Reflections on Tribalism and Aging.

As a geriatric psychiatrist, I have become interested in gene-culture coevolution to better understand the meaning of aging. This investigation has led me to try to understand tribalism. This essay provides a background on gene-culture coevolution and tribalism from five, of several, comprehensible and recommendable books: The Social Conquest of Earth by Edward O.

Reflections on Aging and Wisdom.

The author experienced an unexpected finding over 30 years ago. Despite many losses, older primary care patients had less psychiatric symptomatology than younger patients. This has led to a long learning and teaching focus on the positive relationship between aging and wisdom.

RESPECT-PTSD: re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial.

Background: Although collaborative care is effective for treating depression and other mental disorders in primary care, there have been no randomized trials of collaborative care specifically for patients with Posttraumatic stress disorder (PTSD).

Objective: To compare a collaborative approach, the Three Component Model (3CM), with usual care for treating PTSD in primary care.

Design: The study was a two-arm, parallel randomized clinical trial.

RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care.

Background: U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan.

Problem-solving treatment and coping styles in primary care for minor depression.

Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for minor depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics.

Impact of pain on the outcomes of depression treatment: results from the RESPECT trial.

Objective: Pain is prevalent in patients with depression. The purpose of this study was to determine the impact of pain on depression treatment outcomes.

Methods: Data was analyzed from a randomized controlled trial comparing a collaborative care intervention to usual care for the treatment of depression in 60 primary care practices.

Sustainable impact of a primary care depression intervention.

Background: Re-Engineering Systems for Primary Care Treatment of Depression (RESPECT-D) sought to improve patient outcomes by disseminating the 3-component model of depression management. The purpose of this study was to determine whether an integrated model of depression management continued to be used by primary care clinicians after the end of a randomized controlled trial (RCT).

Methods: A descriptive evaluation was conducted at 2 time points.

A fidelity measure for integrated management of depression in primary care.

Background: Integrated models of primary care depression management improve outcomes. Subsequent dissemination efforts and their evaluation need a fidelity measure.

Objectives: We sought to develop and validate a fidelity measure using data gathered during routine clinical application of the clinical model.

Watchful waiting for minor depression in primary care: remission rates and predictors of improvement.

Objectives: The objectives of this study were to determine remission rates and predictors of improvement for minor depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes.

Methods: Prior to randomization into a clinical trial for minor depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting.

Billing for the Evaluation and Treatment of Adult Depression by the Primary Care Clinician.

Depression is a common problem encountered in primary care practice. There are many barriers that the primary care clinician faces in managing patients with depression. Financial reimbursement is one infrequently addressed barrier that influences how care is provided.

Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial.

Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Design: Cluster randomised controlled trial.

Setting: Five healthcare organisations in the United States and 60 affiliated practices.

Going to scale: re-engineering systems for primary care treatment of depression.

Background: Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy.

Methods: In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy supporting practice change.

Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

Objective: The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients.

Method: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened.

Measures to Assess the Noncognitive Symptoms of Dementia in the Primary Care Setting.

Noncognitive symptoms associated with Alzheimer's disease and related dementias include psychosis, mood disturbances, personality changes, agitation, aggression, pacing, wandering, altered sexual behavior, changed sleep patterns, and appetite disturbances. These noncognitive symptoms of dementia are common, disabling to both the patient and the caregiver, and costly. Primary care physicians will often play a major role in diagnosing and treating dementia and related disorders in the community.

The STIRR model of best practices for blood-borne diseases among clients with serious mental illness.

Objective: Persons with severe mental illness have a markedly elevated risk of several blood-borne infections, including HIV, hepatitis B, and hepatitis C. Prevention, early detection, and treatment of these disorders are crucial interventions for high-risk populations. However, because of a number of barriers, most clients with severe mental illness do not receive these basic best-practice services.

Evidence-based practices in geriatric mental health care: an overview of systematic reviews and meta-analyses.

At least 20% of people over the age of 65 suffer from mental disorders. It is anticipated that the number of older Americans with psychiatric disorders will double over the next 30 years. There is, however, substantial unmet need.

Does antidepressant therapy improve cognition in elderly depressed patients?

Objectives: To analyze the effects of antidepressants on cognitive functioning in elderly depression.

Methods: Data were pooled for elderly participants with major depression from two double-blind 12-week studies (n = 444) comparing sertraline to fluoxetine and to nortriptyline. A cognitive battery was performed pre-treatment and post-treatment that included the Shopping List Task (SLT), which quantifies short-term and long-term memory storage and retrieval, and the Digit Symbol Substitution Test (DSST), which measures visual tracking, motor performance, and coding.

The depression care manager and mental health specialist as collaborators within primary care.

Objective: The authors reviewed the implications of the latest generation of health services research studies on primary care practice system changes for depression management, especially in the roles of care managers and mental health specialists.

Methods: Authors conducted a review of four large, related, multisite trials testing system changes in the delivery of care to depressed, mostly older, primary care patients.

Results: These studies confirm that older patients are more likely to accept collaborative mental health treatment within primary care than within mental health specialty care.

Application of a depression management office system in community practice: a demonstration.

Background: Recent studies provide new insights about strategies that improve depression outcomes. We explored the feasibility of implementing these strategies in community practices.

Methods: Clinicians followed an office system approach to management of depression.

Implementing an office system to improve primary care management of depression.

Studies have shown that many patients treated for depression in primary care settings do not achieve the outcomes demonstrated to be possible in randomized controlled trials. In general, multifaceted interventions have been more successful than single focus interventions in improving care of depression in this setting. This article reports on the implementation of such a mulitfaceted intervention in primary care practices.

Patient beliefs predict response to paroxetine among primary care patients with dysthymia and minor depression.

Background: Dysthymia and minor depression are common problems in primary care, but it is not known how patient health beliefs shape response to antidepressant treatment of these less severe forms of depression.

Methods: Three hundred thirty-three primary care patients with dysthymia or minor depression received at least 4 weeks of paroxetine or placebo in a multicenter, randomized controlled 11-week trial. Patient health beliefs and other characteristics were examined as predictors of treatment adherence and depression remission.

A three-component model for reengineering systems for the treatment of depression in primary care.

Depression in primary care is a chronic disease. As with most chronic diseases, long-term adherence to treatment plans is problematic. Evidence-based systems of care address this problem, but persistence and dissemination of systems after testing is a new problem.