ABSTRACT
A double-blind, randomized 4-week mianserin vs maprotiline trial was conducted in 48 depressed geriatric medical inpatients. The drug dosages were up to 90 mg of mianserin and up to 150 mg of maprotiline per day. Efficacy was measured by the Geriatric Depression Scale, the Hopkins Symptom Check List depression subscale and the Clinical Global Impression Scale. The overall dropout figure was 27% of the sample. Side effects were relatively similar in the two treatment groups and suggested a safety profile somewhat better than that of the first-generation antidepressants. Mianserin showed some advantages in efficacy over maprotiline, particularly by the 4th week of the trial, but the overall figures of treatment responders were rather small (Geriatric Depression Scale: mianserin 48%, maprotiline 30%). Clinical trials vs placebo are needed to clarify the role of antidepressant pharmacotherapy in depressed geriatric medical inpatients.
Subject(s)
Anthracenes/therapeutic use , Depressive Disorder/drug therapy , Maprotiline/therapeutic use , Mianserin/therapeutic use , Psychophysiologic Disorders/drug therapy , Sick Role , Aged , Aged, 80 and over , Depressive Disorder/psychology , Double-Blind Method , Drug Administration Schedule , Female , Humans , Male , Maprotiline/adverse effects , Mianserin/adverse effects , Psychiatric Status Rating Scales , Psychophysiologic Disorders/psychology , Randomized Controlled Trials as TopicABSTRACT
Psychological distress was evaluated in two groups of medical in-patients, one composed of geriatric subjects (178), the other of adults (201). The instrument used for this purpose was the SCL-90. The predominant pattern of emotional response among the geriatric patients was depression; although this pattern was also present among the adult patients, reactions of an anxious type were more common in these subjects. Women of both groups of patients scored significantly higher than men on many of the subscales of the SCL-90. No significant differences emerged in relation to the type of organic disease among the adult patients, while among the geriatric patients, subjects with disorders of the CNS, muscular-skeletal system and blood scored significantly higher than those with other diseases.
Subject(s)
Inpatients/psychology , Patients/psychology , Adult , Affective Symptoms/epidemiology , Age Factors , Aged , Aged, 80 and over , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Male , Middle Aged , Sex Factors , Sleep Wake Disorders/epidemiologyABSTRACT
The frequency of an abnormal response to the dexamethasone suppression test (DST) was examined in 38 geriatric patients hospitalized for medical illnesses and affected by depressive disorders diagnosed according to the DSM III, and in 18 medical patients (used as controls) hospitalized in the same ward. Only 11% of the controls and 11% of those affected by dysthymic disorder had an abnormal DST vs 73% of the patients with major depressive disorder (MDD). The sensitivity of the DST for MDD, in this particular setting, was found to be about 73% and the specificity 89%. The importance of this clinical adjunct in diagnosing the severe depressive disorders is discussed.
Subject(s)
Depressive Disorder/physiopathology , Dexamethasone , Hydrocortisone/blood , Hypothalamo-Hypophyseal System/physiopathology , Pituitary-Adrenal System/physiopathology , Adolescent , Adult , Age Factors , Aged , Child , Female , Humans , Male , Middle AgedABSTRACT
The authors have evaluated the psychotropic drug use patterns and psychological distress (with the Symptom Distress Checklist, SCL-90) amongst 331 elderly medical inpatients. Forty-two percent of the sample took psychotropic drugs during their hospitalization period. The drugs most commonly used were anxiolytics and hypnotics of the benzodiazepine class. Subjects to whom psychotropic drugs were prescribed reported higher psychological distress compared to those not receiving them; however, a score of moderate distress in the depression and sleep disturbances subscales was reported by a relatively high percentage of subjects not receiving psychotropics. Patients taking antidepressants reported scores of psychological suffering higher than those under benzodiazepine treatment: such a difference not only related to the depression subscale, but to the majority of the symptom areas investigated by the SCL-90.
