Depression In Geriatric Patients Research Articles

Multivariate Modeling of Anxiety and Depression in Community-Dwelling Elderly Persons

A sample of community-dwelling geriatric primary care patients were given survey measuring which demographic, medical, and environmental factors predict higher levels of state anxiety, trait anxiety, depression, and comorbid anxiety-depression. The authors used multivariate linear regression methods to predict scores for the outcome measures. Younger age, more stressful life events, increasing medical comorbidity, and fewer years of formal education predicted higher levels of state anxiety. Lower perceived health status, and comparative health status, and benzodiazepine use predicted higher trait anxiety scores. Older age, male gender, benzodiazepine use, more stressful life events, worse comparative health status, and less social support predicted higher depression scores. More stressful life events, less social support, poorer perceived general health status, and benzodiazepine use predicted higher comorbid anxiety-depression scores. The authors discuss the utility of developing clinical models to predict anxiety and depression in geriatric patients. Anxiety and depressive symptoms are distinguished by different psychosocial, clinical, and environmental factors, even in a sample of older subjects, who, by all measures, have good physical and psychological health.

A Comparison of the Cardiac Safety and Therapeutic Efficacy of Trimipramine versus Doxepin in Geriatric Depressed Patients

To compare the cardiac safety and therapeutic efficacy of trimipramine and doxepin. A 1-week single-blind placebo period followed by a 5-week randomized double-blind parallel group clinical trial. Psychiatric out-patient clinic of a general hospital. 37 young-elderly patients with a diagnosis of Major Depressive Episode (DSM-III criteria). Placebo for 1 week, 2 weeks of titration with either drug in the dosage range of 75 mg/day up to a maximum of 200 mg/day. We measured the psychiatric effects with the Hamilton Rating Scale for Depression, the Hamilton Anxiety Rating Scale, and the Clinical Global Impression Scale. Cardiovascular effects were assessed on 12-lead standard electrocardiograms plus 1-minute rhythm and high speed recordings; orthostatic (lying/standing) blood pressures were also taken. Physical exams, lab tests, cognitive functions (Buschke Selective Reminding Test, Hierarchic Dementia Scale, Word Fluency) and adverse reactions were also noted. Both drugs were equally effective in relieving symptoms of depression and anxiety. The cardiovascular effects of both drugs were minimal. Trimipramine did lower blood pressure but this was without clinical significance. Three trimipramine patients and five doxepin patients developed occasional premature ventricular or atrial contractions. Of these, two trimipramine patients and one doxepin patient were among those with abnormal ECG's at entry. The doxepin patient was withdrawn from the study after 21 days of treatment when the PVC's became increasingly frequent. Trimipramine and doxepin are equally safe and effective antidepressants in the young-elderly.

Cognitive performance as modified by age and ECT history

1. Cognitive processing, as measured by 15 subtest from the Wechsler Memory Scale (WMS) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was assessed in 109 depressed inpatients who were classified as under age 65 ( N = 54) or 65 or older ( N = 55) . Within each age group, patients were further classified according to whether they had no prior ECT ( N = 40) , one prior ECT series ( N = 37) , or two or more prior series of ECT ( N = 32) . 2. After examining the data set for possible sources of bias such as group differences in the severity of depression, time since last ECT series, unilateral vs. bilateral electrode placement, adjunctive use of psychotropic medication, gender, education and so forth, a MANCOVA and a series of 15 two (age) by three (ECT history) by two (gender) analyses of covariance (education served as the covariate) were used to examine the main effects of ECT history, age and their interaction on cognitive performance. 3. No generalized adverse effects of prior ECT treatment were found but older patients with two or more prior ECT series performed significantly more poorly than other subgroups on 4 of 15 cognitive tests: (1) Personal and Current Information from the WMS, (2) WMS Stories recall, (3) 30-minute delayed WMS Stories and (4) WAIS-R Similarities. 4. These findings suggest that the verbal-narrative memory functioning of depressed geriatric patients with a history of at least one prior ECT series is particularly vulnerable to disruption.

Cognitive slowing in Alzheimer's disease and geriatric depression.

Response slowing on psychological tasks is found both in Alzheimer's disease and depression. However, the underlying cause for this slowing may be different in the two disorders. This research examined whether the behavioral slowing found in Alzheimer patients results from a reduction in their rate of cognitive processing, whereas the slowing in depressed geriatric patients reflects a purely motor retardation. This hypothesis was tested using a task in which subjects had simply to determine the number of dots present in an array (i.e., enumeration). In all four subject groups (Alzheimer patients, depressed geriatric patients, healthy old controls, and healthy young controls), response time increased linearly with array size. The slope of this linear function (reflecting rate of enumeration) was the same in the normal and depressed patients, but was significantly greater in the Alzheimer patients, suggesting the presence of a cognitive slowing in Alzheimer's disease, but not in depression.

Electroconvulsive therapy for post-stroke depressed geriatric patients.

Medical records were retrospectively reviewed for 20 medically ill geriatric patients who received electroconvulsive therapy (ECT) for post-stroke depression from January 1982 to January 1991 at Massachusetts General Hospital. Of the 19 patients (95%) who improved with ECT, 7 patients (37%) suffered relapses despite maintenance anti-depressant medications. Relapses typically developed approximately 4 months after ECT. Five patients (23%) developed ECT-related medical complications. Three patients (15%) developed transient interictal confusion or amnesia. No patient experienced an exacerbation of preexisting neurologic deficits. These findings indicate that ECT is a generally well tolerated and effective treatment for depressed, medically ill post-stroke geriatric patients.

Sleep Quality in Geriatric Depressed Patients: Comparison with Elderly Demented Patients and Normal Controls and the Effects of Moclobemide

The present study evaluated the effects of treatment with 400 mg Moclobemide in comparison with placebo on sleep quality and morning activity Ievels of geriatric depressed patients. In addition, sleep quality of these patients was compared to that of three groups of elderly patients, multi-infarct dementia, Alzheimer type dementia and normal elderly controls. Sleep quality, assessed by continuous actigraphic monitoring, was not affected by moclobemide. Morning Ievels of activity, however, were found to be significantly increased only in the moclobemide group. Comparing the measures of sleep quality derived from the actigraphic recordings between the four groups of elderly people revealed that patients with multi-infarct dementia had significantly Iower sleep quality measures than the other three groups. There were no statistically significant differences for any of the sleep quality measures between the geriatric depressed patients and the normal controls.

"Cocooning": A Clinical Sign of Depression in Geriatric Patients

"Cocooning": A Clinical Sign of Depression in Geriatric Patients

Hospital Utilization and Readmission Rates for Geriatric and Young Adult Patients With Major Depression: Results From a Historical Cohort Study

Late-life depression may have different clinical features, hospital utilization patterns, and natural history, depending on whether the illness begins in midlife or late life. This historical cohort study examined three patient groups, late-onset geriatric depressed patients, early-onset geriatric depressed patients, and young adult depressed patients, to determine hospital utilization patterns, readmission rates, and whether specific clinical symptoms on admission predisposed patients to readmission. The two geriatric patient groups had similar demographic, medical comorbidity, and hospital utilization profiles, except that the early-onset geriatric depressed group had longer hospital lengths of stay. Hospital utilization patterns for the young adult patients were different from the geriatric patients, but in the expected direction, ie, less medical comorbidity and shorter lengths of stay. Patients with late-onset geriatric depression had the highest 24-month readmission rate (47.4%), followed by early-onset geriatric depression patients (23.1%) and young adult patients (16.7%). Delusional symptoms and agitation were similar across the three patient groups and, as expected, somatic complaints were more frequent in the geriatric patient groups. The relative risk for readmission was greatest for geriatric patients who were somatic. Readmission risk was increased for agitated late-onset geriatric depressed patients and young adult patients, but not for early-onset geriatric depressed patients. Delusional symptoms did not predict readmission for any patient group.

Neuroticism may be associated with history of depression in the elderly

AbstractThe relationships between geriatric depression and various personality traits have never been fully clarified, and their clinical significance is uncertain. Depression in geriatric patients may differ from the disorder found in younger individuals, and may also have distinctive personality antecedents or consequences. In this study 16 elderly subjects who had recovered from depression and 14 elderly control completed the Eysenck Personality Inventory (EPI) and the Personality Disorder Examination (PDE). On the EPI, neuroticism subscale scores were significantly higher for patients than controls, while mean extraversion scores were not significantly different. On the PDE, recovered depressives had higher dimensional scores than controls in each DSM‐III‐R personality disorder except antisocial. Neuroticism scores correlated significantly with PDE dimensional scores for all but two of the DSM‐III‐R personality disorders, while extraversion scores correlated significantly with only two PDE categories. Together, these findings suggest that neuroticism and criteria for most DSM‐III‐R personality disorders may be associated with history of depression in a geriatric population.

Paranoid Ideation in Geriatric Depressed Patients Treated with Alprazolam

Paranoid Ideation in Geriatric Depressed Patients Treated with Alprazolam

Depression in geriatric patients with chronic medical illness

AbstractAll patients (N = 123) on the medical services of a chronic care hospital were approached to complete the Folstein Mini‐Mental State Exam and the Montogomery‐Asberg Depression Rating Scale. Of 63 patients completing the MADRS, 35% had scores in the depressed range. A comparison of MADRS scores for a depressed population of geriatric patients admitted to the psychiatric inpatient unit of the same institution showed that both depressed medical and depressed psychiatric patients were significantly different from the non‐depressed medical patients on all subtests of the MADRS except in the frequency of endorsement of ‘reported sadness’. There was no significant difference between the depressed medical patients and psychiatric inpatients. Two‐thirds of the depressed medical patients had a previously unrecognized diagnosis of depression, highlighting the need for a greater awareness of the degree of depression in institutionalized geriatric patients with chronic medical illness.

Sleep is undisturbed in elderly, depressed individuals who have not sought health care

Sleep deficits are commonly found in geriatric depressed patients, particularly shortened rapid eye movements (REM) latency, disturbed sleep continuity, and decreased slow wave sleep (SWS). Here we report the sleep patterns of community volunteers responding to ads about memory loss and depression. The two groups, 24 geriatric-onset major depressive disorder (MDD) subjects with a minimal history of seeking treatment for depression and 24 gender- and age-matched control subjects, significantly differed from each other on only one measure of sleep-sleep latency; the MDD group showed a modest but significant shortening of latency to fall asleep. All other sleep/wake measures, including REM latency, temporal distribution of REM sleep across the night, SWS, and measures of nighttime wakefulness did not differ between groups. This lack of significant sleep disturbance suggests that the sleep deficits reported in many studies of major depression may be related to factors underlying treatment-seeking behaviors, physical health status, severity of the depression, or heterogeneity within the MDD population with some types seeking treatment and other not seeking it, rather than depressive state per se. The data indicate that community-dwelling healthy elderly individuals who have a diagnosed major depression but who have not actively sought health care do not necessarily manifest the sleep disturbances thought to be characteristic of major depressive illness.

Age at onset in geriatric depression: Relationship to clinical variables

The significance of age at onset of first depressive episode was evaluated in an elderly depressed population. A prospective study of 71 consecutively admitted inpatients with a diagnosis of major unipolar depression examined the relationship between age at onset of illness and several clinical variables. Subjects divided into early-onset (EO) and late-onset (LO) groups, matched for current age, did not significantly differ in terms of symptomatology, cognitive impairment, physical illness, family history or treatment responsivity. These findings do not support a nosologic separation of EO and LO depression in geriatric patients.

Late-Onset Depression

Clinical and biologic studies of geriatric depression are reviewed to evaluate the role of age of onset as a distinguishing parameter. The findings suggest that late-onset depressives have a different presentation, more frequent relapses, and a greater association with medical disorders, dementia, and aging-related biologic changes than early-onset geriatric depressives. Careful clinical evaluation and follow-up of late-onset depressives are suggested. Longitudinal investigations of geriatric depressed patients are needed in order to study the frequency and time of occurrence of various clinical outcomes and identify predictors of outcome in late- and early-onset geriatric depression.

Plasma levels and effects of nortriptyline in geriatric depressed patients.

Pharmacokinetic, therapeutic effects, and side effects of nortriptyline were studied in geriatric depressed patients treated with a standard dose of 150 mg/day. Plasma levels and elimination half-life of nortriptyline were no different in geriatric patients than younger patients. The antidepressant therapeutic effects of nortriptyline appeared to be similar in geriatric patients as in younger depressed patients. Geriatric patients experienced few subjective side effects of nortriptyline. Overall, the drug produced no clinically significant changes in several parameters of the EKG, and no geriatric patient experienced tachycardia on nortriptyline. Nortriptyline did induce significant orthostatic hypotension in the systolic component, but not in the diastolic component. However, the orthostatic hypotension produced by nortriptyline was not greater in geriatric patients than in younger patients treated with the same dose.

Age, therapeutic “milieu” and clinical outcome in depressive patients treated with viloxazine: A study with plasma levels

1. 1. Authors studied 42 depressed patients of both sexes suffering from Major Depression and Dysthimic Disorder, treated with viloxazine for 4 weeks. 2. 2. All patients were divided into two groups on the basis of their age (Group 1 mean age 45 ± 2.2 and Group 2 mean age 68.3 ± 1.12). 3. 3. Viloxazine was effective in different depressive situations, regardless of the age of the patient or the therapeutic context, even if in Group 2 the out-patients did significantly better (p < 0.01) than the hospitalized ones. 4. 4. Mean steady-state plasma levels and level/dose ratios were significantly higher (p < 0.05) in elderly patients than in younger ones. 5. 5. No correlation between viloxazine plasma levels-clinical efficacy and side-effects was found even though patients suffering from Major Depression showed a trend to a better response with plasma levels below 5ɣ/ml. 6. 6. The satisfactory antidepressant activity and the good tolerability of viloxazine in elderly depressed patients make this drug particularly suitable for using in ambulant geriatric depressed patients.

Antidepressant selection in the elderly

Not many specific studies of the pharmacologic treatment of depression in geriatric patients are available, in part because this age group is specifically excluded from most new drug investigations. The author assesses the available information and presents conclusions in regard to the major categories of drugs used for antidepressant purposes. He also examines distinctive features of the elderly that affect choice of drug treatment, such as effects of the physiology of aging on pharmacokinetics, and the fact that possible greater likelihood or severity of side effects may necessitate treatment with lower doses.

Cognitive functioning in depressed geriatric patients with a history of ECT.

Cognitive functioning in depressed geriatric patients, some with a history of ECT, was assessed with the Trail Making B test. Depressed patients over the age of 65 who had had at least one prior series of ECT performed more poorly on the test than did older patients with no history of ECT and younger depressed patients regardless of their ECT history. The groups did not differ in severity of depression. Careful assessment of elderly patients' history of ECT will allow for more informed decisions about the current use of ECT and an understanding of the cognitive status of these patients.

Cigarette smoking and bladder cancer: an epidemiological inquiry in West Yorkshire.

Results are given of a case-control study on bladder cancer in West Yorkshire. The aim of the study was to assess what risks exist for cigarette smoking in the United Kingdom and also to investigate if a dose response effect was present. The study shows for the first time in the United Kingdom a positive but weak relationship between cigarette smoking and bladder cancer. Close examination of the data with regard to this effect shows that a complex set of relationships result when the quantity smoked and the period of smoking are taken into account. A dose response effect is weakly demonstrated when a medium quantity of cigarettes are smoked but it is not present at all in those who smoked most cigarettes for the longest periods. No risk appears to exist for those who have smoked only filter cigarettes. The results are contrasted with similar studies and the significance of the observations are discussed.

ECG findings in geriatric depressives given trazodone, placebo, or imipramine

ECG effects were evaluated in 60 depressed geriatric patients in a drug-free baseline state and weekly during treatment with trazodone, placebo, or imipramine. Eighteen patients underwent crossover from placebo or imipramine to trazodone. Imipramine increased heart rate and was associated with more isolated ECG complications. Trazodone and placebo did not increase heart rate and had no other significant ECG effects.