Abstract
Background
loneliness and social isolation have been associated with mortality and with functional decline in older people. We investigated whether loneliness or social isolation are ...associated with progression of frailty.
Methods
participants were 2,817 people aged ≥60 from the English Longitudinal Study of Ageing. Loneliness was assessed at Wave 2 using the Revised UCLA scale (short version). A social isolation score at Wave 2 was derived from data on living alone, frequency of contact with friends, family and children, and participation in social organisations. Frailty was assessed by the Fried phenotype of physical frailty at Waves 2 and 4, and by a frailty index at Waves 2–5.
Results
high levels of loneliness were associated with an increased risk of becoming physically frail or pre-frail around 4 years later: relative risk ratios (95% CI), adjusted for age, sex, level of frailty and other potential confounding factors at baseline were 1.74 (1.29, 2.34) for pre-frailty, and 1.85 (1.14, 2.99) for frailty. High levels of loneliness were not associated with change in the frailty index—a broadly based measure of general condition—over a mean period of 6 years. In the sample as a whole, there was no association between social isolation and risk of becoming physically frail or pre-frail, but high social isolation was associated with increased risk of becoming physically frail in men. Social isolation was not associated with change in the frailty index.
Conclusion
older people who experience high levels of loneliness are at increased risk of becoming physically frail.
Objective: Loss of pleasure or interest in activities (i.e., anhedonia) is a risk factor for suicidality, treatment nonresponse, and relapse. Extant treatments that focus on reducing negative affect ...have limited effects upon positive affect (a core feature of anhedonia). We investigated whether a novel intervention aimed at increasing reward sensitivity was more efficacious for positive affect than a cognitive-behavior treatment aimed at reducing threat sensitivity, in individuals with clinically severe symptoms of depression or anxiety, and functional impairment. Method: The Treatment for Affective Dimensions trial was offered in a 2-site randomized study at outpatient treatment centers in Los Angeles and Dallas. Ninety-six patients were randomized to 15 weekly, individual sessions of Positive Affect Treatment (PAT) or Negative Affect Treatment (NAT). The primary outcome was improvement in positive affect (Positive and Negative Affect Schedule-Positive) from pretreatment to 6-month follow-up (6MFU). Secondary outcomes were improvements in negative affect (Positive and Negative Affect Schedule-Negative), suicidal ideation, and symptoms (Depression Anxiety Stress Scales). Results: PAT resulted in greater improvements in positive affect, p = .009, d = .52, and higher positive affect at 6MFU, p = .002, d = .67, than NAT. Participants in PAT also reported lower negative affect, p = .033, d = .52, and lower symptoms of depression, p = .035, d = .34, anxiety, p < .018, d = .30, and stress, p = .006, d = .43 at 6MFU. Finally, probability of suicidal ideation at 6MFU was lower in PAT than NAT (1.7% vs. 12.0%), p < .001. Conclusions: Compared to NAT, PAT demonstrated better outcomes (at 6MFU) on positive affect, depression, anxiety, stress, and suicidal ideation, for patients with symptomatic pretreatment levels of these outcomes.
What is the public health significance of this article?
Psychological treatment for individuals with depression or anxiety has typically focused on reducing negative emotions. This study demonstrates the superiority of a novel positive affect treatment designed to increase reward sensitivity over a treatment focused upon reducing threat sensitivity for raising positive affect and reducing depression, anxiety, stress, and suicidal ideation.
Motor performance facilitates the understanding of the functional state related to the progression of Alzheimer's disease (AD). At the translational level, this brief report refines the ...characterization of the motor dysfunction of the 3xTg-AD mouse model in different motor tasks, focusing on the abnormal clasping reflex and coordination impairments measured through the Phenotype Scoring System four items screening originally developed for models of ataxia. We studied male 3xTg-AD mice at 6, 12, and 16 months of age (mimicking the early, advanced, and late stages of the disease, respectively) and their age-matched non-transgenic counterparts with normal aging. According to the score, incidence, or severity of the four items and the total score, the 3xTg-AD mice showed deficiencies in all score elements. Clasping was increased independently of age, and its severity worsened with repeated testing. In contrast, the impairment of coordination worsened with the progress of the disease. The gait score was sensitive to genotype since early stages, and the worse ledge score was evident at 16 months. Kyphosis and ledge scores were sensitive to age. The impairments and functional limitations of male 3xTg-AD mice related to the stages of AD provide a scenario that allows understanding the heterogeneity of non-cognitive symptoms.
•Male 3xTg-AD mice exhibited impairment in all items of the physical phenotype score.•Clasping increased independently of age and severity worsened with repeated testing.•The impairment of coordination worsened with the progress of the disease.•Gait score was sensitive to genotype and worse ledge score was evident at 16 months.•Kyphosis and ledge scores were sensitive to the age effect.
Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of ...selection bias.
We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access.
We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included studies.
Twelve studies were included, totalling 11 958 participants; six studies were of high quality. The rate of TRS was 22.8% (95% CI 19.1-27.0%, P < 0.001) among all first-episode cohorts and 24.4% (95% CI 19.5-30.0%, P < 0.001) among first-episode schizophrenia cohorts. Subgroup sensitivity analyses by location of recruitment, TRS definition, study quality, time of data collection and retrospective versus prospective data collection did not lead to statistically significant differences in heterogeneity. In a meta-regression, duration of follow-up and percentage drop-out did not significantly affect the overall TRS rate. Men were 1.57 times more likely to develop TRS than women (95% CI 1.11-2.21, P = 0.010).
Almost a quarter of people with first-episode psychosis or schizophrenia will develop TRS in the early stages of treatment. When including people with schizophrenia who relapse despite initial response and continuous treatment, rates of TRS may be as high as a third. These high rates of TRS highlight the need for improved access to clozapine and psychosocial supports.
Contrary to common stereotypes, loneliness is not restricted to old age but can occur at any life stage. In this study, we used data from a large, nationally representative German study (N = 16,132) ...to describe and explain age differences in loneliness from late adolescence to oldest old age. The age distribution of loneliness followed a complex nonlinear trajectory, with elevated loneliness levels among young adults and among the oldest old. The late-life increase in loneliness could be explained by lower income levels, higher prevalence of functional limitations, and higher proportion of singles in this age group. Consistent with an age-normative perspective, the association of income, relationship status, household size, and work status with loneliness differed between different age groups. In contrast, indicators of the quantity of social relationships (social engagement, number of friends, contact frequency) were universally associated with loneliness regardless of age. Overall, these findings show that sources of loneliness in older adults are well understood. Future research should focus on understanding the specific sources of loneliness in middle-aged adults.
The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical ...syndrome associated with functional impairment.
To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes.
Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654).
People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did.
Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.
Background
Diagnosis of ‘specific’ language impairment traditionally required nonverbal IQ to be within normal limits, often resulting in restricted access to clinical services for children with ...lower NVIQ. Changes to DSM‐5 criteria for language disorder removed this NVIQ requirement. This study sought to delineate the impact of varying NVIQ criteria on prevalence, clinical presentation and functional impact of language disorder in the first UK population study of language impairment at school entry.
Methods
A population‐based survey design with sample weighting procedures was used to estimate population prevalence. We surveyed state‐maintained reception classrooms (n = 161 or 61% of eligible schools) in Surrey, England. From a total population of 12,398 children (ages 4–5 years), 7,267 (59%) were screened. A stratified subsample (n = 529) received comprehensive assessment of language, NVIQ, social, emotional and behavioural problems, and academic attainment.
Results
The total population prevalence estimate of language disorder was 9.92% (95% CI 7.38, 13.20). The prevalence of language disorder of unknown origin was estimated to be 7.58% (95% CI 5.33, 10.66), while the prevalence of language impairment associated with intellectual disability and/or existing medical diagnosis was 2.34% (95% CI 1.40, 3.91). Children with language disorder displayed elevated symptoms of social, emotional and behavioural problems relative to peers, F(1, 466) = 7.88, p = .05, and 88% did not make expected academic progress. There were no differences between those with average and low‐average NVIQ scores in severity of language deficit, social, emotional and behavioural problems, or educational attainment. In contrast, children with language impairments associated with known medical diagnosis and/or intellectual disability displayed more severe deficits on multiple measures.
Conclusions
At school entry, approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress. Access to specialist clinical services should not depend on NVIQ.
Purpose
Objective functional tests like the five-repetition sit-to-stand test (5R-STS) can supplement an objective dimension to conventional patient-reported outcome measures. The reliability of ...unsupervised obtainment of 5R-STS performance is currently unknown.
Methods
We included patients with degenerative pathologies of the lumbar spine. Patients performed the 5R-STS during the initial clinical visit (supervised), as well as at home after instruction by a physiotherapist. At home, patients were first timed by a relative (unsupervised) and subsequently produced a video recording of themselves performing the 5R-STS for digital measurement (telesupervised). Two raters independently assessed the recordings.
Results
One hundred and twenty-one patients were recruited, of which 100 were eligible. Eighty-eight reported unsupervised results. Sixty-four returned recordings, of which 61 were ratable. Both unsupervised (
r
: 0.94, 95% CI 0.91–0.96,
p
< 0.001) and telesupervised (
r
: 0.90, 95% CI 0.83–0.94,
p
< 0.001) measurements demonstrated excellent correlation with clinical test times. Patients did not perform more slowly at home (
p
> 0.05). The interrater agreement for digital judgement of the telesupervised recording was excellent (ICC: 0.996, 95% CI 0.993–0.998,
p
< 0.001). We confirmed convergent validity with self-reported disability, back pain, and quality of life (all
p
< 0.05), but not with leg pain (
p
= 0.189).
Conclusions
Unsupervised at-home assessment using the 5R-STS is highly reliable. There does not appear to be a specific need for patients to return for a supervised 5R-STS follow-up. Rather, instructions can be provided, and the test performed and rated by a partner or family member at home. This is logistically and economically advantageous for patients, clinicians, and researchers.
Trial registry number
ClinicalTrials.gov Identifier: NCT03321357.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Objectives
Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the ...United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme.
Design
A pre‐registered (CRD42018114796) systematic review and meta‐analysis.
Methods
A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias.
Results
The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI 0.78–0.96, p < .0001) and anxiety (d = 0.88, 95% CI 0.79–0.97, p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI 0.48–0.61, p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed).
Conclusions
Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed.
Practitioner points
IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures.
IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment.
A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development.
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