Treatment outcomes in older adults with hoarding disorder: The impact of self-control, boredom and social support.

OBJECTIVES: Hoarding disorder in older adults often develops in the context of co-occurring psychosocial maladies, and treatment response tends to be suboptimal. This preliminary investigation explored several ageing-related factors and their relationship to hoarding symptom severity (HSS), and examined treatment response to 15 sessions of cognitive behavioural therapy (CBT) with in-home support. METHODS: Twenty-nine participants (Mage = 67) completed self-report questionnaires measuring HSS, self-control, indecisiveness, depression, loneliness, social support and boredom, before (T1) and after (T2) treatment. RESULTS: At T1, HSS was associated marginally with loneliness and significantly with all other variables, except social support. At T2, HSS and depression decreased significantly and only boredom and self-control remained associated with HSS. Attrition rates were high, and those with low social support were more likely to discontinue treatment prematurely. CONCLUSIONS: Increasing social support may improve treatment retention, and pre-emptively reducing sources of boredom and increasing self-control during treatment might improve outcomes for older adults with hoarding disorder.

Delusional Misidentification of the Mirror Image.

PURPOSE OF REVIEW: Delusional misidentification syndromes (DMS) include conditions in which a false belief about the identity of a person, place, or object occurs in the context of psychiatric or neurological disorders. One form of DMS involves the delusion that the patient's mirror image is a separate individual. This review of reported cases characterizes the psychiatric, neuropathological, and neuropsychological aspects of DMS for the mirror image. An individual case presentation highlights the patient's subjective experience. Finally, the impact of this syndrome on the sense of self is considered. RECENT FINDINGS: Mirror DMS is a persistent delusion that occurs in the context of neurological illness. It is associated with right hemisphere impairment and a variety of neuropsychological and neuroimaging abnormalities. This phenomenon contributes to our understanding of a range of neurobehavioral syndromes that can be classified as neuropathologies of the self (NPS). DMS for the mirror image is a neurobehavioral syndrome in which the inability to recognize oneself in the mirror entails neurological, neuropsychological, as well as psychiatric aspects of the sense of self.

Resident Attitudes About Mental Health: a Real-Time Smart Phone Survey.

BACKGROUND: Residents in training have high rates of depression and are reluctant to seek treatment. The goal of the study was to conduct a survey with a high response rate to better understand resident attitudes about mental health. METHODS: A multi-site study of residents from three teaching hospitals in the USA completed a 21-item anonymous questionnaire, on their smartphones, during mandatory lecture sessions. RESULTS: Three-hundred and sixteen resident surveys were completed during 24 didactic sessions. The overall response rate from resident-only presentations was 87.8% and ranged from 76.9% to 100% in presentations that included both residents and other attendees. A significant majority of residents indicated that physicians who seek treatment for medical conditions would not seek treatment for depression (87.7%), physicians do not see acceptance of mental health treatment as a sign of strength (80.1%), and most residents with depression cope with it alone (69.0%). Factors that would encourage residents to seek treatment, including easy access to mental healthcare and acceptance of treatment in the workplace environment, varied significantly when residents were grouped by age and gender. CONCLUSIONS: While residents believe that physicians are highly resistant to mental health treatment, targeted strategies may increase the acceptance of treatment. Administration of surveys to physicians on smartphones at the time of lecture or presentation may improve the response rate.

Correction to: Resident Attitudes About Mental Health: a Real-Time Smart Phone Survey.

[This corrects the article DOI: 10.1007/s40670-019-00745-x.].

Hoarding in the elderly: a critical review of the recent literature.

BACKGROUND: Hoarding is now a stand-alone diagnosis in DSM-5. The objective of this review is to critically evaluate the most recent literature on hoarding disorder (HD) in ageing patients. METHODS: A literature search was conducted using PubMed and PsychINFO to identify papers from 2000 to 2015 that examined HD and hoarding symptoms in late-life participants. RESULTS: Thirteen studies met inclusion criteria. Selected studies had significant methodological limitations with regard to participant sampling, diagnostic criteria, and methods for identifying co-morbid conditions. Hoarding in the elderly generally had onset before age 40 years, increased in severity after middle age, and was linked with social isolation. Depression was associated with hoarding in 14-54% of geriatric cases. Co-morbid anxiety and PTSD were also found. A variety of medical conditions were more common in seniors with hoarding including arthritis and sleep apnea. Late-life hoarding was associated with deficits in memory, attention, and executive function. CONCLUSIONS: HD in the elderly has distinct features. A combination of self-neglect, psychiatric and medical co-morbidities, and executive dysfunction may contribute to the progression of hoarding symptoms in the elderly.

Assessing the benefits of a geropsychiatric home-visit program for medical students.

OBJECTIVE: Authors assessed the benefit of including medical students on geropsychiatric home-visits. METHOD Medical students, during their psychiatry clerkship, were assigned to a home-visit group (N=43) or control group (N=81). Home-visit participants attended the initial visit of a home-bound geriatric patient. The Maxwell-Sullivan Attitude Scale (MSAS), measuring attitudes about geriatric patients, was administered to all students before and after the clerkship. Home-visit participants received a questionnaire to rate the experience. RESULTS: There were no significant differences between the groups with regard to change from baseline to follow-up on the MSAS. On the home-visit questionnaire, participants rated positively the overall experience (mean of 3.5 on a 4-point scale). Most home-visit participants commented positively about their experience. CONCLUSION: No significant effect of the home visit on medical student attitudes was demonstrated. However, the student questionnaire responses suggested that the students found the experience useful.

Treatment of memory loss with herbal remedies.

OPINION STATEMENT: Increased rates of dementia throughout the world are creating an emergent need for successful preventive and treatment strategies. Despite a lack of any significant scientific basis, herbal remedies and other types of "complementary and alternative medicine" (CAM) are being aggressively marketed for both prophylactic and therapeutic effects in regard to memory disorders. In the past few years, a small number of controlled studies have explored the effectiveness of some of the more popular herbal and CAM remedies, including gingko biloba, phosphatidylcholine, phosphatidylserine, and omega-3 fatty acids. To date, the bulk of evidence suggests that such approaches are not successful in preventing or delaying cognitive decline or dementia, and there is little reason to prescribe these remedies for the treatment of established cognitive impairment. Some very preliminary evidence suggests that Gingko biloba may be useful in treating behavioral problems in demented people. It is likely that the absence of regulatory controls on the sale of herbal and CAM preparations will foster continued use of these agents and perhaps even accelerated use as the dementia epidemic increases, assuming no imminent breakthroughs in pharmacotherapy.

Ensuring research competency in psychiatric residency training.

OBJECTIVE: This article discusses the importance of research training in psychiatric residency programs and makes recommendations for enhancement. METHODS: The authors examine the literature detailing the shortage of psychiatrist-researchers and the limitations of research training during residency. The authors then describe the Psychiatrists Acquiring Research Training (PART) program at Beth Israel Medical Center that attempts to address this problem. Data collected on resident scholarly activity, including publications and presentations, is presented. RESULTS: Since its inception, all scholarly activities have increased under the PART program. The 89 residents, followed over 5 academic years, co-authored 32 publications, gave 56 presentations, and received prestigious honors such as NIMH fellowships and national research awards. CONCLUSION: Residents' participation in research has been advanced through participation in PART. Ensuring research competency among all psychiatrists is crucial to providing the best science-based care; PART represents a cost-effective way to integrate research training with psychiatric residency. The authors also discuss opportunities and obstacles to developing research programs as part of psychiatric residency training.

The effects of testosterone on cognition in elderly men: a review.

In this article, the literature examining the relationship between testosterone and various cognitive domains in elderly men is reviewed. The review focuses on the role of endogenous testosterone levels and the effects of androgen depletion and replacement. The cognitive domains most commonly linked to testosterone include memory and visuospatial function. Indeed, the literature suggests that in certain conditions (ie, hypogonadism, cognitive impairment) testosterone levels may be significantly associated with memory and visuospatial function, but not other cognitive functions. Studies with larger sample sizes and more sensitive cognitive measures are indicated, as questions remain about the potential role of testosterone as a cognitive enhancer.

Delusional misidentification.

The Capgras syndrome and other forms of delusional misidentification may be encountered frequently in neuropsychiatric settings. DMS can occur in the presence of idiopathic psychiatric illness, in diffuse brain illness such as dementia, and in focal neurologic disease. In patients who have focal lesions, there is evidence that right hemisphere damage is necessary for the production of DMS. Although DMS is associated with a pattern of neuropsychologic impairments in the domains of memory, perception, and executive function, these impairments alone do not account for the selectivity and delusional nature of DMS. Therefore, other factors such as premorbid psychopathology, motivation, and loss of ego functions may be important in determining which vulnerable patients develop DMS and which do not.

Dimensions of sexual dysfunction in Parkinson disease.

OBJECTIVE: The authors sought to better understand the factors related to sexual dysfunction in Parkinson disease (PD). METHODS: Twenty-one PD patients and their partners received the Derogatis Interview for Sexual Functioning-Self Report (DISF-SR). Additional measures assessed disease severity, autonomic dysfunction, mood, and social circumstance. RESULTS: Data from 17 male patients demonstrated profound impairment in the dimensions of sexual arousal, behavior, orgasm, and drive, with most patients scoring below the 1st percentile on these Derogatis Interview subscales. All four dimensions showed significant intercorrelations. In contrast, 53% of patients scored above the 50th percentile in sexual fantasy. Sexual fantasy subscale scores were positively correlated with duration of PD. CONCLUSIONS: The usefulness of the DISF-SR in this PD population was limited by extremely low scores and strong correlations among the subscales. The increase in sexual fantasy with greater PD duration suggests that patients with advancing disease remain interested in sex and that sexual dysfunction in PD is clinically relevant in this group.

Hypersexuality after pallidal surgery in Parkinson disease.

OBJECTIVE: To examine the possible association of neuropsychiatric symptoms and pallidal surgery for Parkinson disease (PD). BACKGROUND: Parkinson disease may be accompanied by a variety of psychiatric symptoms. It is important to distinguish these from psychiatric syndromes that are associated with the treatment of PD. METHODS: Case description of a patient with PD and a history of right pallidotomy who developed a psychiatric syndrome, including prominent hypersexuality, after surgical implantation of a deep brain stimulator electrode in the left globus pallidus. RESULTS AND CONCLUSIONS: This case demonstrates that patients receiving antiparkinson medication may be at risk for the development of psychiatric sequelae after pallidal surgery.

Home visits in geropsychiatry fellowship training.

PURPOSE: The psychiatric home visit is an effective intervention for elderly patients who otherwise would not receive mental health services. Home visits also have potential to be useful for training. Here, the current practice of home visits in geropsychiatry fellowship programs is examined. DESIGN AND METHODS: The directors of 55 current geropsychiatry fellowships in the United States were sent a 13-item questionnaire regarding the use of home visits for training. RESULTS: Of the 51% of programs responding, 57% provide a formal home-visit experience for fellows. Respondents commented favorably regarding the educational value of home visits, but raised concerns about funding this time-intensive clinical activity. IMPLICATIONS: Training programs in geropsychiatry can benefit from the inclusion of home-visit programs. A description of a recently established home-visit program illustrates the feasibility of such an enterprise when developed as a collaboration between a teaching hospital and an appropriate community agency. This arrangement provides training for fellows and allows the agency to provide broad mental health services.

Negative Symptoms in Patients With Alzheimer's Disease.

This study applies the concept of "negative symptoms," previously used in schizophrenia, to dementia of the Alzheimer type (DAT) and examines the relationship of negative symptoms to cognitive deficits and depression. The negative symptom subscale of the Positive and Negative Symptom Scale (PANSS-N), the Hamilton Depression Scale (Ham-D), and the Mini-Mental State Examination (MMSE) were administered to 26 patients with DAT and to 13 normal control subjects. The mean PANSS-N score in DAT patients was significantly higher than in control subjects. DAT patients demonstrated significant correlation between negative symptoms and cognitive deficits. Ham-D scores did not significantly correlate with MMSE or PANSS-N scores. These results indicate that negative symptoms are prevalent in DAT and do not result from depression.