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| 2. |
- Habich, Annegret, et al.
(författare)
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Stimulating aged brain with transcranial direct current stimulation : Opportunities and challenges
- 2020
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Ingår i: Psychiatry Research. - : Elsevier. - 0925-4927 .- 1872-7506. ; 306
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Tidskriftsartikel (refereegranskat)abstract
- Ageing involves significant neurophysiological changes that are both systematic while at the same time exhibiting divergent trajectories across individuals. These changes underlie cognitive impairments in elderly while also affecting the response of aged brains to interventions like transcranial direct current stimulation (tDCS). While the cognitive benefits of tDCS are more variable in elderly, older adults also respond differently to stimulation protocols compared to young adults. The age-related neurophysiological changes influencing the responsiveness to tDCS remain to be addressed in-depth. We review and discuss the premise that, in comparison to the better calibrated brain networks present in young adults, aged systems perform further away from a homoeostatic set-point. We argue that this age-related neurophysiological deviation from the homoeostatic optimum extends the leeway for tDCS to modulate the aged brain. This promotes the potency of immediate tDCS effects to induce directional plastic changes towards the homoeostatic equilibrium despite the impaired plasticity induction in elderly. We also consider how age-related neurophysiological changes pose specific challenges for tDCS that necessitate proper adaptations of stimulation protocols. Appreciating the distinctive properties of aged brains and the accompanying adjustment of stimulation parameters can increase the potency and reliability of tDCS as a treatment avenue in older adults.
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| 3. |
- Lenouvel, Eric, et al.
(författare)
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Evidence-oriented teaching of geriatric psychiatry : a narrative literature synthesis and pilot evaluation of a clerkship seminar
- 2022
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Ingår i: GMS Journal for medical education. - : German Medical Science. - 2366-5017. ; 39:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education.Project description: A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system “ILIAS”.Results: A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen’s d=1.28).Conclusion: A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes.
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| 4. |
- Lenouvel, Eric, et al.
(författare)
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Instructional Design Strategies for Teaching the Mental Status Examination and Psychiatric Interview : a Scoping Review
- 2022
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Ingår i: Academic Psychiatry. - : Springer. - 1042-9670 .- 1545-7230. ; 46, s. 750-758
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Forskningsöversikt (refereegranskat)abstract
- Objective: The psychiatric mental status examination is a fundamental aspect of the psychiatric clinical interview. However, despite its importance, little emphasis has been given to evidence-based instructional design. Therefore, this review summarizes the literature from an instructional design perspective with the aim of uncovering design strategies that have been used for teaching the psychiatric interview and mental status examination to health professionals.Methods: The authors conducted a scoping review. Multiple databases, reference lists, and the gray literature were searched forrelevant publications across educational levels and professions. A cognitive task analysis and an instructional design framework was used to summarize and chart the findings.Results: A total of 61 articles from 17 countries in six disciplines and three educational levels were identified for data extractionand analysis. Most studies were from the USA, presented as educational case reports, and carried out in undergraduate education in the field of psychiatry. Few articles described the instructional rationale for their curriculum. None of the studies compared the effectiveness of different instructional design components. Reported learning activities for each task domain (knowledge, skills,and attitudes) and for each step of an instructional design process were charted. Most articles reported the use of introductory seminars or lectures in combination with digital learning material (videos and virtual patients in more recent publications) and role-play exercises.Conclusions: Educators in psychiatry should consider all task domains of the psychiatric interview and mental status examination. Currently, there is a lack of empirical research on expertise acquisition and use of instructional design frameworks in this context
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| 5. |
- Leyhe, Thomas, et al.
(författare)
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A common challenge in older adults: Classification, overlap, and therapy of depression and dementia.
- 2017
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Ingår i: Alzheimer's & dementia : the journal of the Alzheimer's Association. - : Wiley. - 1552-5279. ; 13:1, s. 59-71
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Tidskriftsartikel (refereegranskat)abstract
- Late-life depression is frequently associated with cognitive impairment. Depressive symptoms are often associated with or even precede a dementia syndrome. Moreover, depressive disorders increase the risk of persistence for mild cognitive impairment and dementia. Here, we present both the current state of evidence and future perspectives regarding the integration and value of clinical assessments, neuropsychological, neurochemical, and neuroimaging biomarkers for the etiological classification of the dementia versus the depression syndrome and for the prognosis of depression relating to dementia risk. Finally, we summarize the existing evidence for both pharmacotherapy and psychotherapy of depression in demented patients. There is an urgent need for large-scale collaborative research to elucidate the role and interplay of clinical and biological features in elderly individuals with depressive disorders who are at elevated risk for developing dementia. To overcome barriers for successful drug development, we propose the introduction of the precision medicine paradigm to this research field.
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