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Vascular depression: overrepresented among African Americans?
- Authors:
- REINLIEB Michelle E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(5), 2014, pp.470-477.
- Publisher:
- Wiley
Objective: Our primary aim was to compare the rate of vascular depression among a clinical sample of African American and Caucasian depressed older adults. Secondary aims included characterizing the clinical and neuropsychological profile of vascular depression and comparing antidepressant response rates between patients with vascular and nonvascular depression. Methods: This was a two-site, multi-ethnic, open 8-week trial of antidepressant medication in older adults with depression. Men and women 50 years or older meeting DSM-IV criteria for nonpsychotic unipolar depression participated in this trial. Each participant underwent a comprehensive psychiatric and neuropsychological evaluation and a brain MRI, which were performed at baseline. Results: Forty-six patients met inclusion and exclusion criteria. Forty-two of those patients received an MRI at baseline. Sixteen patients met criteria for vascular depression. Patients with vascular depression were significantly more likely to be African American and have a higher likelihood of being female, a higher rate of hypertension and psychomotor retardation, a lower rate of family history of affective illness, and frontal systems dysfunction on neuropsychological testing. The difference in response rates between patients with vascular and nonvascular depression did not reach statistical significance. Conclusions: This is the first study to document high rates of vascular depression in a clinical sample of African Americans and Caucasians. Our findings suggest that vascular depression may be overrepresented among African Americans, which is consistent with the high rates of cardiovascular disease, hypertension, and stroke in this population. (Publisher abstract)
Psychotropic medication discussions in older adults' primary care office visits: so much to do, so little time
- Authors:
- AHN SangNam, et al
- Journal article citation:
- Aging and Mental Health, 15(5), July 2011, pp.618-629.
- Publisher:
- Taylor and Francis
This study investigated discussions of psychotropic medications during older patient's visits to primary care physicians. It also examined different scenarios physicians use to address mental health complaints of older adults. Fifty nine videotaped care visits involving mental health discussions were complemented by patient and physician surveys. Findings revealed that a third of visits contained no psychotropic medication discussions despite its important role in treating mental illnesses. When prescribing psychotropic medicines, physicians presented information about the medication's purpose and brand name more often than adverse effects or usage. More competing demands were associated with less psychotropic medication discussions. Given the seriousness of mental illness in late life, the authors concluded that system-level changes may be needed to correctly diagnose mental illness, take more proactive actions to improve mental health, and enhance information exchange concerning psychotropic medication.
The wrong prescription
- Author:
- WINCHESTER Ruth
- Journal article citation:
- Community Care, 9.8.01, 2001, p.23.
- Publisher:
- Reed Business Information
Reports on how many older people in residential homes are spending their days in a drug-induced haze as the use of anti-psychotic drugs reached record high levels.
The relevance of guidelines for treatment mania in old age
- Author:
- SNOWDON John
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(9), September 2000, pp.779-783.
- Publisher:
- Wiley
Reviews three sets of guidelines for the treatment of patients with bipolar disorder, in order to assess their adequacy in relation to treatment of older persons with mania. One of the three referred to differences encountered when treating elderly people, but none gave adequate attention to age-related changes in pharmacokinetics and whether it is appropriate to prescribe lithium as a first-line mood stabiliser for older persons. Concludes that the guidelines do not give clear guidance on initial management of acutely manic patients who refuse medication. Nor do they give consideration to secondary mania. Recommended that evidence be gathered in order to develop guidelines specifically for management of mental disorders presenting in old age.
Psychopharmacological treatment of dementia
- Author:
- CALLAWAY Janice T.
- Journal article citation:
- Research on Social Work Practice, 8(4), July 1998, pp.452-474.
- Publisher:
- Sage
This article provides an overview and description of dementia, explores current and investigational agents used in the treatment of accompanying cognitive and noncognitive symptoms, and suggests considerations for assessing certain aspects of pharmacological management.
Bring on the health economists: time for a rigorous evaluation of senior participative arts
- Author:
- CHAPWELL Clair
- Journal article citation:
- Working with Older People, 18(1), 2014, pp.4-9.
- Publisher:
- Emerald
Purpose: As our elderly population increases, scheduled to rise by 61 per cent in the next 20 years, a national panic has set in about what to do. Antidepressant use is on the rise, and the figures for loneliness and depression skyrocketing. So far, so normal and so very disheartening. The purpose of this paper is to make a radical plea to change our thinking about how the lives of our senior citizens are lived: bring on the health economists, and let us put some serious funding into studying the effects of participative arts on the lives of older people. Design/methodology/approach: This year the author was awarded a Winston Churchill Fellowship to study participative arts for older people in the USA. The author interviewed Professor Julene Johnson of University of California San Francisco, about “Community of Voices” an ambitious, well-funded five year programme which is launching 12 one-year choirs with low income, non-singers, after which findings will be rigorously tested. Findings: In the USA, proper evaluation of participative arts is being taken seriously as a means of whittling down massive Medicare costs. There is evaluation going on in the UK, but much of it is flawed, usually down to cost. Evaluations generally consist of questionnaires filled in by participants. Findings centre around the psychological arena, rather than physical aspects (balance, hospital visits). Originality/value: It is imperative that one starts thinking about participative arts for seniors in a scientific and serious way. The alternative – roomfuls of elders on antidepressants (the UK's antidepressant use was up 23 per cent between 2010 and 2011) does not bear thinking about (Publisher abstract)
Substance abuse and co-occurring psychiatric disorders in older adults: a clinical case and review of the relevant literature
- Authors:
- SALMON Joanna Marie, FORESTER Brent
- Journal article citation:
- Journal of Dual Diagnosis, 8(1), January 2012, pp.74-84.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Substance misuse is predicted to become an increasing problem in the older adult population in the United States. This article uses a brief clinical case study to illustrate the issues and to introduce a review of the literature related to substance use and psychiatric illness in older adults. The review looks at prevalence of substance use disorders, psychiatric illness and co-occurrence in older adults, drug interactions and sensitivity and tolerance to alcohol and drugs, neurobiological consequences and cognitive impairment, including alcoholism, depression and brain changes, identification and assessment, and treatment of co-occurring disorders in older people. The article notes the unique challenges relating to treatment of older adults with co-occurring disorders. The authors suggest that further research into the older adult population with substance use disorders and co-occurring illness is required.
Understanding behaviour in dementia that challenges: a guide to assessment and treatment
- Author:
- JAMES Ian Andrew
- Publisher:
- Jessica Kingsley
- Publication year:
- 2011
- Pagination:
- 176p.
- Place of publication:
- London
As people grow older, their physical and psychological needs become more complex. Unmet needs often result in challenging behaviour, particularly if the person suffers from dementia. This behaviour can significantly interfere with the quality of life of a person with dementia, as well as that of those who live with and care for them. The author looks beyond the behaviour itself to the causes. He suggests that challenging behaviours occur at times of distress and reflect an attempt to cope with difficult situations. Drawing on the voices of older people themselves the book works towards understanding the nature of this distress, touching on such issues as pain and lack of stimulation, companionship and autonomy. The author describes the different categories and causes of challenging behaviour in people with dementia, and provides models which will aid identification, assessment and treatment. A thorough evaluation of the use of psychotropic medication is provided, as well as of a wide range of psychological and biopsychosocial interventions. The book contains useful tools and protocols derived from the author's work at a specialist challenging behaviour unit, as well as case studies which demonstrate how the various models may be used in practice.
Presentations and management of Post Traumatic Stress Disorder and the elderly: a need for investigation
- Author:
- BUSUTTIL Walter
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.429-439.
- Publisher:
- Wiley
With an aging population increasing presentations of cases of Post Traumatic Stress Disorder (PTSD) can be expected to old age services. While progress has been made in recent years in relation to the understanding and development of aetiological theories, classification, assessment and management strategies and protocols in the adult population, similar advances have lagged behind for the elderly. The aim was to review the adult literature regarding PTSD and discuss how this might apply to an elderly population. An attempt is made to highlight a better awareness of the field of psychological trauma in the elderly in the hope of stimulating debate and research. A review of the adult literature is conducted relating to classification, aetiology, demographic features, vulnerability, assessment, clinical management including psychotherapy and medications and how these may apply to the elderly. Little has been published in this field that directly relates to the elderly. The adult literature allows insight into understanding how PTSD may present in the elderly, and how they may be managed. Further specific research is needed in the elderly in order to facilitate a better understanding of PTSD that present in this unique population. This will lead to better clinical assessment, management and treatment provision.
Gender differences in depression: a study of older unlike-sex twins
- Authors:
- TAKKINEN S., et al
- Journal article citation:
- Aging and Mental Health, 8(3), May 2004, pp.187-195.
- Publisher:
- Taylor and Francis
Gender differences in depressive symptoms, in the diagnosis of major/minor depression, and in the use of antidepressant medication were investigated. The sample included 249 pairs of unlike-sex twins, who were between 70 and 80 years of age at the initial, baseline assessment. A follow-up, in which both members of 145 twin pairs participated, was carried out four years later. Participants completed the Centre for the Epidemiologic Studies Depression Scale (CES-D) for depressive symptoms. Current use of antidepressant medicine was assessed. Medical records of major/minor depression from the period 1985-1998, including a summary of those diagnoses in earlier years, were gathered from several sources. Women had a higher frequency of depressive symptoms and depression diagnoses than their twin brothers. Depressive symptoms and diagnosis of depression increased over time, slightly more among men. The gender difference and increase over time in the depressive symptoms were related to differences in socio-economic status and physical functioning in men and women. No gender difference was found in the use of antidepressant medication.