ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The authors present a literature review and a scientific commentary. The prevalence of depressive disorders in the elderly and their association with significant morbidity and mortality are discussed in relation to study of clinical heterogeneity, which may provide useful insights into etiologic and pathophysiologic variability. The authors summarize findings regarding clinical and associated features of late-life depression, explore the limitations of current factual knowledge and conceptual approaches, and propose directions for future research. They argue that current sample selection procedures minimize the variability of the very phenomena under study; therefore, few phenomenologic differences or risk factors for long-term outcome have been noted consistently. Factors such as medical illness account for much of the observed heterogeneity in presentation and outcome. Future studies must include a broader range of subjects and carefully examine in a multidimensional fashion a wider range of “comorbid” conditions, personality and social assessments, and neuropsychologic and neurobiologic measures. Such approaches will enhance our understanding of the pathophysiologic mechanisms of depression in the elderly and across the lifespan.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Most studies of the elderly use age 65 as the definition of the onset of old age, and most studies of the pharmacologic treatment of depression in the elderly focus on patients between the ages of 60 and 70. Very few patients over the age of 75 have been specifically studied, and virtually none over the age of 80. Data for this review of treatment of depressed patients over the age of 75 were derived from a larger review prepared for a 1992 NIMH consensus development conference on the diagnosis and treatment of depression in late life. Available studies were divided into three categories: 1) mixed-age studies that include subjects over 75 (n= 18); 2) mixed-age reports of patients having a mean age of 75 or older (n= 13); and 3) reports including only patients with minimum age of 75 years or older (n=5). Data are available from only 171 identifiable patients over the age of 75. Consequently, available data for patients in this very old age category are too limited for reliable or valid treatment recommendations to be made; further research is necessary.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This is a longitudinal study of 65 patients who were 80 years old or older at the time they were hospitalized for depression. Thirty-seven were treated with ECT and 28 with medication. Survival after 1, 2, and 3 years in the ECT group was 73.0%, 54.1%, and 51.4%, respectively. Survival after 1, 2, and 3 years in the non-ECT group was 96.4%, 90.5%, and 75.0%, respectively. The relatively high mortality rate in the ECT group in this study suggests that patients over 80 who undergo ECT have more severe physical illness than those who can be treated successfully with medication. Medical comorbidity is a major determinant of long-term outcome of depression in the oldest old.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We studied 154 patients with major depression, with and without personality disorder (PD), consecutively admitted to a geriatric unit and compared their characteristics and responses to acute inpatient treatment. Thirty-seven patients (24%) met DSM-III-R criteria for PD. PD not otherwise specified and dependent PD were the most frequent PD diagnoses, whereas dramatic cluster PDs were rare. Patients with PD were significantly more likely to have had 1) recurrent depression, 2) an earlier age at first episode, and 3) a concurrent anxiety disorder. There was a higher proportion of patients with PD to have 1) never married, 2) separated or divorced, or 3) attempted suicide. During inpatient stays of similar lengths, both groups received similar treatment and improved to a similar and significant extent.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The authors assessed anxiety and depression among nursing home and congregate housing residents at yearly intervals. At baseline, modified DSM-III-R criteria yielded a 3.5% prevalence rate for anxiety or panic disorders. Another 13.2% reported milder symptoms not meeting diagnostic criteria. Anxiety was strongly associated with depression and with physical health, functional disability, and cognitive status. Follow-up data yielded an overall incidence rate of 2.3% for possible anxiety disorders; the majority of these cases were among those with mild anxiety at baseline. Change in anxiety was strongly associated with depression and, less consistently, with functional disability and cognitive status. Results are interpreted as indicating the indistinguishability of anxiety from depression in this frail elderly population.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The authors compared the 2-year survival rates of patients with 1) mixed clinical presentations (n= 58), 2) major depression without cognitive impairment (n= 51), and 3) primary degenerative dementia without depression (n= 34). Two-year survival rates were 100% in healthy controls, 91% in patients with major depression, and 76.1% and 78.3%, respectively, in patients with primary degenerative dementia and mixed symptoms. Patients with cognitive impairment (either primary degenerative dementia or mixed symptoms) were 2.55 times more likely to die within the 2-year follow-up than patients with major depression. These data are consistent with previous observations that survival rates of elderly patients with organic mental syndromes are lower than those of elderly patients with “functional” or “psychogenic” disorders.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The increasing number of elderly patients with psychiatric disorders has led to a shortage of psychiatrists with specialty training in geriatric psychiatry. Despite the emergence of a critical mass of faculty and a steady growth in the number of fellowship training programs, increasing subspecialization in general psychiatry, a dwindling fellowship applicant pool, ageism, and financial concerns have contributed to a potential recruitment crisis. The author discusses such problems and describes strategies to solve them, including providing role models, developing award programs and affinity groups, securing program funding, sharing resources, refining program focus, balancing practice patterns, assisting in practice transitions, and marketing aggressively.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To learn more about elderly patients who use outpatient mental health services, we retrospectively reviewed the charts of 75 patients overage 60 treated in an inner-city community mental health center during a 1-year period and compared them with 34 patients in a hospital-based psychogeriatric clinic and 26 patients in a suburban geriatric outreach program. The patients in the three settings differed with regard to age of onset and type of psychopathology, use of psychotropic medication, and mental health needs.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Ten patients with probable Alzheimer's disease participated in an open-label study of buspirone for agitation. The starting dose of 15 mg/day was increased by 5 mg every week until maximal improvement or 60 mg/day was reached. A significant decrease in agitation scores occurred at an average dose of 35 mg/day.

ISSN:1064-7481    

出版商:OVID    

年代:1993

数据来源: OVID