PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-12 (12)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
Document Types
1.  Is Late-Onset Schizophrenia a Subtype of Schizophrenia? 
Acta psychiatrica Scandinavica  2010;122(5):414-426.
Objective
To determine whether late-onset schizophrenia (LOS, onset after age 40) should be considered a distinct subtype of schizophrenia.
Method
Participants included 359 normal comparison subjects (NCs) and 854 schizophrenia outpatients age > 40 (110 LOS, 744 early-onset schizophrenia or EOS). Assessments included standardized measures of psychopathology, neurocognition, and functioning.
Results
EOS and LOS groups differed from NCs on all measures of psychopathology and functioning, and most cognitive tests. EOS and LOS groups had similar education, severity of depressive, negative, and deficit symptoms, crystallized knowledge, and auditory working memory, but LOS patients included more women and married individuals, had less severe positive symptoms and general psychopathology, and better processing speed, abstraction, verbal memory, and everyday functioning, and were on lower antipsychotic doses. Most EOS-LOS differences remained significant after adjusting for age, gender, severity of negative or deficit symptoms, and duration of illness.
Conclusions
LOS should be considered a subtype of schizophrenia.
doi:10.1111/j.1600-0447.2010.01552.x
PMCID: PMC3939834  PMID: 20199491
Schizophrenia; aging; cognition; negative symptoms; quality of life; positive symptoms
2.  Subthreshold Depression and Successful Aging in Older Women 
Objectives
Subthreshold Depression (StD) is common in older adults and is associated with poor self-rated health. However, the impact of StD on broader indicators of successful aging, such as positive psychological constructs, cognitive functioning, or quality of well-being, has not been assessed. We compared persons with scores above and below a predetermined threshold on the Center for Epidemiological Studies Scale for Depression (CESD) to non-depressed persons (ND) on measures of multiple domains associated with successful aging.
Design
Cross sectional survey-based psychological assessments.
Participants
1,979 community-dwelling older women participating in the Women’s Health Initiative study.
Measurements
ND was defined as a CESD score below 8, StD as a score between 8 and 15, and CESD Depression (CD) as a score of 16 or above. The study questionnaire consisted of multiple self-reported measures of positive psychological functioning (e.g., optimism, resilience), cognitive functioning and complaints, and quality of well-being. We also obtained a history of diagnosis, treatment, and hospitalization related to mental health problems.
Results
20.2% of women met CES-D criteria for StD and 7% for CD. Women with StD had worse self-rated successful aging, worse physical and emotional functioning, lower optimism, more negative attitudes toward aging, lower personal mastery and self-efficacy, and greater anxiety and hostility than ND women, but scored better on all these measures than women with CD. StD subjects also had higher self-reported rates of previous diagnosis, treatment, and hospitalization for mental health problems than the ND group. StD subjects with depressed mood and/or anhedonia were largely similar to those without these symptoms.
Conclusions
Mild-moderate levels of depressive symptoms that likely fall under a general category of StD were common, and were associated with worse functioning on virtually every component of successful aging that we examined. StD represents a clinical entity that may affect the longitudinal course of successful aging for large numbers of persons and is a potential target for clinical intervention.
doi:10.1097/JGP.0b013e3181b7f10e
PMCID: PMC3937985  PMID: 20224518
3.  Older Age is Associated with More Successful Aging: Role of Resilience and Depression 
The American journal of psychiatry  2013;170(2):188-196.
Background
There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging (SRSA).
Methods
In this Successful AGing Evaluation (SAGE) study, we used a structured multi-cohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, aged 50–99 years, with over-sampling of people over 80. A modified version of random digit dialing was used to recruit subjects. Evaluations included a 25-minute phone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including SRSA (scaled from 1 [lowest] to 10 [highest]) and positive psychological traits.
Results
In our sample with mean age of 77.3 years, the mean SRSA score was 8.2, and older age was associated with higher SRSA (R2 = 0.027), despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of variance in SRSA, and included resilience, depression, physical functioning, and age (entering the regression model in that order).
Conclusions
Resilience and depression had a significant association with SRSA with effect sizes comparable to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have as strong effects on successful aging as reducing physical disability, suggesting an important role for psychiatry in promoting successful aging.
doi:10.1176/appi.ajp.2012.12030386
PMCID: PMC3593664  PMID: 23223917
Aging; Resilience; Optimism; Depression; Cognition; Disability
4.  Characterizing Trajectories of Cognitive Functioning in Older Adults with Schizophrenia: Does Method Matter? 
Schizophrenia research  2012;143(1):90-96.
Background
Heterogeneity in clinical outcomes may be caused by factors working at multiple levels, e.g., between groups, between subjects, or within subjects over time. A more nuanced assessment of differences in variation among schizophrenia patients and between patients and healthy comparison subjects can clarify etiology and even facilitate the identification of patient subtypes with common neuropathology and clinical course.
Methods
We compared trajectories (mean duration 3.5 years) of cognitive impairments in a sample of 201 community-dwelling schizophrenia (SCZ) patients (aged 40–100 years) with 67 healthy comparison (HC) subjects. We employed growth mixture models to discover subclasses with more homogenous between-subject variation in cognitive trajectories. Post hoc analyses determined factors associated with class membership and class-specific correlates of cognitive trajectories.
Results
Three latent classes were indicated: Class 1 (85% HC and 50% SCZ) exhibited relatively high and stable trajectories of cognition, Class 2 (15% HC and 40% SCZ) exhibited lower, modestly declining trajectories, and Class 3 (10% SCZ) exhibited lower, more rapidly declining trajectories. Within the patient group, membership in Classes 2–3 was associated with worse negative symptoms and living in a board and care facility.
Discussion
These results bridge the gap between schizophrenia studies demonstrating cognitive decline and those demonstrating stability. Moreover, a finer-grained characterization of heterogeneity in cognitive trajectories has practical implications for interventions and for case management of patients who show accelerated cognitive decline. Such a characterization requires study designs and analyses sensitive to between- and within-patient heterogeneity in outcomes.
doi:10.1016/j.schres.2012.10.033
PMCID: PMC3540183  PMID: 23218560
Late-Life Schizophrenia; Cognition; Trajectories; Heterogeneity; Growth Mixture Models
5.  To What Factors Do Rural-Dwelling Hispanics Attribute Depressive Symptoms? 
This study is a retrospective chart review comparing rural-dwelling Caucasian and Hispanic outpatients' attribution of depressive symptoms. Based on the data gathered at intake, Hispanics were more likely to attribute depression to curse/spell and supernatural causes, while Caucasians were more likely to attribute symptoms to hereditary factors or job stress. Among both groups, higher CESD score was associated with problems with significant others or how they got along with others. Among Hispanics, depression severity was additionally associated with problems related to job or finances. Our findings point to a consequential role for clinical inquiry into attributed causes of depressive symptoms.
doi:10.1155/2013/781986
PMCID: PMC3677663  PMID: 23781333
6.  Adding antidepressants to antipsychotics for treatment of subsyndromal depressive symptoms in schizophrenia: Impact on positive and negative symptoms 
Indian Journal of Psychiatry  2013;55(2):144-148.
Objectives:
It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms.
Materials and Methods:
Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms.
Results:
There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores.
Conclusions:
In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.
doi:10.4103/0019-5545.111452
PMCID: PMC3696237  PMID: 23825848
Citalopram; depression; negative symptom; schizophrenia
7.  Psychopathological and Functional Correlates of Behavioral Activation and Avoidance in Schizophrenia 
Behavioral activation and avoidance are well studied in depression, yet the relationship of these constructs to symptoms, cognitive ability and functioning in schizophrenia is poorly understood. In a sample of 73 middle-aged and older outpatients with schizophrenia (mean age=50.3, sd=6.3), we examined the relationship of the Activation and Avoidance subscales of the Behavioral Activation for Depression Scale with measures of psychopathology (Positive and Negative Symptoms, Depression), global cognitive ability, and global cognitive ability, and functioning (observer-rated, performance-based, and subjective functioning). Neither activation nor avoidance related to sociodemographic variables, age of onset, or anti-psychotic dose. Although activation and avoidance were significantly inter-correlated, only behavioral activation was significantly associated with depression and subjective functioning, whereas only avoidance related to negative symptoms. Avoidance accounted for significant variation in observer-rated functioning after adjusting for cognitive ability. These results suggest that activation and avoidance may be important therapeutic targets in schizophrenia, with somewhat divergent pathways among psychopathologic features to functional impairment.
doi:10.1097/NMD.0b013e3182349cb7
PMCID: PMC3233969  PMID: 22048138
Schizophrenia; psychosis; activation; avoidance; depression; functioning
8.  Attitude Toward Own Aging and Mental Health in Post-menopausal Women 
Asian journal of psychiatry  2011;4(1):26-30.
Introduction
Attitudes toward own aging (ATOA) refers to expectations about the personal experience of aging. As of now, there is limited literature that addresses the impact of ATOA on indicators of psychological, physical, and social health. In this study, we examine associations between ATOA and several measures associated with successful aging.
Methods
A detailed cross-sectional survey questionnaire on successful aging was completed by 1,973 older women enrolled in the San Diego site of the Women's Health Initiative study. ATOA was measured using the Philadelphia Geriatric Morale Scale (PGMS)
Results
The final sample consisted of 1151 women. The mean ATOA score was 3.8 indicating generally positive ATOA. Positive ATOA score was significantly associated with younger age, lower income, being married, higher SF-36 Physical Composite scores, higher SF-36 Mental composite scores, lower depression scores, and higher resilience scores. Approximately 40% of variance in ATOA scores was explained by successful aging-related domain scores.
Conclusions
Better physical and emotional functioning, greater resilience and lower depression are associated with more positive ATOA. Associations with sociodemographic traits are complex. Modifying ATOA may have potential to impact a broad range of health and successful aging related outcomes.
doi:10.1016/j.ajp.2011.01.006
PMCID: PMC3098443  PMID: 21607197
Attitude toward aging; Depression; Health; Social status; Spirituality; Personal mastery; Optimism
9.  Correlates of Spirituality in Older Women 
Aging & mental health  2011;15(1):97-102.
Introduction
The role of spirituality in the context of mental health and successful aging is not well understood. In a sample of community-dwelling older women enrolled at the San Diego site of the Women's Health Initiative study, we examined the association between spirituality and a range of variables associated with successful cognitive and emotional aging, including optimism, resilience, depression, and health-related quality of life (HRQoL).
Methods
A detailed cross-sectional survey questionnaire on successful aging was completed by 1,973 older women. It included multiple self-reported measures of positive psychological functioning (e.g., resilience, optimism,), as well as depression and HRQoL. Spirituality was measured using a 5-item self report scale constructed using two items from the Brief Multidimensional Measure of Religiosity/Spirituality and three items from Hoge's Intrinsic Religious Motivation Scale
Results
Overall, 40% women reported regular attendance in organized religious practice, and 53% reported engaging in private spiritual practices. Several variables were significantly related to spirituality in bivariate associations; however, using model testing, spirituality was significantly associated only with higher resilience, lower income, lower education, and lower likelihood of being in a marital or committed relationship.
Conclusions
Our findings point to a role for spirituality in promoting resilience to stressors, possibly to a greater degree in persons with lower income and education level. Future longitudinal studies are needed to confirm these associations.
doi:10.1080/13607863.2010.501069
PMCID: PMC3017739  PMID: 20924814
Spirituality; religiosity; elderly; successful aging; resilience
10.  Exergames for Subsyndromal Depression in Older Adults: A Pilot Study of a Novel Intervention 
Objectives
Subsyndromal depression (SSD) is several times more common than major depression in older adults, and is associated with significant negative health outcomes. Physical activity can improve depression, yet adherence is often poor. We assessed the feasibility, acceptability, and short-term efficacy and safety of a novel intervention using exergames (entertaining video games that combine game play with exercise) for SSD in older adults.
Methods
Community-dwelling older adults (N = 19, age 63–94) with SSD participated in a 12-week pilot study (with follow-up at 20 to 24 weeks) of Nintendo’s Wii Sports, with three 35-minute sessions a week.
Results
86% of enrolled participants completed the 12-week intervention. There was a significant improvement in depressive symptoms, mental health-related quality of life, and cognitive performance, but not physical health-related quality of life. There were no major adverse events, and improvement in depression was maintained at follow-up.
Conclusions
The findings provide preliminary indication of the benefits of exergames in seniors with SSD. Randomized controlled trials of exergames for late-life SSD are warranted.
doi:10.1097/JGP.0b013e3181c534b5
PMCID: PMC2827817  PMID: 20173423
Physical activity; Aging; Videogames; Depression; Quality of life; Cognition
11.  Subjective Reasons for Adherence to Psychotropic Medication and Associated Factors among Older Adults with Schizophrenia 
Schizophrenia research  2008;106(2-3):348-355.
Rationale
There are limited data examining subjective influences on medication adherence among older persons with schizophrenia. The subjective reasons for adherence to antipsychotic medication and associated clinical and psychosocial factors in this population are examined.
Methods
The sample consisted of 198 community dwelling persons aged ≥55 who developed schizophrenia before age 45. Using the Rating of Medication Influences Scale (ROMI), a principal component factor analysis with varimax rotation yielded three subscales: Medication Affinity and Prevention, Influence of Others, and Impact of Authority. These subscales were dichotomized into high and low based on a median split. We also created an ordinal High Adherence measure based on the summed scores of each person’s three dichotomized ROMI subscales. A modified health belief model was used to examine the association between 18 predictor variables and the ROMI subscales and the adherence scale.
Results
The mean subscale rankings were Medication Affinity and Prevention> Impact of Authority> Influence of Others. In logistic regression, lower education, more side-effects, higher depression scores, and more mental health services were associated with higher scores on Influence of Others subscale. More side-effects and more entitlements were associated with higher scores on the Medication Affinity and Prevention subscale. The Impact of Authority subscale had no significant associations. More side effects and higher depression scores were associated with higher scores on High Adherence measure.
Conclusion
We identified a three-dimensional model for explaining the subjective reasons for medication adherence in older persons with schizophrenia. Our findings suggest that cognitive approaches and use of authority figures may be useful for promoting adherence in older adults. Independent variables associated with these subscales may provide guidance for improving adherence in this population.
doi:10.1016/j.schres.2008.09.004
PMCID: PMC2615578  PMID: 18851906
Schizophrenia; Aging; Adherence; Subjective factors
12.  Comparison of the Conceptualization of Wisdom in Ancient Indian Literature with Modern Views 
Psychiatry  2008;71(3):197-209.
The study of wisdom has recently become a subject of growing scientific interest, although the concept of wisdom is ancient. This article focuses on conceptualization of wisdom in the Bhagavad Gita, arguably the most influential of all ancient Hindu philosophical/religious texts. Our review, using mixed qualitative/quantitative methodology with the help of Textalyser and NVivo software, found the following components to be associated with the concept of wisdom in the Gita: Knowledge of life, Emotional Regulation, Control over Desires, Decisiveness, Love of God, Duty and Work, Self-Contentedness, Compassion/Sacrifice, Insight/Humility, and Yoga (Integration of personality). A comparison of the conceptualization of wisdom in the Gita with that in modern scientific literature shows several similarities, such as rich knowledge about life, emotional regulation, insight, and a focus on common good (compassion). Apparent differences include an emphasis in the Gita on control over desires and renunciation of materialistic pleasures. Importantly, the Gita suggests that at least certain components of wisdom can be taught and learned. We believe that the concepts of wisdom in the Gita are relevant to modern psychiatry in helping develop psychotherapeutic interventions that could be more individualistic and more holistic than those commonly practiced today, and aimed at improving personal well-being rather than just psychiatric symptoms.
doi:10.1521/psyc.2008.71.3.197
PMCID: PMC2603047  PMID: 18834271

Results 1-12 (12)