Treating Depressed, Cognitively Impaired Elders

描述(由候选人提供)：此应用程序旨在支持候选人的研究培训，以成为一名独立的研究人员在精神治疗领域的抑郁，认知障碍，残疾的老年人。老年人的抑郁、认知障碍和残疾往往并存，并导致痛苦和家庭破裂。此外，许多抑郁、认知受损的老年人对抗抑郁药物的反应缓慢、差或不稳定。尽管需要非药物干预，但大多数心理治疗研究的重点要么是认知正常的、有有限残疾的年轻老年患者，要么是有明显残疾的精神错乱患者。因此，现有的治疗方法不能完全满足大量患有中度认知障碍和残疾的抑郁症老年人的需要。这位候选人决定把他的职业生涯奉献给这些人。他建议使用问题解决疗法(PST)作为他的治疗框架，并在其中融入补偿策略，使患者能够绕过他们的行为限制，参与PST过程。补偿策略是从其他经过适当适应后认知受损的精神疾病人群的文献中“引进”的。治疗在患者自己的家中进行，残疾患者在那里度过了他们的大部分时间，经历了他们的大部分问题。当需要时，邀请家庭成员/照顾者参与，利用技术帮助患者解决问题，增加患者的积极互动和愉快的事件。因此，拟议的治疗旨在创造一个“生态系统”，让患者的能力在解决他们自己的问题时发挥作用。拟议的培训旨在加强候选人在补偿战略、涉及照顾者的治疗方法、手工开发以及与治疗试验相关的实验设计和统计方面的技能。目前的治疗手册草案将在收到顾问的意见和在授标的第一个1.5年期间治疗10名患者后进行升级。然后，通过将其与家庭递送的支持性心理疗法进行比较，对所得到的治疗进行试点测试(N=60)。由全国精神分裂症和抑郁症研究联盟和康奈尔老龄研究和临床护理中心支持的一项小型试点研究的初步数据为拟议研究的可行性提供了证据。参与者将是韦斯特切斯特县老年计划和服务部上门送餐计划的抑郁、认知障碍和残疾接受者，该计划是康奈尔ACISR研究网络发展核心的合作伙伴。

DESCRIPTION (provided by candidate): This application aims to support the candidate's research training to become an independent investigator in the area of psychotherapy for depressed, cognitively impaired, disabled elders. Depression, cognitive impairment, and disability in the elderly often coexist and lead to suffering and family disruption. Moreover, many depressed, cognitively impaired elders have slow, poor, or unstable response to antidepressant drugs. Despite the need for non-pharmacological interventions, most psychotherapy research focuses on either cognitively intact, "young old" patients with limited disability or on demented patients with pronounced disability. Thus the available treatments do not fully address the needs of the large number of depressed elders with intermediate cognitive impairment and disability. The candidate decided to devote his career to the care of this population. He proposes to use Problem Solving Therapy (PST) as his treatment framework and integrate in it compensatory strategies enabling patients to circumvent their behavioral limitations and participate in the PST process. The compensatory strategies are "imported" from literature on other cognitively impaired psychiatric populations after appropriate adaptation. The treatment is administered at the patients' own homes, where disabled patients spend most of their time and experience most of their problems. Family members/caregivers are invited to participate, when needed, utilizing techniques to help patients with problem solving and with increasing the patients' positive interactions and pleasant events. Thus the proposed treatment aims to create an "ecosystem" that allows the patients' competencies to be brought to bear in solving their own problems. The proposed training aims to strengthen the candidate's skills in compensatory strategies, treatment approaches involving caregivers, manual development, and experimental design and statistics relevant to treatment trials. The current draft of the treatment manual will be upgraded after receiving input from consultants and from treating 10 patients during the first 1.5 year of the award. The resultant treatment will, then, be pilot-tested (N=60) by comparing it with home delivered Supportive Psychotherapy. Preliminary data from a small pilot study, supported from the National Alliance of Research on Schizophrenia and Depression and the Cornell Center for Aging Research and Clinical Care, provides evidence for the feasibility of the proposed study. The participants will be depressed, cognitively impaired, disabled recipients of the Home Delivered Meals Program of the Westchester County Department of Senior Programs and Services, a partner of the Research Network Development Core of the Cornell ACISR.