The Effectiveness of a Caregiver Support and Education Intervention Designed for Caregivers of Veterans

Veterans are at increased risk for dementia and multiple comorbid conditions, often making the family caregiving experience particularly challenging. The objective of this study was to examine the effectiveness of a telephone-based, collaborative dementia care program for improving caregiver (CG) outcomes in CGs of veterans with dementia. All CGs (n=107) received individual care management and were randomized to either individual intervention alone or individual plus group education and social support. CGs were on average 72.5 (+/-11.0) years old, and the majority were female, spouses/partners of the care recipient (CR), and providing care for ≥1 year. Pre-post analyses indicate that CGs experienced a significant reduction in both the frequency of CRs’ dementia-related symptoms (e.g. memory difficulties, disruptive behaviors, depressive affect) and their own distress in response to these symptoms. Our study adds to the literature on the development and evaluation of understudied CG populations, such as CGs of veterans with dementia.

Stability and Change in Relations Between Personality Traits and the Interpersonal Problems Circumplex During Cognitive Therapy for Recurrent Depression

Both personality impairment and maladaptive-range traits are necessary for diagnosis in the alternative model of personality disorder. We clarified personality impairment-trait connections using measures of the interpersonal problems circumplex and personality traits among adult outpatients ( N = 351) with major depressive disorder receiving cognitive therapy (CT). The trait scales’ circumplex projections were summarized by elevation (correlations with general interpersonal problems), amplitude (specific relations to the circumplex dimensions of dominance and affiliation), and angle (predominant orientation in the two-dimensional circumplex). Most trait scales showed hypothesized circumplex relations, including substantive elevation (e.g., negative temperament, mistrust), amplitude (e.g., aggression, detachment), and expected angles (e.g., positive temperament and manipulativeness oriented toward overly nurturant/intrusive or domineering/vindictive problems, respectively), that were stable across time during CT. These results revealed meaningful and consistent impairment-trait connections, even during CT when mean depressive affect decreased substantially.

Loneliness Is Associated with Depressive Affect, But Not with Most Other Symptoms of Depression in Community-Dwelling Individuals: A Network Analysis

There is a strong relationship between loneliness and depression, but depression is a heterogeneous disorder. We examined the profile of depressive symptoms most strongly related to loneliness. Study participants were 2007 community-dwelling individuals (median age 31 years, 70.4% women) who completed an online survey on loneliness (single-item question: “never”, “sometimes”, “often”), depressive symptoms (Patient Health Questionnaire-9) and demographics. The relationship between loneliness and depressive symptoms was evaluated with linear regression and network analyses. The prevalence of loneliness (sometimes or often) and of moderate depression was 47.1% and 24.0%, respectively. Loneliness explained 26% of the variance in the total depressive symptom score (p < 0.001), independent of covariates. This result was almost exclusively explained by the relationship with a single depression symptom (“feeling down, depressed, or hopeless”), irrespective of whether loneliness was treated as a nominal or continuous variable. The findings of our study suggest that the role of loneliness in depression should not only be investigated at the syndrome level, but also at the symptom level. Studies are warranted to test whether targeted treatment of depressive affect is particularly effective against loneliness.

Untangling racism: Stress reactions in response to variations of racism against Black Canadians

The ability to effectively contend with racism is likely undermined by factors that promote uncertainty regarding racist motives. A national policy of multiculturalism exists in Canada, which is intended to encourage cultural diversity, but can also serve to mask systemic racism. This may contribute to uncertainty when racism is encountered, with implications for the appraisals, coping, and stress-related outcomes of ethnoracial minorities. Two studies were conducted to assess Black Canadians’ experiences of racism, and their reactions to variations in the nature of the experience. A survey study found that Black Canadians’ (n = 158) self-reported past encounters with explicit racism were associated with anger-out coping, which in turn was related to lower depressive affect. In contrast, ambiguous racism was related to keeping anger in and higher depressive affect; this relation was exacerbated when participants believed Blacks were held in high regard by others, likely adding uncertainty to interpreting behaviours as racist. An experimental study manipulated the nature of racist cues conveyed in a videotaped description of the experiences of a Black male interviewee. When the Black interviewee described racist experiences that were ambiguous (vs. explicit) both White (n = 112) and Black (n = 99) observers were less likely to appraise events as racist, even when physical violence was involved. However, the moment-to-moment distress elicited while listening the interviewee’s description of their racist experiences was uniquely associated with higher cortisol levels among Blacks (but not Whites), especially when physical violence was present. Taken together, the findings contribute to our understanding of the processes by which ambiguous racism might operate to undermine the well-being of targeted groups. Moreover, it is suggested that policies conveying that ethnoracial groups are highly valued (e.g., multiculturalism) might actually exacerbate negative effects of racist experiences, particularly in the absence of an open discourse acknowledging the presence of systemic racism.

Systematic Changes in Gait Pursuant to Choir Participation for Caregivers and Persons With Dementia

Choir interventions confer psychological benefits for persons with dementia (PwD) and their caregivers. However, less is known about whether physiological function also exhibits improvements pursuant to such social-cognitive interventions. The present study, based upon a subsample of the Voices in Motion (ViM) project, explored whether participation in an intergenerational choir results in systematic improvements in gait velocity (indexed using a GAITRite computerized walkway) for both informal caregivers (n=14; 71.4% female) and PwD (n=14; 64.3% female). Longitudinal burst data from the first of three cohorts spanning 4 assessments over 3.5 months was analysed using multilevel modeling. Whereas caregivers exhibited significant improvements (p&lt;.05) in gait velocity, PwD showed no improvement. Ongoing analyses are exploring additional cohorts, and whether improvements in gait dynamically covary with reductions in comorbidities (e.g., neuropsychological function, caregiver burden, depressive affect). These results underscore the potential of choir for facilitating both psychosocial and physiological function for caregivers and PwD.

The Historical Aspect of Depressive Delusions Phenomenon Studies

The aim: to provide an overview of domestic and international studies examining various aspects of issue of depressive delusional ideas in endogenous delusional depression disease patternMaterials and method: in order to compile a literature review for the keywords depressive delusions and delusional depressions, data from scientific articles posted in MedLine and PubMed databases as well as other bibliographic sources have been searched and analyzed during the formation of scientific psychiatry to the present.Discussion: based on the analysis of scientific publications, this paper presents data on the psychopathological description of depressive delusions and its relatedness to the depressive affect. The researchers’ viewpoints on primary and secondary characteristics of depressive delusions are being analyzed. We have identified pathogenetic characteristics of the latter that affect the prognostic assessment, such as features of the depressive triad in endogenous depression, severity and type of depressive affect, risk of suicidal behavior, characteristics of premorbid personality traits, genetic background, as well as therapeutic efficacy of treatment methods for depressive delusions in patients with delusional depression. This research reveals the controversial nature of some provisions of scientific publications that gradually divert from clinical diagnostic approaches, which tend to be replaced by psychological and psychoanalytic ones when carrying out prognostic assessment in cases of depressive delirium, which is characteristic of current psychiatric science.Conclusions: scientific publications data analysis testifies to the priority of the clinical and psychopathological method in studying the issues of depressive delusions structure in delusional depression disease pattern as well as in clinical differentiation of depressive delusions, justifies its clinical and prognostic value and enables to choose the treatment effectively.

Neuroinflammation, Depressive Affect, and Amyloid Burden in Alzheimer's Disease: Insights from the Kynurenine Pathway

Background: Depressive symptoms in Alzheimer's disease (AD) predict worse cognitive and functional outcomes. Both AD and major depression are characterized by shunted tryptophan metabolism away from serotonin (5-HT) and toward the neuroinflammatory kynurenine (Kyn) pathway. The present study assessed the role of Kyn across the AD continuum in behavioral, neuroanatomical, neuropathological, and physiological outcomes. Methods: In 746 participants from the Alzheimer's Disease Neuroimaging Initiative-1 (ADNI1) cohort, serum markers of 5-HT, tryptophan, and Kyn were measured and their relationships investigated with immunologic markers, affect and functional outcomes, CSF markers of beta-amyloid (Aβ) and tau, and regional gray matter. Results: A higher Kyn/Tryptophan ratio was linked to many inflammatory markers, as well as lower functional independence and memory scores. A higher Kyn/5-HT ratio showed similar associations, but also strong relationships with depressive affect and neuropsychiatric disturbance, executive dysfunction, and global cognitive decline. Further, gray matter atrophy was seen in hippocampus, anterior cingulate, and prefrontal cortices, as well as greater amyloid and total tau deposition. Finally, using moderated-mediation, several pro-inflammatory factors partially mediated Kyn/5-HT and depressive affect scores in participants with subclinical Aβ (i.e., Aβ-), whereas such associations were fully mediated by Complement 3 in Aβ+ participants. Conclusions: These findings suggest that neuroinflammatory signaling cascades may occur during AD, resulting in increased Kyn metabolism that influences the pathogenesis of depressive symptoms. Aβ and the complement system may be critical contributing factors in this process.