Antidepressant efficacy and safety of low-dose sertraline and standard-dose imipramine for the treatment of depression in older adults: results from a double-blind, randomized, controlled clinical trial.

This study compared the efficacy and tolerability of 150 mg/day imipramine and 50 mg/day sertraline for the treatment of a major depressive episode (DSM-IV) in older adults (N = 55) in an 8-week, randomized, double-blind, controlled clinical trial. Intention-to-treat analysis (last observation carried forwards) showed a reduction of 50% or more on the baseline scores of the Montgomery-Asberg Rating Scale (MADRS) in 60.7% and 55.6% of patients receiving imipramine and sertraline, respectively (p = .698). Full remission of symptoms (MADRS < 9) was observed in 50.0% and 51.8% of patients, respectively (p = .891). Side effects were more frequent among patients treated with imipramine (86.7%) than among patients treated with sertraline (42.1%) (p = .008). Dropout rates were high in both groups (46.4% and 29.6% respectively, p =.200). These results indicate that imipramine and sertraline are equally effective for the treatment of major depression in later life, although adverse reactions are more frequent among subjects treated with imipramine than with sertraline.

Validity of the Michigan Alcoholism Screening Test (MAST) for the detection of alcohol-related problems among male geriatric outpatients.

Alcoholism is a frequent and underdiagnosed mental health problem of later life. Its detection often relies on the use of screening instruments such as the Michigan Alcoholism Screening Test (MAST). The authors investigated the properties of the scale in a sample of 122 older adults recruited from a geriatric outpatient service in São Paulo, Brazil. Thirty-five subjects met criteria for the diagnosis of alcohol abuse or dependence according to DSM-III-R. The cutoff point 4/5 was associated with a sensitivity of 91.4%, specificity of 83.9%, and positive and negative predictive values of 69.6% and 96.0%, respectively. These results indicate that the MAST is a good screening test for the detection of alcohol abuse and dependence in an elderly male population and that the MAST should be used in combination with a questionnaire assessing the frequency/quantity of alcohol consumption to optimize the detection of cases and characterize their current drinking patterns.

Antidepressant efficacy of sertraline and imipramine for the treatment of major depression in elderly outpatients.

CONTEXT: Most double-blind studies of efficacy and tolerability of sertraline as compared to tricyclics in the treatment of late-life major depression have used amitriptyline as a standard, leading to the inevitable conclusion that the former drug is better tolerated than the latter, with both being equally efficacious. OBJECTIVE: To compare the antidepressant efficacy and tolerability of sertraline (50 mg/day) and imipramine (150 mg/day) in the first 6 weeks of the treatment of major depression in the elderly. DESIGN: A randomized double-blind parallel study with 6 weeks of follow-up. SETTING: The psychogeriatric clinic at the Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo. PARTICIPANTS: 55 severe and moderately depressed non-demented outpatients aged 60 years or more. INTERVENTION: Patients were assigned to sertraline 50 mg/day or imipramine 150 mg/day. MAIN MEASUREMENTS: CAMDEX interview. Psychiatric diagnosis followed the guidelines for "Major Depressive Episode" according to DSM-IV criteria. Severity of symptoms was evaluated using the "CGI" and "MADRS" scales. Cognitive state was assessed using the Mini-Mental State Examination. Side effects were assessed using the "Safetee-Up" schedule. RESULTS: Both groups had a significant decrease in depressive symptoms according to the MADRS scores after 6 weeks of treatment (P = 0.01). No significant differences between groups were detected regarding treatment outcome (t = 0.4; P = 0.7). Although the dropout rate was greater in the imipramine group, the overall tolerability among patients who completed the 6-week trial was similar in both test groups. CONCLUSIONS: Both sertraline and imipramine exhibited good efficacy and an acceptable side-effect profile for elderly depressed patients after 6 weeks of antidepressant treatment.

[Scintigraphic study of gastric emptying and intragastric distribution of a solid meal: gender differences]. / Estudo do esvaziamento gástrico e da distribuição intragástrica de uma dieta sólida através da cintilografia: diferenças entre os sexos.

Gender-related differences in gastric emptying are still controversial. The aims of this study were: to confirm the sex-related difference in gastric emptying of a solid meal and to investigate its association with different patterns of meal distribution between the proximal and distal gastric compartments. Eighteen healthy volunteers (nine males, mean age 35 +/- 9 years; nine females, mean age: 41 +/- 11 years) were studied in the morning, after ingestion of the solid test-meal (an omelette labeled with 185MBq of 99mTc-sulfur colloid). Simultaneous anterior and posterior images of the stomach were acquired immediately after ingestion of the meal and every 10 minutes for 120 minutes. Time versus activity curves were obtained for the whole, proximal and distal stomach. Gastric T1/2 was longer in women (96.1 +/- 17.2 min) than in men (79.9 +/- 17.8 min; P = 0.02). The analysis of the meal distribution inside the stomach showed no differences between males and females in proximal gastric emptying, but the meal retention in the distal compartment was significantly increased among women (P = 0.04). In conclusion, gastric emptying of a solid meal is slower in pre-menopausal women than in age-matched men, probably due to an increased retention of the meal in the distal compartment. This should be taken into consideration to avoid misleading diagnosis of gastroparesis for female patients.

Alcoholism in a geriatric outpatient clinic of São Paulo-Brazil.

Alcohol abuse and dependence are an increasing health problem among the elderly, but there is only scanty information about their prevalence and associated risk factors in developing countries. The authors set out to evaluate the prevalence and associated clinical/demographic features of alcoholism in a sample of male elderly subjects attending a Geriatric Primary Health Outpatient Clinic in a State University Hospital in the City of São Paulo-Brazil. Three hundred four patients were assessed with the Brazilian version of the Michigan Alcoholism Screening Test and a semistructured questionnaire designed to investigate associated features. Lifetime alcoholism was present in 15.1% of the sample, although only 4.3% were active drinkers. Patients classified as "cases" were younger than their nonalcoholic counterparts (70.61 vs. 73.31), and there was a mild, though not significant, excess of Blacks and Mulattos among the former (32.6% vs. 15.9%). Cases were also more likely to rely on their family for financial support (59.0% vs. 43.5%) and to acknowledge a positive family history of alcoholism (51.4% vs. 31.2%). Alcohol abuse or dependence was further associated with heavy smoking (58.7% vs. 44.0%). The authors concluded that alcoholism in this Brazilian elderly sample was likely to be associated with an earlier age at onset of medical problems, financial dependence, Black/Mulatto race, smoking, and positive family history of alcohol abuse/dependence. The authors suggest that the use of standardized methods of assessment of alcoholism in general medical settings may increase the detection of cases and contribute to improved health measures for the management of these patients.

Estruturacao de um grupo de medicosresidentes no atendimento de alcoolatras. / Structuration of a medical residency group in the care of alcoholics

O artigo descreve a formacao de um grupo de trabalho com funcoes especificas no tratamento de alcoolatras, em pesquisa cientifica na area especifica, bem como no ensino medico a nivel de graduacao e residencia medica