Treatments for dysfunctional behaviour

Study of behavioural treatments of depression  in patients with dementia. Seventy- two patients, and their carers were randomly assigned to two experimental conditions and two control conditions.

Control Condition 1 = Typical Care

Control Condition 2 = Placement on a waiting list.i

Experimental Condition 1 = Pleasant Events treatment: addressing depression problems and then identifying pleasant events for the patient.

Experimental Condition 2 = Behaviour therapy problem solving.

Patients in both experimenatl conditions showed significant improvements in depression symptoms compared with those in control conditions. This shows that behaviour interventions for dementia can be thoroughly effective.

Fourteen patients with depression were PET scanned before and after a 15 - 20 session course of cognitive behavioural therapy (CBT). Patients were introduced to a number of therapeutic strategies intended to reduce negative thoughts. The participants responded to the Hamilton depression rating scale before and after the training. Scorese were reduced from a mean of 20 before training to a mean of 7 after CBT training indicating a reduction in self reported depression symptoms.

Analysis of the PET scans showed increased actiation of the hippocampus after training, and decreased activation in prefrontal regions.

A comparison group of 13 patients treated with antidepressant drugs, showed opposite patterns.

Approach: Biological
Method: Meta-analysis

Procedure: Analysed data from randomised controlled trials that evaluated the effect of SSRI's compared with placebo's. Outcomes that were evaluated include serious adverse effects, suicide related behaviours, response to treatment etc.

 
Results: Fluoxetine had a positive benefit/risk ratio but other drugs evaluated had either weak or negative benefit risk ratio . With the exception of fluoxetine all drugs reported on had in comparison with placebo treated groups, increased risk of severe adverse events including suicidal thoughts and attempted suicide.