#GeriMedJC invites #PsychJC to join in the January 2015 short article discussion.

For this month’s short article, #GeriMedJC would like to extend a warm invitation to the fans of #PsychJC, a Twitter-based psychiatry journal club.  This article is sure to be of interest to both groups.

What does a short article mean?  In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, the last 15 minutes of the hour is devoted to the presentation and discussion of the article.

Antidepressants have limited efficacy in older adults with major depression, cognitive impairment and disability. Can problem adaptation therapy (PATH), which uses strategies consistent with the process model of emotion regulation when delivered in the home setting work?  Join the discussion when we focus on this randomized trial:

Kiosses DN, Ravdin LD, Gross JJ, Raue P, Kotbi N, Alexopoulos GS. Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry. 2015 Jan 1;72(1):22-30. 

The article can be found here: and the abstract is posted below.

Engage in the discussion on Twitter on January 30, 2015 at 08:00 EST / 13:00 GMT and don't forget to use the hashtag #GeriMedJC.

OBJECTIVE:
To test the efficacy of 12-week PATH vs supportive therapy for cognitively impaired patients (ST-CI) in reducing depression and disability in 74 older adults with major depression, cognitive impairment, and disability.

DESIGN, SETTING, AND PARTICIPANTS:
A randomized clinical trial at the Weill Cornell Institute of Geriatric Psychiatry from April 1, 2006, to September 31, 2011. Interventions were administered at the participants' homes. Participants included 74 older individuals (age ≥65 years) with major depression and cognitive impairment to the level of moderate dementia. They were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry and were randomly assigned to 12 weekly sessions of PATH or ST-CI (14.8% attrition rate).

INTERVENTIONS:
Home-delivered PATH vs home-delivered ST-CI. Problem adaptation therapy integrates a problem-solving approach with compensatory strategies, environmental adaptations, and caregiver participation to improve patients' emotion regulation. Supportive therapy for cognitively impaired patients focuses on expression of affect, understanding, and empathy.

MAIN OUTCOMES AND MEASURES:
Mixed-effects models for longitudinal data compared the efficacy of PATH with that of ST-CI in reducing depression (Montgomery-Asberg Depression Rating Scale) and disability (World Health Organization Disability Assessment Schedule II) during 12 weeks of treatment.

RESULTS:
Participants in PATH had significantly greater reduction in depression (Cohen d, 0.60; 95% CI, 0.13-1.06; treatment × time, F1,179 = 8.03; P = .005) and disability (Cohen d, 0.67; 95% CI, 0.20-1.14; treatment × time, F1,169 = 14.86; P = .001) than ST-CI participants during the 12-week period (primary outcomes). Furthermore, PATH participants had significantly greater depression remission rates than ST-CI participants (37.84% vs 13.51%; χ2 = 5.74; P = .02; number needed to treat = 4.11) (secondary outcome).

CONCLUSIONS AND RELEVANCE:
Problem adaptation therapy was more efficacious than ST-CI in reducing depression and disability. Problem adaptation therapy may provide relief to a large group of depressed and cognitively impaired older adults who have few treatment options.