Electroconvulsive therapy in the very old.

At least one study has questioned the safety of electroconvulsive therapy (ECT) in the very old. In this study, the authors reviewed a 5-year experience with ECT at two university psychiatric services for patients 75 years of age or older. Both outcomes and complications were reviewed. Nineteen of 22 patients (86.3%) were ECT responders. Five patients (22.7%) suffered complications which varied from minor to substantial. ECT was found to be an effective and reasonably safe treatment for depression in the very old.

Delirium. Quick recognition, careful evaluation, and appropriate treatment.

Delirium is a common medical condition, especially in elderly hospitalized patients. The syndrome is characterized by a short course of confusion and changes in perception and behavior. Early detection can be enhanced by routine assessment of cognitive functioning in hospitalized patients, especially those at risk for delirium. Prompt recognition and aggressive treatment of the underlying cause are essential for a positive outcome. Supportive measures are designed to calm and protect the patient and provide symptomatic relief until the precipitating condition is corrected.

Adapting cognitive behavioral therapy for the frail elderly.

Depression is a common psychiatric disorder of the aged. This article briefly reviews the literature on the use of cognitive behavioral therapy (CBT) with the elderly, and suggests some changes in using CBT with the elderly based on the authors' clinical experiences. Recommended changes in technique and common themes when dealing with the frail elderly are described, including the use of "supportive CBT" for patients with mild cognitive impairment. The authors' experiences suggest that CBT is an effective treatment for depression and other affective disorders of the frail elderly, and is especially useful when somatic treatments are contraindicated or produce intolerable side effects.

Obsessive-compulsive disorder responsive to electroconvulsive therapy in an elderly woman.

An elderly woman with a long history of obsessive-compulsive disorder (OCD) was treated with electroconvulsive therapy (ECT) after intractable depression developed. OCD had been well established for many years before onset of the depressive symptoms. After ECT, there was resolution of both OCD and depression. The patient eventually had relapse and was treated with maintenance ECT.

Depression in the elderly.

Depression is a common psychiatric problem in old age. The magnitude of the problem will become greater as this segment of the population grows. Depression is often overlooked in the elderly, contributing to a greater risk of suicide in this group than in younger patients. Depression may be masked by hypochondriasis or somatization. Special problems in diagnosis include bipolar disorder, pseudodementia, pathological grief, and organic mood disorder as related to medications or physical illness. Pharmacokinetic changes with aging need to be kept in mind by physicians treating the elderly with antidepressant medications. Tricyclic antidepressants are the traditional first line pharmacologic agents. Tricyclics with a low side effect profile, such as desipramine or nortriptyline, are generally preferred. However, newer medications including serotonin reuptake inhibitors and bupropion are becoming more widely used. Other medications, including monoamine oxidase inhibitors, lithium, and stimulants, also have a place in the treatment of depression in old age. Electroconvulsive therapy is a useful treatment for patients with treatment-resistant or psychotic depression. Psychotherapy in the elderly has not been well studied, but is believed to be effective if patients are properly selected for therapy and appropriate modifications are made.

Obsessive-compulsive disorder. Characteristic features, pharmacologic management.

Obsessive-compulsive disorder is a fascinating and troubling clinical problem that is now believed to be relatively common. New approaches to research are beginning to unlock its secrets and explore its biological underpinnings. Drugs such as fluoxetine hydrochloride (Prozac) and clomipramine hydrochloride (Anafranil) now offer hope for improvement in the lives of affected persons.

Suicide in the elderly: a two-year study of data from death certificates.

Data from death certificates in Kentucky in 1987 and 1988 for persons 65 years old and older were analyzed. There were 205 suicides in the 2-year study period. Suicide rates were higher for the elderly than for any other population group. White men, the group at highest risk, committed approximately 80% of the suicides in the elderly group. Suicide among minorities was rare. Self-inflicted gunshot wounds accounted for 88% of the suicides in the elderly group. Despite their high risk of suicide, elderly white men are underrepresented in terms of psychiatric admissions.

Pancreatic carcinoma in an elderly woman with an organic affective disorder and AIDS delusion.

An elderly woman with symptoms of depression and an AIDS delusion was found also to have pancreatic carcinoma. I have discussed her case in conjunction with organic affective disorder, the evaluation of depression in the elderly, and suicide in the elderly.

Psychosocial aspects of Alzheimer's disease.

November is national Alzheimer's disease month. This disorder involves not only cognitive dysfunction but also psychiatric symptoms. Alzheimer's disease places a tremendous burden on caregivers. These psychosocial factors are often the causes of institutionalization.

Suicide in the elderly.

Suicide is more common among the elderly than any other age group. Elderly white males constitute the group at highest risk for suicide in the United States. Older persons typically choose means of high lethality in suicide attempts. Previous suicide attempts, bereavement, alcohol abuse, depression, psychosis, physical illness, and social isolation are all risk factors for suicide in the elderly. Clinicians who treat this patient group should have a high index of suspicion for suicidal ideation.

Utilizing cognitive therapy on the short-term psychiatric inpatient unit.

Cognitive therapy as applied to the short-term psychiatric inpatient unit is explored. The authors provide an overview of the cognitive model and the utilization of cognitive-behavioral therapies for a variety of diagnostic categories. Adaptations of cognitive techniques to the inpatient unit are described and illustrated through case presentations.

Paranoid disorders in the elderly.

Paranoid disorders in the elderly are relatively common and represent a variety of diagnostic categories. Appropriate treatment depends on careful diagnostic assessment. Therapy of concomitant medical disorders, psychiatric medications, and psychotherapy all play a role in the management of these patients.

Axis II diagnoses in geriatric inpatients.

Little is known about personality disorders in the elderly. Review of 100 consecutive inpatient admissions revealed that 7% [corrected] received an Axis II diagnosis of personality disorder. Sixteen percent received a diagnosis of personality disorder trait.

Senile macular degeneration and psychosis.

Two cases are reported in which visual hallucinations occurred in elderly patients after the development of senile macular degeneration, a condition that causes gradual loss of visual acuity with preservation of peripheral vision. The hallucinatory experiences are interpreted as delusional explanations for pathologically altered vision, rather than as psychological or physiological consequences of sensory deprivation. Ocular pathology should be considered in the evaluation of psychotic states in the elderly.

Mania and pseudodementia.

A 73-year-old woman who was initially believed to be demented was later given the diagnosis of bipolar disorder, manic phase. Treatment with lithium carbonate resolved the mania and the apparent cognitive deficits.

Bone-conduction electrocochleography: clinical applications.

Cases are presented which show the clinical utility of recording an electrocochleographic response to bone-conducted stimuli. The procedure is fraught with problems of acoustic control and artifact generation, but has distinct although limited values in clarifying masking dilemmas in patients with bilateral hearing loss.

Round window rupture secondary to acoustic trauma.

Perilymph fistulas are a known cause of sudden hearing loss. The two cases presented illustrate round window ruptures secondary to acoustic trauma. The important considerations are early diagnosis and treatment, the possibility of associated congenital anomalies, and future protection against sound.