Atypical antipsychotics in older adults.

Psychotic symptoms are common in older adults and reflect a variety of psychiatric and medical conditions. Antipsychotic drugs form the core of the treatment of these symptoms; however, treatment of the elderly is complicated by a high frequency of comorbid medical illnesses, risk of side effects, and age-related changes in pharmacodynamics and pharmacokinetics. The superior safety and efficacy of atypical antipsychotics makes them first-line agents for managing psychotic patients with schizophrenia. Their uses now extend to other conditions such as schizoaffective disorders, delusional disorder, and mood disorders with psychotic features. Although the drugs have been studied extensively in young subjects, well-designed, double-blind, placebo-controlled studies are relatively lacking in the elderly. Our knowledge of their safety, efficacy and dosage in older adults is based on a few studies with small samples or extrapolated from studies of younger patients. Several psychiatric and medical conditions that are associated with psychotic symptoms in older people are reviewed, as well as how these patients may benefit from treatment with these agents.

Sex and the mature woman.

Menopause is associated with myths about the death of sexual vitality. While menopause causes many women to experience vasomotor instability, problems with osteoporosis, urogenital aging, and increased risk of heart disease, these issues can now be addressed with hormonal replacement strategies or alternative therapies. The menopausal woman today can be relatively comfortable with regard to direct menopausal symptoms of estrogen deficiency as a result of medical therapies. Sexual health and intimacy should also be considered in a holistic approach to the menopausal patient. The mature or postmenopausal woman need not abandon sexual intimacy. This review article presents information about sexual health in woman who are perimenopausal or postmenopausal. It explores a variety of medical, psychiatric, and psychological factors that can lead to either sexual health and comfort or sexual dysfunction and dissatisfaction. Given the benefit of good health, a loving relationship, and appropriate medical care, sexual vigor can continue in the mature years of a woman's life.

Postpartum mood disorders: clinical perspectives.

Mood disorders are common in women. A prepregnancy personal history of mood disorder (bipolar or major depression), premenstrual syndrome, or (possibly) postpartum blues places a woman at high risk for a postpartum exacerbation of symptoms. Untreated or unrecognized postpartum mood disorders can lead to serious psychologic and social consequences, in some cases even leading to suicide or infanticide. Women at risk for postpartum mood disorders need to be referred for psychiatric consultation before pregnancy and parturition. Informed, professional collaboration offers the best opportunities for prevention, as well as the earliest recognition and treatment of emergent symptoms.

Women and mood disorders. Menarche to menopause.

Considering the multiple issues affecting women and their experiences with mood disorders, several clinical observations may be pertinent: Because women are very vulnerable to depression, physicians in all patient care related specialties need to be familiar with the diagnosis of depression and related mood syndromes. Early intervention may be far more critical than previously considered in preventing chronic, tragic outcomes for major depression, bipolar disorder, and even severe premenstrual depression. Both dysphoric mania (because of its poor prognosis) and rapid cycling bipolar disorder (because the majority of cases involve women) distinguish bipolar illness in women. In these situations, anticonvulsants such as carbamazepine or valproic acid may offer treatment advantages over lithium. Premenstrual depression is very strongly linked to traditional psychiatric mood syndromes and is likely to benefit from appropriate antidepressant therapy. The serotonin-specific reuptake inhibitors are especially attractive in this situation because of their low side effect profiles (including low weight gain percentages) and safety in overdoses. Previous experience with psychiatric illness, especially bipolar disorder, is often predictive of postpartum mood episodes. Aggressive early treatment is critical to prevent or successfully manage postpartum episodes. Menopause cannot yet be linked to a specific or unique mood syndrome.

Premenstrual syndrome: concerns, controversies, and treatment.

Premenstrual syndrome is of interest to health care professionals today because of media attention and large numbers of women who are concerned about their premenstrual symptoms. At the same time, there is a lack of consensus as to diagnostic criteria and specific treatment. There appears to be a relationship between mood disorders such as major depression and luteal phase symptoms. An approach to the diagnosis and treatment of the patient with premenstrual syndrome is described.

Bromocriptine associated with symptom exacerbation during neuroleptic treatment of schizoaffective schizophrenia.

Bromocriptine is a dopamine agonist with potential mental side effects. The authors report a case involving a patient with neuroleptic-induced remission of psychiatric symptoms in whom bromocriptine was associated with temporary exacerbation of schizophrenic symptoms. Other treatment approaches than bromocriptine are suggested for amenorrhea-galactorrhea induced by neuroleptic medication. The use of bromocriptine requires monitoring for changes in mental status.

Depression: a new approach to an old syndrome.

Depression is a medical illness related to an interplay of genetic, biochemical and environmental/experiential factors. Careful diagnosis, using contemporary psychiatric criteria, simplifies treatment by the family physician. Awareness of these criteria may lead to improved selection of candidates for drug treatment and early intervention in recurrent illness. The new nosology in psychiatry avoids much confusion and should take some of the guesswork out of psychiatric treatment in the family physician's office.

The psychiatric abortion consultation.

The role of the psychiatric consultant has changed with the recent liberal "on demand" abortion legislation. This paper emphasizes factors relevant to the psychiatric consultant in the evaluation of the adolescent patient, the retarded patient and the patient with psychiatric illness. In addition, a survey of the literature is made to identify the patient who is at high risk of developing postabortion psychiatric complications. The authors conclude that postabortion complications are infrequent and that there are no absolute psychiatric contraindications to elective abortion.

Toxoplasmosis masquerading as a psychotropic side effect.

When treating a patient with neuroleptics or tricyclic antidepressants, it is usually assumed that complaints of blurred vision can be ascribed to the anticholinergic side effects of these drugs. The authors present a patient treated with imipramine and trifluoperazine whose complaints of blurred vision led to the diagnosis of toxoplasma chorioretinitis.