ABSTRACT
BACKGROUND: Excess brain changes in geriatric manic patients have been hypothesized. Few neuroimaging studies are available. METHODS: Brain computed tomography scans in geriatric patients with manic disorder (n = 30) were compared to those in same-age control subjects (n = 18). Ratings of cortical sulcal widening (CSW), lateral ventricle-brain ratio (VBR), and related linear measures were determined. RESULTS: Patients had greater CSW scores (Exact p = .002) and VBR (t = 2.51, df = 46, p < .02) compared to control subjects. CSW was positively associated with age at illness onset (rs = .46, p < .01) and age at first manic episode (rs = .53, p < .005). VBR was poorly correlated with CSW and was not associated with these indices of illness course. CONCLUSIONS: These findings support the need for further investigation of relationships between brain structure and clinical features in geriatric mania.
Subject(s)
Bipolar Disorder/diagnostic imaging , Brain/diagnostic imaging , Geriatric Assessment , Aged , Atrophy/pathology , Brain/pathology , Female , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
In geriatric patients with major depression (N=15), the authors compared response to treatment with nortriptyline as it relates to brain morphology assessed by computed tomography. There was a significant negative association between ventricle-brain ratio and response to nortriptyline (rs=-0.63; P=0.015).
Subject(s)
Antidepressive Agents, Tricyclic/pharmacology , Antidepressive Agents, Tricyclic/therapeutic use , Brain/drug effects , Brain/diagnostic imaging , Depressive Disorder, Major/drug therapy , Nortriptyline/pharmacology , Nortriptyline/therapeutic use , Aged , Antidepressive Agents, Tricyclic/blood , Depressive Disorder, Major/diagnosis , Female , Humans , Male , Middle Aged , Nortriptyline/blood , Predictive Value of Tests , Prospective Studies , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Among psychiatric inpatients with primary degenerative dementia, those with psychotic symptoms (N = 20) were older than those without (N = 20) (t = 3.48; p < 0.001). Persecutory delusions were the most frequent psychotic phenomena. Duration of dementia overlapped, but scores on the Global Deterioration Scale and the Cornell Scale for Depression in Dementia were lower in the psychotic group after correcting for age. The limited literature concerning demographic and clinical correlates of psychosis in dementia is reviewed; the age difference noted is consistent with two other reports.
Subject(s)
Dementia/complications , Neurocognitive Disorders/etiology , Age Distribution , Aged , Aged, 80 and over , Case-Control Studies , Delusions/etiology , Female , Hallucinations/etiology , Humans , Logistic Models , Male , Psychiatric Status Rating Scales , Severity of Illness Index , Time FactorsABSTRACT
Recovery from lithium-induced neurotoxicity can take much longer than the 2 to 3 weeks previously reported. Contributing factors could include advanced age and underlying clinical or subclinical brain disease. However, the occurrence of lithium-induced neurotoxicity does not preclude reinstitution of lithium treatment. We report three case histories that illustrate these points.
Subject(s)
Bipolar Disorder/drug therapy , Lithium/adverse effects , Psychoses, Substance-Induced/diagnosis , Aged , Aged, 80 and over , Bipolar Disorder/psychology , Dose-Response Relationship, Drug , Electroencephalography/drug effects , Female , Humans , Lithium/administration & dosage , Lithium/pharmacokinetics , Lithium Carbonate , Male , Middle Aged , Neuropsychological Tests , Psychoses, Substance-Induced/blood , Psychoses, Substance-Induced/psychologyABSTRACT
While rapidly spreading "crack" addiction is a major concern in our community, current research in this area is focused mainly on adolescents and young adults. We discuss a case of crack addiction developing for the first time in an elderly person and subsequent complications. We believe no such cases have been previously reported. We hope this will be helpful to practicing clinicians and stimulate research to understand cocaine and crack abuse patterns in the elderly.
