Improvement in depression-related cognitive dysfunction following ECT.

Long-term cognitive changes were observed in 8 depressed patients whose pretreatment cognitive impairment (depressive dementia or pseudodementia) resolved after treatment with ECT. Improved performance on the Mattis Dementia Rating Scale was maintained throughout a 4-year follow-up period. Improvements on Memory and Initiation and Perseveration subscales were most consistent over time. These aspects of cognitive functioning may be the most susceptible to the effects of depression, and this may be a factor to consider in clinically evaluating older patients with both depression and cognitive impairment. The findings indicate that elderly patients with cognitive dysfunction secondary to depression may experience improvement in cognitive functioning that is stable over time with remission of the affective disorder.

Rehospitalization rates in older depressed adults after antidepressant and electroconvulsive therapy treatment.

OBJECTIVE: To determine (1) if a "high risk" period for rehospitalization can be identified in a population of depressed older adults and (2) if age of onset and previous history of depression is associated with an increased risk of rehospitalization. DESIGN: Naturalistic, longitudinal treatment outcome study. SETTING: Medical-psychiatry unit and outpatient clinic at a university hospital. PATIENTS: Ninety-four older adults diagnosed with major depression based on SCID and DSM-III-R criteria who were hospitalized for treatment. INTERVENTIONS: All patients were initially hospitalized on a medical-psychiatry unit and treated with either antidepressants or electroconvulsive therapy. MEASUREMENTS: Patients were initially evaluated with the Structured Clinical Interview for DSM-III-R (SCID), the Hamilton Depression Rating Scale, and a battery of neuro-psychological and behavioral tests. Patients were followed over time with an average follow-up interval of 3.09 + 1.45 years, and the date of the first psychiatric rehospitalization (if any) was recorded. RESULTS: Approximately 43.6 percent of the total sample required at least one psychiatric rehospitalization. The greatest risk of rehospitalization occurred in the first 18 months. No significant differences were noted between patient groups treated with ECT and those treated with antidepressants or between patients with a younger and those with an older age of onset of depressive disorder. A statistical trend was observed in which patients without previous episodes of depression had a lower overall rate of rehospitalization compared with patients with one or more previous episodes of depression. CONCLUSIONS: There appears to be a relatively high risk of psychiatric rehospitalization in depressed older adults, particularly in the first 18 months. This rate of rehospitalization underscores the importance of providing maintenance therapy and intensive psychiatric supervision for a minimum of 18 months to 2 years during the course of a depressive episode requiring inpatient hospitalization.

Lived experience of never-married women.

A phenomenological research design was used to explore the meaning of singleness to women who have never married. Nine never-married, heterosexual, childless women were interviewed about how they experienced singleness in their lives. Constant comparative analysis of the data resulted in 13 categories that reflected the meaning of singleness for this group of never-married women. Singleness emerged as a multifaceted experience with different meanings, not only for different women, but also for an individual never-married women, depending on her perspective at any given point in time. The findings of this study, by sensitizing nurses to the subjective world of never-married women, can enhance the act of nursing female clients who have never married.

Autism: psychobiological perspectives.

The purpose of this article is to discuss the syndrome of autism and review current research findings related to this disorder. Emphasis is placed on autism as a disorder of brain function. In this context, theory and treatment approaches, including new pharmacological interventions, are explored. Implications for nursing practice also are discussed.