Nomifensine in the treatment of depressed geriatric patients.

In a randomized double-blind study, the efficacy and safety of nomifensine and amitriptyline were compared in 33 geriatric patients with endogenous and reactive depression. Significant improvement was noted over the 4-week study period for all groups on the Clinical Global Impression, Hamilton, and Plutchik rating scales. There was significantly more improvement among the patients with reactive depression treated with nomifensine and among the patients with endogenous depression treated with amitriptyline, as assessed by the Plutchik Geriatric Rating Scale.

Nylidrin HCL in the treatment of symptoms of the aged: a double-blind placebo controlled study.

This study was designed to assess the effectiveness and the safety of nylidrin HCL in the geriatric patient and mild to moderate symptoms of cognitive, emotional and physical impairment. Following a 3 week placebo washout, 60 patients received either nylidrin HCL or placebo for 12 weeks. Efficacy evaluations were made utilizing the Sandoz Clinical Assessment Geriatric (SCAG) Scale, a nurse's rating of ward behavior (SCASNO), the Hamilton Psychiatric Rating Scale for Depression, and 2 of the Katz Adjustment Scales. Significant improvement in symptom severity was demonstrated in the nylidrin group as compared to the placebo group. There were no abnormalities of clinical significance in the safety measurements and few side effects were reported.

Comparison of oxazepam, flurazepam and chloral hydrate as hypnotic sedatives in geriatric patients.

In a four-week study, a comparison was made of oxazepam, flurazepam and chloral hydrate as hypnotic sedatives in 17 geriatric patients. Each drug was given alone for six nights, with a two-night placebo interval following each phase. Each patient completed an additional placebo phase (up to six nights) before each drug phase. The number of awakenings per night and the sleep latency (time required to fall asleep) were determined from the patients' reports and from the reports of a nurse-observer. Only for oxazepam was the number of patient-reported awakenings per night significantly less than for placebo, although with both oxazepam and flurazepam the awakenings were fewer than with chloral hydrate. According to the patient-reports, sleep latency was significantly lower with flurazepam than with placebo; for oxazepam and chloral hydrate the latencies were not significantly different from those for flurazepam or placebo. Only for oxazepam were the patients' ratings of sleep quality significantly greater than for placebo. The objective assessment of sleep by the nurse-observer usually confirmed the patients' assessments. Morning drowsiness was the most common side effect, reported equally for placebo and for the active drugs. Drowsiness during the day was reported less frequently for oxazepam than for flurazepam, chloral hydrate or placebo. It is concluded that oxazepam is safe and efficacious for the short-term management of insomnia in the elderly.

Piperacetazine versus thioridazine in the treatment of organic brain disease: a controlled double-blind study.

In a double-blind cross-over study, 50 geriatric patients with organic brain disease were divided into two groups. One group first received piperacetazine for 15 days and then thioridazine for 15 days. For the other group the sequence was reversed. Piperacetazine proved to be at least as effective as thioridazine and seemed to be more effective against certain target symptoms; side effects were less common and less severe.

Hypochondriasis and the elderly.

Hypochondriasis is poorly understood and poorly treated. Attempts to classify it have been unsatisfactory except for Pilowsky's division into primary and secondary groups. Twenty consecutive cases of hypochondriasis in elderly patients were studied; 4 were of the primary type and 16 of the secondary type. For the primary group, neither family therapy nor hospitalization was needed, and the prognosis was good. In contrast, hospitalization was always advised for the secondary group, and such patients improved while in the hospital. Psychotropic drugs, a therapeutic milieu, and often electroshock therapy were needed to treat depression. After discharge, successful treatment necessitated Day Care programs and the long-term use of family therapy. Treatment was unsuccessful in 8 patients characterized by refusal to become involved in post-discharge Day Care programs and family therapy.

A geriatric functional rating scale to determine the need for institutional care.

This study was carried out to validate a rating scale which could serve as a guide in determining the need for institutional care. The scale assesses the subject's physical and mental disability, balanced against his ability to function and the support available from relatives and community resources. Cut-off points were tested by the use of an 18-month follow-up interval. Initially, 130 aged men and women from three different settings were rated. At the time of follow-up eighteen months later, 83 per cent of the subjects who had obtained an initial score indicative of their inability to function in the community were either dead or in an institution. In contrast, 90 per cent of those who obtained an initial score indicating that they were able to continue in the community, were not in an institution at the time of follow-up. The rating scale can be used not only to help decide the need for institutional care, but also to help determine the most suitable setting for the patient if placement is necessary.

The team approach in a psychogeriatric unit.

The importance of a multidisciplinary team approach was recognized when a 14-bed short-term Psychogeriatric Unit was opened in a psychiatric hospital. The limited time available to the psychiatrist in charge placed a heavy clinical responsibility on the paramedical personnel who formed the team. Initially, role distinctions were kept vague and regarded as not overly important. Six months after the Unit opened, all the staff members filled out a questionnaire. They felt that communication within the team was good, that they could fulfill the role of primary therapist, and that they understood their own roles and those of others. All regarded the psychiatrist as the head of the team. The psychiatrist felt that he had the ultimate responsibility for over-all care of the patients, that any attempt ot blur roles caused problems, and that there had been a partial regression to more traditional patterns. Members of the Unit regarded themselves as a team, able to work together and pool skills in treating patients, and thus play a significant part in total care. This attitude proved more valuable than attempting to break away from the medical model or decrying the importance of roles.