[Drug use on admission and discharge in a geriatric department of a psychiatric hospital]. / Het geneesmiddelengebruik bij opname en ontslag op een afdeling geriatrie van een psychiatrisch ziekenhuis.

Change in medication use was studied in patients admitted to a short-stay geriatric ward of a psychiatric hospital. One hundred ten patients were followed up until discharge from the short-stay ward, or, after transfer, until discharge from the medium-stay ward to home or to a nursing-home. Mean drug use on admission was 2.6 drugs; at discharge mean use was 2.1 drugs. Drugs most prescribed at admission were neuroleptics (41%) and benzodiazepines (39%). At discharge 15% used neuroleptics and 22% benzodiazepines. A reduction in use of cardiovascular drugs, and especially of digoxin, was found. Prescription of laxatives and vitamins, especially folic acid and vitamin B12, increased. In comparison with studies on two other geriatric wards in general hospitals in The Netherlands the most marked difference was a reduction of 17% in this study of the number of patients using benzodiazepines on discharge in contrast to an increase of 18 and 3% in the two other studies. The number of patients using neuroleptics on discharge decreased in the present study with 26%; in the two other studies respectively a decrease of 7% and a constant prescription level was found.

Lithium augmentation in geriatric depression.

In the geriatric department of a Dutch psychiatric hospital the charts of 51 patients treated with lithium in addition to cyclic antidepressants were reviewed. A response was seen in 33 patients (65%). For patients with recurrent depressive episodes, a statistical trend was found towards more responders with more complete responses, compared to patients with first depressive episodes. During lithium augmentation, 10 patients suffered from severe adverse effects 12 times. In spite of adverse effects, with expert monitoring lithium augmentation can, in our opinion, be of value in the treatment of older depressed patients.

[Lithium in the treatment of depressed elderly patients]. / Lithium bij de behandeling van depressieve bejaarden.

In the geriatric department of a Dutch psychiatric hospital the charts of 65 patients treated with lithium for depression were reviewed. We assessed efficacy and adverse effects. The sample included 65 patients, 12 men and 53 women, mean age 77 (64-91) years. A complete or partial response was seen in 30 out of 43 patients (70%) treated with lithium in addition to a cyclic antidepressant. Six out of 22 patients treated with lithium as a sole antidepressant responded completely or partially. During lithium therapy 16 patients suffered from severe adverse effects. In our view and in spite of severe adverse effects, with expert monitoring lithium can be of value in the treatment of (very) old and depressed patients.

[Profile of a geriatric department in a psychiatric hospital]. / Contouren van een Geriatrische Afdeling in een Psychiatrisch Ziekenhuis (GAPZ).

In 1967 a geriatric department was established at the psychiatric hospital 'Bloemendaal' in The Hague. It consists of two admission wards, two medium-stay wards and an out-patient department. The history, development, function and working methods are described, based on the figures of 1982. Admitted to the GAPZ: 289 patients, average age 79.4, female/male ratio 2 : 1. About 90% came from their own homes, half lived alone. Discharged from the GAPZ: 292 patients, about 50% needed long-stay psychogeriatric care. The variety and combinations of the mental and physical disorders are given. Social problems were often contributing factors, but were difficult to measure. The contacts with the geriatric services of the community mental health centers (RIAGG's), the procedures for admission and discharge and the problems of insufficient nursing-facilities for chronic patients, are discussed. The importance of the existence of a GAPZ with its out-patients facilities, is emphasized.