The American journal of psychiatry
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Review
Proxy and surrogate consent in geriatric neuropsychiatric research: update and recommendations.
The ethics of involving decisionally incapable adults in research will continue to grow in importance as more research is conducted to address the problems of decisionally impaired persons, especially elderly persons. The authors provide an updated discussion, critique, and recommendations regarding the need for clear legal and regulatory policy on this issue. ⋯ It is imperative that the scientific community, patients and their advocates, and policy makers at all levels establish a constructive dialogue to clarify ethical and legal standards in the area of proxy and surrogate consent for research.
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Randomized Controlled Trial Clinical Trial
Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia.
This study evaluated the effectiveness of a supervised benzodiazepine taper, singly and combined with cognitive behavior therapy, for benzodiazepine discontinuation in older adults with chronic insomnia. ⋯ A structured, time-limited intervention is effective in assisting chronic users of benzodiazepine medication to discontinue or reduce their use of medication. The addition of cognitive behavior therapy alleviates insomnia, but sleep improvements may become noticeable only after several months of benzodiazepine abstinence.
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Intensive care often means exposure to physical and psychological stress, with long-lasting emotional sequelae for most patients. Psychiatric morbidity and negative effects on health-related quality of life were assessed in long-term survivors of acute respiratory distress syndrome. ⋯ Long-term survivors of acute respiratory distress syndrome seem to face a major risk of PTSD and major impairments in health-related quality of life in the long term.
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Comparative Study
Cigarette smoking in relation to depression: historical trends from the Stirling County Study.
Building on findings about the prevalence and incidence of depression over a 40-year period, the authors provide data on trends in cigarette smoking and associations with depression. ⋯ In terms of population trends, the association between depression and cigarette smoking became prominent as the use of tobacco declined because of awareness of the risks involved. The findings about individuals followed over time suggest that those who became depressed were more involved with nicotine than those who never had a depression. The authors discuss hypotheses involving "self-medication," risk-taking, and changes in the social climate but conclude that the relationships between smoking and depression are probably multiple and complex.