Comorbid depressive symptomatology or diagnosed depression is not more prevalent in early, mild or severe Alzheimer’s disease. This is an important conclusion from a recent systematic review. Before theories existed about the relationship between Alzheimer’s and depression. These theories said that the prevalence of depression either decreases or increases with the increasing severity of Alzheimer’s disease.
This is comparable to the relationship between depression and personality, does personality predispose to depression or is personality affected by going through depression.
Previous reviews stated that no conclusions could be drawn due to large differences between studies. This review tried to overcome this problem. They made sure all studies consisted of patients with Alzheimer, valid assessments of depression and severity of Alzheimer were performed.
Instead of a linear correlation between Alzheimer’s disease and depression this result could be explained by a theory that neurological and psychosocial factors can reinforce or diminish each other, depending on the specific situation of a patient.
The real answer can only come from a longitudinal study with Alzheimer patients.
A history of depression is associated with an increased risk for Alzheimer’s disease, a new study has found, especially when the depression develops before age 60.
Verkaik, R., Nuyen, J., Schellevis, F., Francke, A. (2007). The relationship between severity of Alzheimer’s disease and prevalence of comorbid depressive symptoms and depression: a systematic review. International Journal of Geriatric Psychiatry, 22(11), 1063-1086. DOI: 10.1002/gps.1809
Online game players score higher in openness, conscientiousness and extraversion compared to non players. They are eager to learn and master new challenges, they are motivated by competition and they enjoy social activities which can all be provided by online game playing.
The online game playing provides them with initial experiences of success and then provide them with more complex challenges creating a flow of immersed experience further satisfying their needs. Not only self-satisfied, these online slots also guarantee real money by winning in the games. This creates a positive spiral enhancing their online game experience.
Chin-I Teng the author of this articles says:”I also believe that skill of players matters in player intention to continuously play online games.” Not only personality but also skills such as visuospatial memory,speed of reaction, problem solving skills play an important role.
Participants played various online games, including international popular games such as Warcraft3, Lineage2,Crazyracing, Rich Online, and Nostale.
Eight hundred three Taiwanese students were approached in high schools and universities, and 591 questionnaires were collected, producing an effective return ratio of 74%. The matched sample comprised 130 pairs of students, which was used for analysis. The two students in each pair were matched by gender and age because players and nonplayers were found significantly different in gender and age. A matched sample was used to minimize the confounding effects of gender and age. Seventy-one percent of participants were male, and all were between 12 and 22 years of age (Mean 16.06). Of the participants, 89% had a monthly income below U.S. $180,while 98% had access to a computer at home, reflecting the Taiwanese student population.
I wasn’t sure about the design so I emailed the author and he confirmed that from the 591 students 130 pairs were formed matched for age and sexe consisting of an online gamer and someone not playing online games. The author:”Yes, each pair consist of a online game player and a non online game player.”
The researchers used a scale to measure openness, conscientiousness and extracersion, the so called Mini-Marker scale of Saucier
This scale determines varying levels of introversion and extraversion. Along with introversion and extraversion the inventory also measures openness, conscientiousness, agreeableness, and neuroticism. The mini-marker asks participants to rate themselves according to 40 different measures (e.g. creative, extraverted, philosophical, and sloppy) using a Likert scale from 1 to 9, with 1 being extremely inaccurate and 9being extremely accurate. Although the mini-marker is a shortened version (about half the personality measures) of the NEO-5 factor, Saucier (1994) determined that it was representative of the full 100 trait NEO-5 factor inventory. The mini-marker was developed on behalf of many people who appreciated the fact that it was shorter and more efficient; however, Saucier (1994) stresses that because of the smaller version it may create lower reliabilities.
Online game players and non players didn’t differ in agreeableness and neuroticism.
According to the authors this research shed some light on online game playing and personality, their suggestion for further research is to investigate personality to different online games.
The limitation of this study is the selection of personality traits, the change of finding what you are looking for is relatively large with this design. The selection of participants is relatively selective, students just aren’t the average kid in the Internet cafe around the corner. These results can not be generalized to larger populations.So this research has some limitations nevertheless I like the outcome it counter balances all the negative publicity around internet addiction and game addiction.To my opinion these are just other disguises of the same problem and not a reason to hamper new developments such as Internet and gaming since this would lead to throw the baby out with the bath water.
Teng, C. (2008). Personality Differences between Online Game Players and Nonplayers in a Student Sample. CyberPsychology & Behavior, 11(2), 232-234. DOI: 10.1089/cpb.2007.0064
Patients often improve more with computer based cognitive-behavioral psychotherapy than with conditions such as waiting list control or care as usual, says a recent review. This is coupled with an over 50% cut in usual therapist time. This review is published in a book: Hands-on Help Computer-aided Psychotherapy. A book review in the Am. J. Psychiatry
Hands-on Help is a narrative review of the mushrooming field of computer-aided psychotherapy for mental health problems as a whole, from the time it began in the 1960’s through to the present day. The many types of computer-aided psychotherapy and how each might be accessed are detailed together with the pros and cons of such help and the functions it can serve. The authors review prevention as well as treatment.
Such a therapy for depression in the UK is called: Beating the Blues
Beating the Blues® is a computerised cognitive behavioural therapy (CCBT) program for depression and anxiety that is available via CD-ROM and the Internet. It has been shown to be a cost effective and time efficient way of helping people suffering from these conditions to get better and stay better. In Feb 2006 the National Institute of Health and Clinical Excellence (NICE) recommended Beating the Blues® as a treatment option for all people seen with mild or moderate depression.
Cognitive-behavioral psychotherapy is a form of psychotherapy that lends it self well for a computer based program. Computer based forms of Psychoanalytic Psychotherapy are far more complicated to my opinion. We recently discussed using a blog during psychodynamic psychotherapy, blogtherapy. Based on this review you can conclude that at least some patients may benefit from this kind of therapy. Nevertheless despite a lot of research questions about computer based psychotherapy remain.
As with other new developments healthcare companies are reluctant to pay for this kind of therapy. What should be the price and who do you have to pay. The developer of the program, the therapist working with patient and computer?
How much human contact with the therapist is best? No human contact at all in these programs are associated with large drop out rates.When should human contact be necessary, with intake or followup or during the program for monitoring progress?
How should human contact take place, by telephone, email, face to face?
What should be the background of the therapists? Psychologists trained in cognitive behavioral therapy, trained nurses, general practitioners, trained volunteers?
Most trials with CBT were with care as usual and waiting lists conditions. These trials suffer from a large placebo effect and high expectancy of the participants of the new treatment. Trials with comparison to other therapies are necessary. Knowledge of what works in this kind of psychotherapy is still fragmentary.
Some patients prefer live to computer-guided help. Not all depressions can be treated by computer psychotherapy. Mostly mild to moderate depression can benefit, more severe forms of depression will still need other forms of therapy of which medication is one.
Overall computer aided psychotherapy as an early option in the treatment of depression is opening up new possibilities. It can be a cost-effective treatment that can reduce chronicity and perhaps even prevalence of depression. Will computer-aided psychotherapy integrate smoothly into the palette of therapeutic options? A lot of research and time will tell.
Computer based cognitive-behavioral therapy is not only used in depression but also in other psychiatric conditions such as anxiety disorders, obsessive-compulsive disorders and problem drinking to name a few.
Advantages are:
No lengthy clinician contacts
Reduce waiting lists
No travel to a therapist
No stigma
Self-empowerment
What is Computer aided cognitive-behavioral therapy?
Computer-aided cognitive–behavioural therapy (CCBT) is any computing system that aids cognitive–behavioural therapy by using patient input to make at least some computations and treatment decisions. This definition excludes video conferencing and ordinary telephone and electronic mail consultations, chat rooms and support groups, which expedite communication and overcome the tyranny of distance but do not delegate any treatment tasks to a computer or other electronic device. It excludes, too, the electronic delivery of educational materials and electronic recording of clinical state or behaviour where those allow no more interaction than do paper leaflets and workbooks.
Computer-aided therapy may be delivered on a range of computing devices, such as stand-alone personal computers, internet-linked computers, palmtops and personal digital assistants, telephone interactive voice response systems, gaming machines, CD–ROMs, DVDs, cellphones and virtual reality devices.
This post was inspired by a recent editorial in the British Journal of Psychiatry.
Marks, I.M., Cavanagh, K., Gega, L. (2007). Computer-aided psychotherapy: revolution or bubble?. The British Journal of Psychiatry, 191(6), 471-473. DOI: 10.1192/bjp.bp.107.041152
Relaxation techniques such as deep breathing, progressive relaxation, and guided imagery help in improving the quality of sleep.
Behavior therapy includes cognitive therapy, stimulus control, and sleep hygiene, which helps in improving sleep, and of course, if you get a good mattress that will also help you sleep better, check the labor day weekend mattress sales for more info.Of these I think sleep hygiene is the most important:Maintaining sleep routine, that is sleep and wake up times should be same every day, engaging in regular exercise workout, avoiding naps in daytime, preventing nicotine and caffeine 3 to 4 hours before bed time and keeping worries out of your bedroom before going to sleep are necessary for getting quality sleep.
Exercise, a sleep aid, not only helps you to sleep better but it also helps you to be alert and effective during day. You shouldn’t exercise before you go to sleep. Before going to sleep do relaxation techniques
Hot bath is one of the sleep aids that relax your body. It raises your body temperature, which helps in getting sleep. It is another way to relax. The water shouldn’t be to hot.
Diet to promote sleep. No caffeine of alcohol before bed time, a Dolphin fluid immersion mattress should be enough to make you sleep like a baby for a long term. Sleep inducing foods are: milk, oatmeal, bananas, almonds and turkey, most of them rich in trypthophan. Don’t eat to much, this will keep you awake.
Bright light in the morning to set your internalclock.
Regularly I write posts about medical education.Medical education is not alway fun. Female students suffer sexual harassment, during clerkship they sometimes have to stay late, which isn’t always such a good idea. In my time most students dropped out at the first years. Don’t know if that is still the case. But how do you prepare your self for choosing med school? MedSchool Hell has: 101 Things You Wish You Knew Before Starting Medical School.
Some examples:
You won’t be a medical student on the surgery service. You’ll be the retractor bitch.
Residents will probably ask you to retrieve some type of nourishment for them.
Most of your time on rotations will be wasted. Thrown away. Down the drain.
You’ll look forward to the weekend, not so you can relax and have a good time but so you can catch up on studying for the week.
You’ll meet a lot of cool people, many new friends, and maybe your husband or wife.
# If you piss off your intern, he or she can make your life hell. If your intern pisses you off, you can make his or her life hell.
You’ll probably change your specialty of choice at least 4 times.
This is a serious blog but so is soccer. Man United draws 0-0 at Barcelona. Barcelona, looking for its second Champions League title in three seasons both Lionel Messi and Samuel Eto’o had good chances. This is a video of Lionel Messi, one of the best players today according to Dr Shock. An artist.This rush is often compared with the rush by Maradonna.
Novelist Amy Tan digs deep into the creative process, journeying through her childhood and family history and into the worlds of physics and chance, looking for hints of where her own creativity comes from. It’s a wild ride with a surprise ending.
There is even some neuroscience in this excellent talk.
This new portable device brings a shocking experience to your playfull-life. Enjoy this game with your friends, be quick and you won’t be the one who suffers from a tiny electric shock wave.
Each of the four players keep their hands on the base of the device. You push the center button and the music starts to play accompanied with red light flashes. Suddenly, the music stops and the light turns green, and if you’re not quick enough to hit your button you’ll be the one that will receive the electric shock.
The quality of information on cocaine addiction on the web is generally poor, confirming previous studies on other health issues. Furthermore, universities seem to be poorly active in proposing websites (8.2%), while commercial organizations hold 55.7% of the studied websites.
This seems a little of topic but for depression the quality of websites for information about depression and it’s treatment is also poor. Wouldn’t it be nice to have a quality scale for health websites?
The authors used quality indicators. They looked at: quality of content, design and aesthetics of the site, readability, dating of information, authority of source, ease of use, accessibility and disclosure of authors and sponsors.
Health on the Net foundation (HON) has issued a code of conduct for medical sites covering much of the above mentioned and attributes a quality label taking into account the following points: disclosure of authorship, sources, updating of information, disclosure of editorial and publicity policy, as well as confidentiality.
Sites having the HON label scored higher.
The global score seems to be a direct content quality indicator. It could be helpful for people to be informed by this quality indicator. It remains however a complex measure.
Further larger studies on websites, including more sites with the HON label may help to conclude about its usefulness as a content quality indicator.
Another quality measure used was the Silberg measure. This measure used accountability standards (disclosure of authorship, ownership and currency of information). They may be useful indicators of the quality of web health information. These accountability criteria have been widely assumed to reflect web site quality. But it doesn’t account for website content.
DISCERN is a brief questionnaire which provides users with a valid and reliable way of assessing the quality of written information on treatment choices for a health problem. DISCERN can also be used by authors and publishers of information on treatment choices as a guide to the standard which users are entitled to expect.
The biggest problem is how to evaluate content. In this study they used the following criteria:
Content quality was examined around the following five points: frequency of cocaine addiction and cocaine abuse; possible somatic, social and psychological complications of cocaine addiction and abuse; cocaine withdrawal; pharmacological treatment options and limitations; motivational and psychotherapeutic treatments and that’s why Understanding Drug Addiction could be essential to get the right treatment for this. Comparison of information found was done in consensus with field experts (American Psychiatric Association, 2006: Practice guidelines for the treatment of substance use disorders). Coverage and correctness of medical information were evaluated. The coverage of a topic was characterized as “none”, “minimal” and “sufficient” (0–2 points). Correctness of information was characterized as “mostly not”, “mostly” and “completely right” (0–2 points)
They reviewed 120 websites. There was a sensible overlap in the sites identified by the two search engines (Google, Yahoo) and the three keywords: cocaine, cocaine addiction and cocaine dependence (35/120). This left 85 websites. Of these, 24 were excluded for the following reasons: 6 contained no information on cocaine addiction; 3 were inaccessible, 2 required an access fee; 13 were not websites (only external links or books). They included 61 sites in our study.
In the article on depression they used the following content assessment:
Concordance between site information and best practice was assessed using a 43-item rating scale based on the evidence-based AHCPR clinical practice guidelines for treating depression
Does anyone know a better way to score the quality of content of health websites, please let me know in the comments.
KHAZAAL, Y., CHATTON, A., COCHAND, S., ZULLINO, D. (2008). Quality of web-based information on cocaine addiction. Patient Education and Counseling DOI: 10.1016/j.pec.2008.03.002