Paroxetine: pharmacokinetic and antidepressant effect in the elderly.

To evaluate the pharmacokinetic properties, efficacy, and tolerability of paroxetine in elderly depressed patients, a clinical study was set up--initially at Aalborg Psychiatric Hospital in Denmark, and subsequently at the University Hospital in Linköping, Sweden. A total of 21 patients with a median age of 72 years were included in the study. After a single dose of 20 or 30 mg of paroxetine followed by two drug-free days, treatment continued with 20 or 30 mg daily for seven weeks. The majority of patients showed a continuous reduction in their HAMD scores, starting in the second week of treatment. Paroxetine was well tolerated at the doses given, and side-effects were mostly mild and transient. Steady-state, pre-dose plasma levels of paroxetine showed considerable variability, and the median steady-state concentration was higher in elderly patients compared with data from a previous study in young volunteers. Elimination half-lives also showed variability between these elderly patients, but tended to be longer after cessation of multiple dosing than after a single dose. They also tended to be longer than in the young volunteers. The results of this study do not advocate reduced doses of paroxetine in the elderly, but further studies are warranted.

Evaluation of 294 psychiatric consultations involving in-patients above 70 years of age in somatic departments in a university hospital.

The integrated geropsychiatric service of the Psychiatric Department of the University Hospital in Linköping consists of an observation ward, a day unit and an out-patient unit. One of the main tasks of the last-mentioned unit is to provide geropsychiatric consultations for in-patients in the non-psychiatric departments of the hospital. During the first 2 years from October 1982 to October 1984 300 consultations were performed. The consultations included registration of social, medical and psychiatric data, a psychiatric examination, discussions with the staff and a psychiatric report. Out of the total number of 300 consultations 294 could be evaluated completely. They comprised 247 individuals. The evaluation was performed after the first 2 years by screening the patients' psychiatric records and reports and by computer-analysis of 89 variables covering medical as well as social data. The patients' mean age was 78 years and 52% were treated in the Department of Internal Medicine. Fifty-three percent had had previous psychiatric contacts. Many were suffering from serious somatic diseases and 22% from depressive states. Only 9% showed no signs of psychiatric disorders. Twenty-three percent of the patients were transferred to the geropsychiatric observation ward or day unit and only 3% were recommended to be certified and transferred to a mental hospital. Pertinent findings are discussed in the light of international data on geropsychiatric consultations and liaison psychiatry. The study shows the importance of providing special geropsychiatric consultations for in-patients in somatic departments as a part of an integrated geropsychiatric service.