Journal of geriatric psychiatry最新文献

{"title":"Mood disorders following stroke: new findings and future directions.","authors":"R G Robinson,&nbsp;S E Starkstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Previous investigations by our group and others have demonstrated that poststroke depressions are not fully explained by the severity of associated impairment. We have consistently found, however, a strong association between development of major depression and left anterior brain injury. Recent studies have demonstrated that either left anterior cortical or subcortical lesions may lead to the development of major depression and that preexisting subcortical atrophy may play an important permissive role in the development of major depression. Patients with a mild degree of ventricular enlargement perhaps related to perinatal damage may be more likely to develop poststroke major depression following a lesion of the left frontal cortex or left basal ganglia than a patient without preexisting atrophy. Poststroke mania, on the other hand, is strongly associated with right hemisphere lesions as well as a preexisting subcortical atrophy and sometimes a family history of affective disorder. Thus, mania following brain injury may require the convergence of two factors: a right hemisphere brain injury and either a preexisting subcortical atrophy or a genetic vulnerability. PET scan findings have suggested that the biochemical response of the two hemispheres to stroke may be different. Right hemisphere stroke produces an increase in serotonin receptor binding, which is not found following comparable left hemisphere strokes. Within the left hemisphere, the lower the serotonin binding, the more severe the depression. This suggests that the right but not the left hemisphere may have an ability to increase serotonin binding in noninjured regions, producing a biochemical \"compensation\" for damage. This differential biochemical response to injury between the right and left hemisphere may partially explain why left hemisphere injury leads to depression and right hemisphere injury (in special circumstances) lead to mania. There remain, however, numerous unanswered questions and many important areas for future research. Although this area of neuropsychiatry is just beginning to develop, it is hoped that insights gained from studying mood disorders in brain-injured patients may also help to illuminate mechanisms involved in affective disorder in patients without brain injury.</p>","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiology of depression in late life.","authors":"D Blazer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In contrast to previous observations, which had indicated an increased prevalence of depressive symptoms among the elderly, recent epidemiological studies have shown a decreasing current and lifetime prevalence after age 20 or 30. The question whether depression is more or less common among older adults can best be resolved by turning to some of the core tasks of epidemiology: the identification of cases of depression, the distribution of cases in the population, and historical trends in the incidence of cases. In case identification there is agreement among clinicians on the signs and symptoms of depression, but controversy regarding depressive syndromes. The latter may be seen as forming a continuum (with little change in prevalence across the life cycle) or as including differing categories (with some, such as depressive reactions to physical illness, being more significant among the elderly). DSM-III and DSM-III-R do not capture all of the important subtypes of depression. Scepticism has been aroused over the recent finding of case distribution showing lower prevalence among the elderly because the lifetime prevalence has also been reported as lower. It is suggested here that a \"cohort effect\" may account for this finding. Recent data bearing upon historical trends suggest that the current 65- to 85-year-old group has been protected against major depression and suicide. While suicide rates do increase with advanced age in white males, current older men have lower suicide rates than previous cohorts at the same age (60 years). This may reflect better health and economic status of the current group or, perhaps, an increase of depression among younger adults now. Better case definition of depression and further epidemiological studies including consideration of cohort effects are indicated.</p>","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"35-52"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13832886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prospective payment system: DRGs and the frail elderly--issues, problems, and recommendations.","authors":"T R Prohaska,&nbsp;T Ehrenpreis","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 2","pages":"219-29"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13662239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonsuicidal mortality in late-life depression.","authors":"J Lindesay","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>While suicide is the most dramatic cause of premature death in depressed older persons, it is a rare event in old age. Most of the excess mortality associated with late-life depression is due to \"natural causes,\" especially cardiovascular illness. In the past much of the premature death related to psychiatric disorders was the result of epidemics in large, overcrowded institutions, and even today institutional factors may account for some excess mortality. A recent prospective study comparing depressed patients with nondepressed controls found that neither the initial level of physical health nor social factors explained the excess mortality, but it suggested that some of the excess is due to physical causes not readily apparent or disabling. The effects of grief, tricyclic antidepressants, chronic dysphoria, smoking and alcohol abuse, and organic brain disease are considered. Evidence suggests a complex interaction between depression and physical illness (particularly cardiovascular disease) that develops throughout life. Pursuant to these findings, some questions for future research are offered.</p>","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"53-65"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological abnormalities in late-life depression.","authors":"G S Alexopoulos","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"25-34"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13717297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiologic face of late-life depression.","authors":"J M Murphy","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"67-75"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I can't play ball anymore.","authors":"W A Myers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The case material from the treatments of four older individuals suffering from late-life depressions reveal that their conditions were precipitated by the presence of physical problems that led to an interference with long-standing athletic skills. Since the skills in question had developed in the context of a tie with an important early object, the loss of the athletic function led to a double loss, that of the object tie as well. In addition, it was seen that the tie with the original object also served as a protection for patients against the specter of the imminence of their own deaths. The loss of this protective function intensified feelings of castration and of vulnerability to death.</p>","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"121-39; discussion 141-4"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coexisting depression and dementia.","authors":"P V Rabins","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13832885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of affective illness in the elderly with drugs and electroconvulsive therapy.","authors":"M A Jenike","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Affective illness is common, frequently debilitating, and sometimes life-threatening in the elderly. Considerations pertaining to treatment with heterocyclic drugs, MAOIs, lithium, psychostimulants and thyroid hormone, as well as ECT, have been reviewed. Amitriptyline and imipramine cause significant orthostatic hypotension and probably should be avoided in the elderly. In addition, amitriptyline is extremely anticholinergic. Amoxapine is essentially a neuroleptic sequelae, including tardive dyskinesia. If a patient has had a prior positive response or has a relative who had a good outcome from a particular drug, it may be best to begin treatment with that drug. Initial choice of antidepressant can be based largely on the clinical picture. For example, if a depressed patient is sleeping much more than usual, try a potentially activating agent like desipramine or protriptyline. if, on the other hand, the patient is unable to sleep, a more sedating agent like nortriptyline, maprotiline, trimipramine, or trazodone should be tried. Risks and side effects of these drugs, as well as their use in cardiac patients, have been reviewed in detail. Many clinicians avoid MAOIs in elderly patients because of fear of adverse reactions. This fear is largely unfounded. Precautions, side effects, and specific recommendations have been outlined. Using lithium in the elderly requires special precautions because of decreased GFR and potential interactions with concomitantly used drugs. This paper has discussed possible side effects and toxicity. The usage of psychostimulants, such as methylphenidate and amphetamine, to treat medically ill depressed patients is reviewed. These agents are also sometimes useful in demented individuals or in patients with abulic frontal lobe syndromes. Poststroke depressions are common, and recent evidence indicates that they can be adequately treated. Stroke patients have many difficulties dealing with rehabilitation and should not be forced to suffer concomitant depression when we have the tools at hand to effectively treat such symptoms. Recent data on the potentiation of antidepressant effects by lithium or T3 indicate that they may be useful adjuvants in some tricyclic-resistant patients. Risks, side effects, and recent procedural advances in the use of ECT have been reviewed. Electroconvulsive therapy is both more effective and faster-acting than drugs in the treatment of depression. Many depressed elderly patients, especially those with psychotic symptoms, do not respond to drugs but improve with ECT.</p>","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"77-112; discussion 113-20"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13832887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The many faces of late-life depression.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76002,"journal":{"name":"Journal of geriatric psychiatry","volume":"22 1","pages":"1-150"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}