ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The Institute of Medicine has formed a Committee on Improving Quality in Long-Term Care, which is examining the legislative and quality-of-care impact that the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) had on long-term care. The American Psychiatric Association and the American Association for Geriatric Psychiatry were asked to provide written and oral testimony before the Committee in March 1998. The two organizations summarized the key outcomes of OBRA '87 on the psychiatric needs of individuals who receive services in long-term care settings. The written testimony also encouraged the Committee to insist that the long-term care industry develop, test, and refine psychiatric and mental health quality outcome measures for nursing facilities and other long-term care settings.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In men, testosterone secretion affects neurobehavioral functions such as sexual arousal, aggression, emotional tone, and cognition. Beginning at approximately age 50, men secrete progressively lower amounts of testosterone; about 20% of men over age 60 have lower-than-normal levels. The psychiatric sequelae are poorly understood, yet there is evidence of an association with depressive symptoms. The authors reviewed 1) the physiology of the hypothalamic-pituitary-gonadal axis and its changes with age in men; and 2) the evidence linking testosterone level and major depression in men. Data on this relationship are derived from two types of studies: observational studies comparing testosterone levels and secretory patterns in depressed and nondepressed men, and treatment studies using exogenous androgens for male depression. The data suggest that some depressed older men may have state-dependent low testosterone levels and that some depressed men may improve with androgen treatment.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors examined impairment in self-maintenance skills and in instrumental activities of daily living (IADL) among 211 older patients with unipolar major depression. In regression models, self-maintenance impairment was associated with older age, less reported depressed mood, psychomotor retardation, and severe chronic medical illness. IADL deficit was associated with older age, greater severity of depression, less guilt, more apathy, weight loss, greater cognitive impairment, more severe chronic medical illness, less social interaction, lower subjective social support, and greater instrumental support. The authors conclude that efforts to remediate basic skills deficits in depressed older adults should focus on treating comorbid medical conditions; impaired IADL skills in geriatric depressed patients should improve with treatment of depression and medical illness. Clinicians should be aware that substantial IADL impairment may accompany mild cognitive impairment associated with depression in older patients.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors examined 1) effects of nortriptyline (NT) on electroencephalographic (EEG) sleep measures in elderly patients with bereavement-related depression in remission under randomized, double-blind, placebo-controlled conditions, and 2) the effects of clinical remission on sleep after discontinuation of medication. Subjects were classified as responders to placebo (n=9) or NT (n=18) and had EEG sleep studies at three time-points: before treatment (T1), remitted on medication or placebo (T2), and remitted off medication or placebo (T3). As compared with placebo, NT was differentially associated with decreases in REM sleep time and percent and increases in REM sleep density (T2). No changes in EEG sleep measures occurred in placebo responders. REM sleep measures in NT responders reverted to T1levels after T3, with persistence of robust clinical remission and normal subjective sleep quality. These data suggest that NT alters REM sleep, but that EEG sleep characteristics in bereavement-related depression persist into remission.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors evaluated a consecutive sample of 542 elderly hospital patients for depression; of these, 160 depressed and 171 nondepressed patients were followed up for a median of 47 weeks after discharge. A subset of 113 depressed patients had significant physical disability. Depressed patients saw physicians more frequently, particularly during the 9- to 12-month period after hospital discharge. Depressed patients also had higher rates of rehospitalization and spent more days in the nursing home. These findings persisted after physical health status was controlled. Patients who remained both depressed and physically disabled during the follow-up period used the most general-medical services during the year after hospital discharge, but did not see mental health specialists any more frequently than those whose depression and physical disability improved. These results underscore the importance of diagnosing and treating depression during and after hospital discharge to increase quality of life and possibly reduce health service use.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This study, based on evaluations of 240 outpatients with Alzheimer's disease or multi-infarct dementia, examines whether race has any independent effects on the prevalence and levels of related neuropsychiatric symptoms. After the authors controlled for 14 potentially confounding variables, race had a significant independent effect on the levels of psychotic and depressive symptoms, the former being greater among blacks and the latter among whites. There were no differences in symptoms between U.S.-born African Americans and African Caribbeans. Although it is likely that racial differences reflect variations in symptoms brought in for evaluation, the absence of intraracial differences suggests the possibility of an underlying biological process.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors compared response rates, by age (60–69 vs. 70+), to acute, continuation, and 1-year maintenance depression treatment. Patients (N=180) received open combined treatment with nortriptyline (NT)/placebo and interpersonal psychotherapy (IPT). Patients who recovered then entered randomized, double-blind maintenance treatment with NT or placebo or received maintenance monthly IPT (combined with NT or placebo). Comparison of time-to-remission and recovery and absolute rates of remission, relapse, recovery, and recurrence yielded similar times to/rates of remission and recovery; however, older patients had far more recurrence during the first year of maintenance therapy. Although responses to acute and continuation treatment with combined NT and psychotherapy were similar, the older group had more recurrence in the first year of maintenance. Continuation of combined medication and psychotherapy may represent the best long-term treatment.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Elderly patients with schizophrenia and dementia patients with agitation are frequently candidates for antipsychotic treatment. Conventional neuroleptics have relatively little effect on negative symptoms and may cause considerable side effects, especially in elderly patients. The authors have found a 29% cumulative annual incidence of tardive dyskinesia (TD) in middle-aged and elderly outpatients treated with relatively low doses of conventional neuroleptics. Newer antipsychotics are less likely to cause extrapyramidal symptoms and may be associated with a lower risk of TD. They are generally effective for both positive and negative symptoms and may also improve some aspects of cognition, but these drugs have their own side effects. Dosing requirements for elderly patients tend to be much lower than those for younger adults.

ISSN:1064-7481    

出版商:OVID    

年代:1999

数据来源: OVID