD and Johan Samanta, MD

Sleep Difficulties. Insomnia. By Thomas Freedom, MD and Johan Samanta, MD Sleep Difficulties By Thomas Freedom, MD and Johan Samanta, MD For most people, night is a time of rest and renewal; however, for many people with Parkinson s disease nighttime is a struggle to get the

More information

What is the Effect of a Support Program for Female Family Caregivers of Dementia on Depression? 1

What is the Effect of a Support Program for Female Family Caregivers of Dementia on Depression? 1 , pp.39-46 http://dx.doi.org/10.14257/ijbsbt.2013.5.5.04 What is the Effect of a Support Program for Female Family Caregivers of Dementia on Depression? 1 Hyoshin Kim Dept. of Nursing, Chungwoon University,

More information

Evidence-Based Psychological Treatments for Insomnia in Older Adults

Evidence-Based Psychological Treatments for Insomnia in Older Adults Psychology and Aging Copyright 2007 by the American Psychological Association 2007, Vol. 22, No. 1, 18 27 0882-7974/07/$12.00 DOI: 10.1037/0882-7974.22.1.18 Evidence-Based Psychological Treatments for

More information

Oncology Nursing Society Annual Progress Report: 2008 Formula Grant

Oncology Nursing Society Annual Progress Report: 2008 Formula Grant Oncology Nursing Society Annual Progress Report: 2008 Formula Grant Reporting Period July 1, 2009 June 30, 2010 Formula Grant Overview The Oncology Nursing Society received $12,473 in formula funds for

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

Attachment A Minnesota DHS Community Service/Community Services Development

Attachment A Minnesota DHS Community Service/Community Services Development Attachment A Minnesota DHS Community Service/Community Services Development Applicant Organization: First Plan of Minnesota Project Title: Implementing a Functional Daily Living Skills Assessment to Predict

More information

CRITICALLY APPRAISED PAPER (CAP)

CRITICALLY APPRAISED PAPER (CAP) CRITICALLY APPRAISED PAPER (CAP) FOCUSED QUESTION Does a neurocognitive habilitation therapy service improve executive functioning and emotional and social problem-solving skills in children with fetal

More information

ELEANOR MANN SCHOOL OF NURSING: Leeanne Compere Yopp THE RELATIONSHIPS BETWEEN NURSING STAFF KNOWLEDGE OF PERSONHOOD AND RESIDENT COGNITIVE STATUS

ELEANOR MANN SCHOOL OF NURSING: Leeanne Compere Yopp THE RELATIONSHIPS BETWEEN NURSING STAFF KNOWLEDGE OF PERSONHOOD AND RESIDENT COGNITIVE STATUS THE RELATIONSHIPS BETWEEN NURSING STAFF KNOWLEDGE OF PERSONHOOD AND RESIDENT COGNITIVE STATUS By Leeanne Compere Yopp Eleanor Mann School of Nursing Faculty Mentor: Dr. Nan Smith-Blair Eleanor Mann School

More information

Dr Sarah Blunden s Adolescent Sleep Facts Sheet

Dr Sarah Blunden s Adolescent Sleep Facts Sheet Dr Sarah Blunden s Adolescent Sleep Facts Sheet I am Sleep Researcher and a Psychologist. As a Sleep Researcher, I investigate the effects of poor sleep on young children and adolescents. I also diagnose

More information

Psychosocial treatment of late-life depression with comorbid anxiety

Psychosocial treatment of late-life depression with comorbid anxiety Psychosocial treatment of late-life depression with comorbid anxiety Viviana Wuthrich Centre for Emotional Health Macquarie University, Sydney, Australia Why Comorbidity? Comorbidity is Common Common disorders,

More information

Conjoint Professor Brian Draper

Conjoint Professor Brian Draper Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course

More information

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders

More information

Alzheimer s disease. The importance of early diagnosis

Alzheimer s disease. The importance of early diagnosis Alzheimer s disease The importance of early diagnosis Key Facts Alzheimer s disease and other dementias 1 Alzheimer's disease is the leading form of dementia and accounts for 50%-75% of all cases. 1 Vascular

More information

SLEEP AND PARKINSON S DISEASE

SLEEP AND PARKINSON S DISEASE A Practical Guide on SLEEP AND PARKINSON S DISEASE MICHAELJFOX.ORG Introduction Many people with Parkinson s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are

More information

Depression & Multiple Sclerosis. Managing Specific Issues

Depression & Multiple Sclerosis. Managing Specific Issues Depression & Multiple Sclerosis Managing Specific Issues Feeling blue The words depressed and depression are used so casually in everyday conversation that their meaning has become murky. True depression

More information

Excellence in Prevention descriptions of the prevention programs and strategies with the greatest evidence of success

Excellence in Prevention descriptions of the prevention programs and strategies with the greatest evidence of success Name of Program/Strategy: Coping With Work and Family Stress Report Contents 1. Overview and description 2. Implementation considerations (if available) 3. Descriptive information 4. Outcomes 5. Cost effectiveness

More information

Summary of health effects

Summary of health effects Review of Findings on Chronic Disease Self- Management Program (CDSMP) Outcomes: Physical, Emotional & Health-Related Quality of Life, Healthcare Utilization and Costs Summary of health effects The major

More information

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Statewide Inpatient Psychiatric Program Services (SIPP) Statewide Inpatient Psychiatric

More information

ASD, ABA and Impact on Caregiver Burden. Erin Nolan & Fletcher Wood

ASD, ABA and Impact on Caregiver Burden. Erin Nolan & Fletcher Wood ASD, ABA and Impact on Caregiver Burden Erin Nolan & Fletcher Wood Family Match ALEX, 6 Max, 6 Background Family Match Growing numbers of children identified with autism (suggested 1 in 50 by CDC). ABA

More information

Weighted Quilts and Their Effect on Sleep in Patients with Depression, Anxiety or Bi-polar Disorder: A Pilot Study

Weighted Quilts and Their Effect on Sleep in Patients with Depression, Anxiety or Bi-polar Disorder: A Pilot Study Weighted Quilts and Their Effect on Sleep in Patients with Depression, Anxiety or Bi-polar Disorder: A Pilot Study Jolene Laurence, RNC, MS Marjie Gruenberg, RN, MS Michael Schmitz, Psy.D., LP, CBSM Sue

More information

Dementia: Delivering the Diagnosis

Dementia: Delivering the Diagnosis Dementia: Delivering the Diagnosis Daniel D. Christensen, M.D. Clinical Professor of Psychiatry Clinical Professor of Neurology Adjunct Professor of Pharmacology University of Utah Diagnosing Dementia

More information

Department of Psychiatry, The University of Melbourne

Department of Psychiatry, The University of Melbourne Azlina Wati Nikmat 1,2 Graeme Hawthorne 1, Sam Korn 1 1 Department of Psychiatry, The University of Melbourne 2 Department of Psychiatry, University Teknologi MARA Worldwide: Predicted 2 billion people

More information

kaiser medicaid uninsured commission on The Role of Medicaid for People with Behavioral Health Conditions November 2012

kaiser medicaid uninsured commission on The Role of Medicaid for People with Behavioral Health Conditions November 2012 on on medicaid and and the the uninsured November 2012 The Role of Medicaid for People with Behavioral Health Conditions Introduction Behavioral health conditions encompass a broad range of illnesses,

More information

Refinements in the Assessment of Dementia-Related Behaviors: Factor Structure of the Memory and Behavior Problem Checklist

Refinements in the Assessment of Dementia-Related Behaviors: Factor Structure of the Memory and Behavior Problem Checklist Psychological Assessment: Copyright 1990 by the American Psychological Associatkm, Inc. A Journal of Consulting and Clinical Psychology 1040-3590/90./$00.75 1990, VoL 2, No. 2, 129-133 Refinements in the

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

Running Head: INTERNET USE IN A COLLEGE SAMPLE. TITLE: Internet Use and Associated Risks in a College Sample

Running Head: INTERNET USE IN A COLLEGE SAMPLE. TITLE: Internet Use and Associated Risks in a College Sample Running Head: INTERNET USE IN A COLLEGE SAMPLE TITLE: Internet Use and Associated Risks in a College Sample AUTHORS: Katherine Derbyshire, B.S. Jon Grant, J.D., M.D., M.P.H. Katherine Lust, Ph.D., M.P.H.

More information

WHODAS 2.0 World Health Organization Disability Assessment Schedule 2.0 36-item version, self-administered

WHODAS 2.0 World Health Organization Disability Assessment Schedule 2.0 36-item version, self-administered The APA is offering a number of emerging measures for further research and clinical evaluation. These patient assessment measures were developed to be administered at the initial patient interview and

More information

Caregiving Issues for those with dementia and other cognitive challenges.

Caregiving Issues for those with dementia and other cognitive challenges. Caregiving Issues for those with dementia and other cognitive challenges. Sue Maxwell, MSW Director of Gerontology Lee Memorial Health System Fort Myers, Florida August 2009 Goals & Objectives Understand

More information

Participating in Alzheimer s Disease Clinical Trials and Studies

Participating in Alzheimer s Disease Clinical Trials and Studies Participating in Alzheimer s Disease Clinical Trials and Studies FACT SHEET When Margaret was diagnosed with earlystage Alzheimer s disease at age 68, she wanted to do everything possible to combat the

More information

BEST in MH clinical question-answering service

BEST in MH clinical question-answering service Best Evidence Summaries of Topics in Mental Healthcare BEST in MH clinical question-answering service Question In people with PTSD (including single and multiple event trauma) how effective is prazosin

More information

Frequent headache is defined as headaches 15 days/month and daily. Course of Frequent/Daily Headache in the General Population and in Medical Practice

Frequent headache is defined as headaches 15 days/month and daily. Course of Frequent/Daily Headache in the General Population and in Medical Practice DISEASE STATE REVIEW Course of Frequent/Daily Headache in the General Population and in Medical Practice Egilius L.H. Spierings, MD, PhD, Willem K.P. Mutsaerts, MSc Department of Neurology, Brigham and

More information

Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis, MD, MPH

Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis, MD, MPH CBT for Youth with Co-Occurring Post Traumatic Stress Disorder and Substance Disorders Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis,

More information

Depression: Facility Assessment Checklists

Depression: Facility Assessment Checklists Depression: Facility Assessment Checklists A facility system assessment is a starting point for a quality improvement project. The checklists included in this booklet will be most useful if you take a

More information

Meeting the Needs of Aging Persons. Aging in Individuals with a

Meeting the Needs of Aging Persons. Aging in Individuals with a Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Aging in Individuals with a Developmental Disability Module 3 Based on ADRC training developed

More information

Schizophrenia. This factsheet provides a basic description of schizophrenia, its symptoms and the treatments and support options available.

Schizophrenia. This factsheet provides a basic description of schizophrenia, its symptoms and the treatments and support options available. This factsheet provides a basic description of schizophrenia, its symptoms and the treatments and support options available. What is schizophrenia? Schizophrenia is a commonly misunderstood condition,

More information

Summary chapter 2 chapter 2

Summary chapter 2 chapter 2 Summary Multiple Sclerosis (MS) is a chronic disease of the brain and the spinal cord. The cause of MS is unknown. MS usually starts in young adulthood. In the course of the disease progression of neurological

More information

BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 bps@aphanet.org www.bpsweb.

BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 bps@aphanet.org www.bpsweb. BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 bps@aphanet.org www.bpsweb.org Content Outline for the PSYCHIATRIC PHARMACY SPECIALTY

More information

A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability

A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability Marcia Huipe April 25 th, 2008 Description of Project The purpose of this project was to determine

More information

CULTURALLY AFFIRMATIVE PRACTICE WITH DEAF AND HARD OF HEARING OLDER ADULTS

CULTURALLY AFFIRMATIVE PRACTICE WITH DEAF AND HARD OF HEARING OLDER ADULTS CULTURALLY AFFIRMATIVE PRACTICE WITH DEAF AND HARD OF HEARING OLDER ADULTS David M. Feldman, Ph.D. Assistant Professor of Psychology Barry University 1 MODELS OF DEAFNESS Medical vs. Cultural Prelingual

More information

Facts About Long-Term Care Insurance In Virginia

Facts About Long-Term Care Insurance In Virginia 1-877-310-6560 www.scc.virginia.gov/division/boi/index.htm Facts About Long-Term Care Insurance In Virginia Shop Carefully and Avoid Pitfalls Long-term care insurance is designed to assist individuals

More information

#3: SAMPLE CONSENT FORM

#3: SAMPLE CONSENT FORM #3: SAMPLE CONSENT FORM [Key Element #3: Who is conducting the study] UPMC University of Pittsburgh Medical Center Western Psychiatric Institute and Clinic CONSENT TO ACT AS A PARTICIPANT IN A RESEARCH

More information

Cognitive behavioral therapy (CBT) may improve the home behavior of children with Attention Deficit/Hyperactivity Disorder (ADHD).

Cognitive behavioral therapy (CBT) may improve the home behavior of children with Attention Deficit/Hyperactivity Disorder (ADHD). ADHD 4 Cognitive behavioral therapy (CBT) may improve the home behavior of children with Attention Deficit/Hyperactivity Disorder (ADHD). CITATION: Fehlings, D. L., Roberts, W., Humphries, T., Dawe, G.

More information

Elderly males, especially white males, are the people at highest risk for suicide in America.

Elderly males, especially white males, are the people at highest risk for suicide in America. Statement of Ira R. Katz, MD, PhD Professor of Psychiatry Director, Section of Geriatric Psychiatry University of Pennsylvania Director, Mental Illness Research Education and Clinical Center Philadelphia

More information

Collaborative Care for Alzheimer s Disease

Collaborative Care for Alzheimer s Disease The Health Care Workforce for Older Americans: Promoting Team Care Institute of Medicine Symposium October 2008 Collaborative Care for Alzheimer s Disease Christopher M. Callahan, MD Cornelius and Yvonne

More information

TECHNICAL/CLINICAL TOOLS BEST PRACTICE 7: Depression Screening and Management

TECHNICAL/CLINICAL TOOLS BEST PRACTICE 7: Depression Screening and Management TECHNICAL/CLINICAL TOOLS BEST PRACTICE 7: Depression Screening and Management WHY IS THIS IMPORTANT? Depression causes fluctuations in mood, low self esteem and loss of interest or pleasure in normally

More information

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool The Pharmacological Management of Cancer Pain in Adults Clinical Audit Tool 2015 This clinical audit tool accompanies the Pharmacological Management of Cancer Pain in Adults NCEC National Clinical Guideline

More information

Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital

Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital Mahidol University Journal of Pharmaceutical Sciences 008; 35(14): 81. Original Article Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital

More information

Case Formulation in Cognitive-Behavioral Therapy. What is Case Formulation? Rationale 12/2/2009

Case Formulation in Cognitive-Behavioral Therapy. What is Case Formulation? Rationale 12/2/2009 Case Formulation in Cognitive-Behavioral Therapy What is Case Formulation? A set of hypotheses regarding what variables serve as causes, triggers, or maintaining factors for a person s problems Description

More information

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You

More information

Clinical Audit: Prescribing antipsychotic medication for people with dementia

Clinical Audit: Prescribing antipsychotic medication for people with dementia Clinical Audit: Prescribing antipsychotic medication for people with dementia Trust, team and patient information Q1. Patient's DIS number... Q2. Patient s residence: Home Residential Home Nursing Home

More information

Michael E Dewey 1 and Martin J Prince 1. Lund, September 2005. Retirement and depression. Michael E Dewey. Outline. Introduction.

Michael E Dewey 1 and Martin J Prince 1. Lund, September 2005. Retirement and depression. Michael E Dewey. Outline. Introduction. 1 and Martin J Prince 1 1 Institute of Psychiatry, London Lund, September 2005 1 Background to depression and What did we already know? Why was this worth doing? 2 Study methods and measures 3 What does

More information

Fixing Mental Health Care in America

Fixing Mental Health Care in America Fixing Mental Health Care in America A National Call for Measurement Based Care in Behavioral Health and Primary Care An Issue Brief Released by The Kennedy Forum Prepared by: John Fortney PhD, Rebecca

More information

Bipolar Disorder and Substance Abuse Joseph Goldberg, MD

Bipolar Disorder and Substance Abuse Joseph Goldberg, MD Diabetes and Depression in Older Adults: A Telehealth Intervention Julie E. Malphurs, PhD Asst. Professor of Psychiatry and Behavioral Science Miller School of Medicine, University of Miami Research Coordinator,

More information

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment

More information

Family members, often at great personal cost, provide

Family members, often at great personal cost, provide Article Sustained Benefit of Supportive Intervention for Depressive Symptoms in Caregivers of Patients With Alzheimer s Disease Mary S. Mittelman, Dr.P.H. David L. Roth, Ph.D. David W. Coon, Ph.D. William

More information

Mode and Patient-mix Adjustment of the CAHPS Hospital Survey (HCAHPS)

Mode and Patient-mix Adjustment of the CAHPS Hospital Survey (HCAHPS) Mode and Patient-mix Adjustment of the CAHPS Hospital Survey (HCAHPS) April 30, 2008 Abstract A randomized Mode Experiment of 27,229 discharges from 45 hospitals was used to develop adjustments for the

More information

Evidence Summary for Treatment Foster Care Oregon (formerly Multidimensional Treatment Foster Care, or MTFC)

Evidence Summary for Treatment Foster Care Oregon (formerly Multidimensional Treatment Foster Care, or MTFC) Top Tier Evidence Initiative: Evidence Summary for Treatment Foster Care Oregon (formerly Multidimensional Treatment Foster Care, or MTFC) HIGHLIGHTS: Intervention: A foster care program for severely delinquent

More information

In an experimental study there are two types of variables: Independent variable (I will abbreviate this as the IV)

In an experimental study there are two types of variables: Independent variable (I will abbreviate this as the IV) 1 Experimental Design Part I Richard S. Balkin, Ph. D, LPC-S, NCC 2 Overview Experimental design is the blueprint for quantitative research and serves as the foundation of what makes quantitative research

More information