A double-blind comparison of mianserin and maprotiline in depressed medically ill elderly people.

A double-blind, randomized 4-week mianserin vs maprotiline trial was conducted in 48 depressed geriatric medical inpatients. The drug dosages were up to 90 mg of mianserin and up to 150 mg of maprotiline per day. Efficacy was measured by the Geriatric Depression Scale, the Hopkins Symptom Check List depression subscale and the Clinical Global Impression Scale. The overall dropout figure was 27% of the sample. Side effects were relatively similar in the two treatment groups and suggested a safety profile somewhat better than that of the first-generation antidepressants. Mianserin showed some advantages in efficacy over maprotiline, particularly by the 4th week of the trial, but the overall figures of treatment responders were rather small (Geriatric Depression Scale: mianserin 48%, maprotiline 30%). Clinical trials vs placebo are needed to clarify the role of antidepressant pharmacotherapy in depressed geriatric medical inpatients.

Longitudinal evaluation of psychological distress in medical geriatric in-patients.

A longitudinal evaluation of the degree and type of psychological distress was carried out in 50 geriatric medical in-patients, using the Symptom Distress Checklist. They were tested within three days of admission, after 12-15 days of hospital stay, and 20-30 days after discharge. The first two evaluations showed significantly higher distress than the third for almost all the subscales. Scores indicating a significant depressive distress decreased from 70 per cent (first evaluation) and 76 per cent (second evaluation) to 34 per cent at the third one. The number of patients with significant distress for the other SCL-90 subscales was, at the third evaluation, rather low. Our data hence seem to show that the phenomenon of psychological distress in the hospital setting is transitory, and mainly arises from the factors of 'disease' and 'hospitalization'. However, in the case of some particular aspects of psychological distress, such as depression, whilst most patients overcome it, one out of three still presents a significant degree of suffering after returning home.

[Identification and appreciation of the psychological distress in hospitalized elderly persons]. / Identification et appréciation de la souffrance psychologique chez les personnes âgées hospitalisées.

We evaluated psychological distress in a survey of 398 geriatric medical inpatients, using the Symptom Distress Check-List (SCL-90). Predominant patterns of emotional response are depression, somatization and sleep disorders. Women scored higher than men for psychological suffering on many of the SCL-90 subscales. Those who lived alone, and those who entered the hospital with a neurological disturbance, scored higher for depression than the others. We briefly discussed the need for attention to psychological reactions in this setting.

Evaluation of use patterns of psychotropic drugs in an Italian geriatric hospital.

This study is a survey of psychotropic drug use patterns among 934 elderly patients admitted to the Padua Geriatric Hospital. 34% of the patients took psychotropic drugs during their stay in hospital. The drugs most commonly used are anxiolytics and hypnotics of the benzodiazepine class. Women subjects living alone, and to a lesser extent those suffering from particular disorders, as of the central nervous system and the musculoskeletal apparatus, seem to be at higher risk in the use of psychotropic drugs. Moreover, the results show that psychotropic drugs are prescribed during the stay in hospital and even on discharge to a high percentage of subjects who did not use such drugs before admission to the hospital.