Psychotherapy with elderly depressed patients.

Although psychotherapy outcome research is not without controversy, available evidence suggests that elderly patients benefit from an active, structured relationship with a therapist who provides a helpful therapeutic setting for comprehending and mastering problems that contribute to depression. Until research can evaluate better the various types of therapies, it is reasonable to integrate aspects of different therapies in the clinician's approach to depressed elderly patients, depending on the clinician's understanding of the patient's diagnosis, ego strengths and weaknesses, and capacity to cope and change. The therapist can use psychodynamic, cognitive, behavioral, interpersonal, and supportive techniques in a flexible manner, individualizing therapy to meet the patient's specific needs. Antidepressants are helpful in conjunction with psychotherapy, particularly for patients with major depression and for patients with prominent neurovegetative signs of depression. A tailored, individualized approach that considers the patient's unique needs can strengthen the therapeutic relationship, which may be the primary "nonspecific factor" through which all psychotherapies appear to benefit patients.     

The prevalence and aetiology of long-term L-dopa side-effects in elderly parkinsonian patients

Fifty-one elderly parkinsonian patients (mean age 80 years) on long-term (greater than 5 years) L-dopa therapy were identified from the patients within the three geriatric units in Edinburgh. Side-effects were identified in 57% of patients and tended to be mild in severity. Mean duration of disease was 10.2 years in those with side-effects and 6.7 years in those without (p less than 0.01). Past and present L-dopa side-effects are more likely to be caused by disease progression than by L-dopa therapy. It is therefore recommended that L-dopa should be prescribed at disease onset to elderly Parkinsonian patients.     

Inpatient behavior therapy of depressed elderly patients]

Though cognitive-behavioral approaches have been shown to be suitable for and efficient in the treatment of depression in old age, they are not yet frequently applied with elderly patients. Our clinic has developed a concept for in-patient psychotherapy with older depressed people based on cognitive-behavioral methods. The theoretical foundations and practical implementation are described.     

Effectiveness and safety of venlafaxine extended release in elderly depressed patients

The main objectives of this multicenter, naturalistic, open-label study is to evaluate the effectiveness, tolerability and safety of venlafaxine extended release (VXR) in a sample of 59 patients older than 60 years of age diagnosed of depressive disorders in the primary care setting. VXR was administered for 24 weeks at daily doses ranging from 75 mg to 225 mg. Effectiveness measurements included the 17 items Hamilton Depression Rating Scale (HAM-D₁₇), the Clinical Global Impression Scales for Severity (CGI-S) and Improvement (CGI-I), the Visual Analogical Scale for Pain (P-VAS), and the Mini-Mental State Examination (MMSE) scale. At the endpoint, VXR achieved response and remission rates of 81.6% and 59.2%, respectively. Treatment was associated with a significant improvement of the patient's condition (89.8% of patients were rated by physicians as “much/very much improved”). Painful physical symptoms (p < 0.0001) and cognitive state (p = 0.0017) scores decreased along the study. A total of 83% of patients completed the study. Seven adverse events were recorded for four patients (6.8% overall). Data of this study suggest that VXR could be an effective and safe therapeutic option in the treatment of geriatric depression, reducing also the associated painful physical symptoms.     

Usefulness of paroxetine in depressed men with paroxysmal atrial fibrillation

The occurrence and the duration of paroxysmal atrial fibrillation (AF) are influenced by vagal tone. Paroxetine, an antidepressant, can modulate vagal tone at the level of the mid-brain and inhibit the vasovagal reflex. In this study, oral paroxetine 10 mg/day was administered to patients with multidrug-resistant paroxysmal AF. Nine consecutive men responded favorably to the drug. In 3 patients, AF resolved completely. One patient could not tolerate the drug because of nausea and nervousness. These preliminary results suggest that paroxetine could be a choice in the pharmacologic treatment of paroxysmal AF.     

Hypochondriasis in the elderly depressed

The significance of hypochondriacal complaints in elderly depressives was explored. Sixty percent of patients had such symptoms on admission. Twelve percent were delusional. At discharge, hypochondriasis was present in 40% of the sample, with 0% delusional. Hypochondriasis was associated with anxiety (P less than .05) and somatic concerns (P less than .001), but not with complaints of depressed mood, suicidality, or short-term outcome. In dependent physical illness ratings did not correlate with hypochondriasis, however nonpsychotropic medication use did (P less than .01). Improvement in hypochondriacal complaints with treatment, yet persistence of less intense hypochondriacal concerns after remission suggests that these features may represent an admixture of state and trait phenomena in elderly depressives.     

米氮平与帕罗西丁治疗老年抑郁症的对照研究

老年抑郁症患者往往伴有严重的失眠症状,常有苯二氮节类药物滥用史,为寻找有效而副反应较小的抗抑郁药物,我们对比研究了米氮平和帕罗西丁治疗老年抑郁症的临床疗效和安全性。     

Propafenone in ventricular extrasystole in elderly patients. Tolerance and efficacy

The tolerance and efficacy of propafenone were studied in cases of chronic ventricular extrasystoles of the elderly (age greater than 70 years). Only patients presenting more than 1,000 extrasystoles per day and requiring a treatment, were included in this study. Patients presenting non-compensated cardiac insufficiency, hypotensive patients, patients with conduction disorders without pacemakers as well as patients presenting a severe renal or hepatic insufficiency, were excluded. After making sure that the rhythm disorder was chronic, a control Holter was performed, then, 600 mg of propafenone per day, in 3 doses were prescribed for 5 days. On the 5th day, a Holter was performed as well as a blood propafenone level. Some patients received then 900 mg per day with a new Holter and plasma propafenone titration on the 10th day. 11 patients were studied in this fashion. The tolerance to 600 mg was good in 10 out of 11 cases. The efficacy, appreciated by the decrease of the number of isolated ventricular extrasystoles (-69%), doublets (-95%), triplets (-98%) and salvos of ventricular tachycardias (-100%), was excellent in 6 cases, average in 2 cases and mediocre in 3 cases. Increase of the dosage to 900 mg does not improve significantly the anti-arrhythmic efficacy while the side effects seem more frequent. It is not possible to establish a relationship between plasma concentrations and efficacy. At a dosage of 600 mg per day, propafenone is therefore effective in the treatment of ventricular extrasystoles in elderly patients and its tolerance is good. Higher doses are not advisable as they seem much less well tolerated without any additional advantage.     

Noncardiac side-effects of long-term oral amiodarone in the elderly

Amiodarone is a powerful anti-arrhythmic drug. However, its use is somewhat limited by side-effects. No study examining side-effects specifically in elderly patients exists. We have reviewed noncardiac side-effects in 61 elderly patients on long-term oral amiodarone treatment (follow-up 3-66 months). The most troublesome side-effect was hypothyroidism (nine patients, 15%). No cases of frank hyperthyroidism were seen. Elevation of aspartate transaminase (AST) was common (16 patients, 26%), but generally mild and transient. Photosensitivity occurred in six patients (10%). Corneal deposits were common but gave rise to symptoms in only one patient. Two patients reported tremor. Hypothyroidism appeared to be more common and photosensitivity less common than in previously reported series in younger adults. Possible reasons for this are discussed. It is our policy to continue to prescribe amiodarone to elderly patients, regulate monitoring for adverse effects is however mandatory.     

The elderly and aging depressed patient

Using an one-year-analysis depressive people beyond the age of 60 are analysed during a catamnesis-project considering clinical dates (under psychopathological, psychosocial and therapeutical emphasis) in which have directions for a change of the proportion of sick people to healthy people and the change of the shape of age-depressive syndromes deduced.     

老年高血压患者合并抑郁的早期诊断及帕罗西汀应用安全性研究

目的探讨老年高血压患者合并抑郁的早期诊断及帕罗西汀应用的安全性。方法选择老年高血压患者260例,通过老年抑郁量表和汉密尔顿抑郁量表筛查抑郁状态,并分为抑郁组113例和非抑郁组147例,抑郁组患者随机分为帕罗西汀组56例和心理治疗组57例2个亚组。同时检测血浆5-羟色胺(5-HT)、白细胞介素6(IL-6);观察治疗前后收缩压、舒张压、脉压指数、5-HT、IL-6变化。结果与非抑郁组比较,抑郁组患者血浆5-HT、IL-6含量明显增高(P0.05);与同组治疗前比较,帕罗西汀组和心理治疗组收缩压均明显下降,IL-6也明显下降(P0.05);帕罗西汀组脉压指数较心理治疗组下降明显(P0.05)。结论 5-HT与IL-6可作为老年高血压患者早期诊断抑郁状态的参考指标,帕罗西汀在老年患者应用虽副作用较多,但疗效肯定。     

卡维地洛治疗老年心力衰竭患者的耐受性研究

目的评估卡维地洛治疗老年心力衰竭患者的耐受性。方法52例稳定性老年(>70岁)心力衰竭患者接受卡维地洛递增剂量治疗。治疗前后分别对血压、心率,心脏射血分数和纽约心脏病学协会(NYHA)分级进行检测,评判疗效和安全性。结果卡维地洛治疗后,患者收缩压从133.3mmHg降为120.8mmHg,舒张压从78.0mmHg降为70.4mmHg,治疗前后比较,差异均有统计学意义(P<0.01);心率从81.9次/min下降为70.7次/min(P<0.01),射血分数从39.8%上升为43.9%(P<0.05),NYHA分级下降;平均剂量为36.8mg/d,其中55.8%的患者可以耐受卡维地洛50mg/d,除2例退出,96.1%的老年患者心力衰竭可坚持卡维地洛治疗。结论老年心力衰竭患者基本可以耐受卡维地洛治疗。     

Tolerance and outcomes of sorafenib in elderly patients treated for advanced hepatocellular carcinoma

IntroductionUse of sorafenib remains debated in elderly patients treated for advanced hepatocellular carcinoma (HCC).MethodsThis was a bicentric retrospective study including all patients ≥75 years and treated with sorafenib for advanced HCC between January 2010 and March 2014.ResultsOf the 51 patients included (median age: 78 years, range: 75–92; performance status (PS) 0–1: 98%; cirrhosis: 88.2%; Child–Pugh A: 95.6%) all experienced at least one adverse event (AE). About 2/3 of them (66.7%) had grade 3–4 toxicities, including fatigue (43.1%), hand foot skin syndrome (11.8%), anorexia (9.8%) or diarrhea (9.8%). After adjustment for arterial hypertension, heart failure, other(s) cardiovascular history(ies), and sorafenib dose at baseline, only patients ≥80 years were associated with severe AE (OR: 13.3; p = 0.009). Discontinuation for toxicity was reported in 31 (60.8%) patients, mainly within the 3rd months, especially in those who had PS ≥1 at baseline (OR: 10.4; p = 0.01), or other cardiovascular histories (OR: 30.9; p = 0.016). In this setting, overall survival was significantly reduced (HR: 4.5; p < 0.0001).ConclusionTolerance of Sorafenib seems to be low in elderly, especially for patients aged ≥80 years or with PS ≥1. Starting with reduced dose of sorafenib does not seem to impact results. Some of these patients may truly benefit from the treatment in terms of survival.     

Cognitive behavior therapy with depressed elderly patients: initial experiences and results]

Our understanding of depression in old age focuses on a) restrictions and changes in living conditions, in social and somatic functions, in social contacts; b) real or perceived lack of control over those changes; c) rigid, absolute, negative expectations and assumptions; d) deficits in alternative behavior. A group program for treatment of depressed older patients based on those elements is described and first results of pilot studies are presented. These findings are quite promising and congruent with the few available Anglo-American studies. Despite the results, we are still far from being able to give empirically supported advice on how to efficiently treat depressed older patients. Further controlled investigation is necessary, including larger samples, multiple assessments, and well-designed pharmacological and psychological control conditions.     

帕罗西汀治疗老年人慢性原发性失眠症的临床疗效观察

目的 探讨帕罗西汀治疗老年人慢性原发性失眠症的疗效和安全性。方法 采用随机、单盲、安慰剂、对照方法，将90例老年原发性失眠症患者随机分为帕罗西汀组30例、阿普唑仑组30例和安慰剂组30例，治疗12周。采用匹兹堡睡眠质量指数、临床疗效和治疗药物副作用量表评定疗效和副作用。结果 帕罗西汀组的总有效率为93％，显效率为83％，阿普唑仑组分别为83％和53％，帕罗西汀组显效率高于阿普唑仑组（P＜0．01）。帕罗西汀组常见副作用有口干、便秘、恶心等，不影响治疗。结论 帕罗西汀治疗老年人原发性失眠症疗效确切，副作用轻微。     

Issues in clinical trials with the depressed elderly

Despite the fact that there is a high prevalence of depression among the elderly, little research on the efficacy of psychotherapy or pharmacotherapy with the elderly has been reported in the literature. This paper describes a sample of 18 elderly patients who received both psychotherapy and pharmacotherapy for the treatment of depression. Psychotherapy involved weekly 30-50 minutes sessions of interpersonal psychotherapy with a treating psychiatrist. The drug treatment consisted of random assignment, double-blind, to either alprazolam, imipramine, or pill-placebo for six weeks. The focus of therapy was on the attendance, compliance, and symptomatic relief in elderly depressed patients, as well as on the major life problems identified by these patients in psychotherapy. Results indicated that elderly patients respond to community publicity regarding a psychotherapy treatment program. However, the majority are inappropriate referrals for diagnostic reasons. If accepted, elderly patients showed good compliance with drugs, and attendance was comparable to that in younger populations. The elderly patients responded well to treatment, with immediate and marked improvement on the Hamilton and Raskin Depression Scales, which was maintained after treatment. Grief and role transitions specific to life changes were frequent antecedents to depression in this elderly population and thus were the major foci in psychotherapy.     

First results on the effects of MAO inhibition on cognitive functioning in elderly depressed patients

Elderly depressed patients who met the Research Diagnostic Criteria (RDC) for major depressive illness, were treated with phenelzine, a non-selective monoamine oxidase inhibitor, for a period of 2 to 7 wk, following 2 wk of placebo washout period. Possible pre- and post-treatment differences on the cognitive test battery were evaluated using the Wilcoxon test. Although recovery from depression was obtained in the majority of patients (Hamilton, Global and Self-rating Scales), none of the cognitive measures showed statistically significant changes over the course of the treatment period and the cognitive tests scores did not change as a result of treatment. It is of interest that tricyclic antidepressants (TCAs) are known to impair memory in geriatric patients, presumably due to their sedative and anticholinergic effects. The lack of an adverse cognitive effect for phenelzine therefore suggests a possible advantage of monoamine oxidase inhibitors over tricyclic antidepressants for the treatment of geriatric depression.     

Signal detection analysis of recognition memory in depressed elderly

Abstract

The purpose of this study was to examine the relationship of late-life depression to memory complaint and objective performance in a recognition memory task. Fifty-seven individuals between the ages of 58 and 88 were evaluated for depression using the Beck Depression Inventory (short form). They were then shown two stimulus lists, each consisting of high-imagery and low-imagery words. Recognition for these words was subsequently tested. Error rates and nonparametric signal detection measures were analyzed as indices of performance. Respondents gave global self-assessments of memory and, during the recognition task, also made self-ratings of performance. Depressed individuals showed more conservative response biases than nondepressed respondents, reflected in a higher false-negative error rate but a lower false-positive rate. Neither overall memory sensitivity as assessed by signal detection analysis nor self-ratings of performance were related to depression, though global memory self-ratings were. Elderly depressed individuals thus presented a pattern of greater memory complaint and unwillingness to venture responses in spite of showing small or no information-processing deficits.     

Signal detection analysis of recognition memory in depressed elderly

The purpose of this study was to examine the relationship of late-life depression to memory complaint and objective performance in a recognition memory task. Fifty-seven individuals between the ages of 58 and 88 were evaluated for depression using the Beck Depression Inventory (short form). They were then shown two stimulus lists, each consisting of high-imagery and low-imagery words. Recognition for these words was subsequently tested. Error rates and nonparametric signal detection measures were analyzed as indices of performance. Respondents gave global self-assessments of memory and, during the recognition task, also made self-ratings of performance. Depressed individuals showed more conservative response biases than nondepressed respondents, reflected in a higher false-negative error rate but a lower false-positive rate. Neither overall memory sensitivity as assessed by signal detection analysis nor self-ratings of performance were related to depression, though global memory self-ratings were. Elderly depressed individuals thus presented a pattern of greater memory complaint and unwillingness to venture responses in spite of showing small or no information-processing deficits.