Fabrizio Schifano

Depression in Geriatric and Adult Medical Inpatients.

The authors administered two scales for the evaluation of depression, the Zung SDS and the DFS (Depression Factor Score), derived from the SCL-90, to two groups of medical inpatients: One composed of adult subjects (N = 201) and the other of geriatric subjects (N = 178). The results confirm a high presence of depressive symptoms among patients with medical problems, particularly among geriatric subjects; the prevalence of depression was 20.39% for the adults and 42.13% for the elderly patients. High indices of correlation between the two scales were found for both populations. A multiple regression analysis indicated that the factors most predictive of depressive symptoms are female sex and the presence of somatic symptoms likely to lead to disability for elderly subjects and low social class and female sex for adults.

Lithium alone or in combination with carbamazepine for the treatment of rapid-cycling bipolar affective disorder

The authors retrospectively examined the clinical outcome (after 1,2 and 5 years of beginning the therapeutic protocols) for 16 rapid‐cycling bipolar affective disorder patients given either lithium alone or lithium plus carbamazepine. The results suggest that both therapeutic protocols have been safe and clinically effective. However, improvement was observed earlier in the patients given lithium and carbamazepine.

Pain as a symptom in elderly depressed patients

SummaryThe presence of pain as a symptom has been studied in a series of 51 depressed elderly inpatients and in a control group of 71 subjects. The frequency of patients with moderate to severe pain was significantly higher in the experimental group (72%) than in the controls (33.8%). Of the various categories diagnosed according to the DSM III° criteria, the highest scores for pain were gained by the subjects suffering from dysthymic disorder and atypical depression, while those obtained by the patients with major depression and adjustment disorder with depressive mood were lower. The difference does not seem to depend on the quantity of anxiety present.

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.

Psychological distress in geriatric and adult medical in-patients

Psychological distress was evaluated in two groups of medical in-patients, one composed of geriatric subjects (178), the other of adults (201). The instrument used for this purpose was the SCL-90. The predominant pattern of emotional response among the geriatric patients was depression; although this pattern was also present among the adult patients, reactions of an anxious type were more common in these subjects. Women of both groups of patients scored significantly higher than men on many of the subscales of the SCL-90. No significant differences emerged in relation to the type of organic disease among the adult patients, while among the geriatric patients, subjects with disorders of the CNS, muscular-skeletal system and blood scored significantly higher than those with other diseases.

Results of dexamethasone suppression test in early Alzheimer dementia.

SummaryThe frequency of an abnormal response to the Dexamethasone Suppression Test (DST) was examined in 24 non-depressed patients in the early stages of Alzheimer dementia. Results were compared with those obtained in 51 geriatric medical inpatients: 15 with major depression, 18 with dysthymic disorder and 18 normal controls. As an abnormal lack of suppression was found in 9 demented patients, in 9 with major depression, 1 with dysthymic disorder and in 2 the normal controls, it appears that DST alone is not useful in distinguishing dementia, even in its early stages, from major depression. In our experience abnormal DST results in demented patients were unrelated to mood.

The dexamethasone suppression test in depressed and non-depressed geriatric medical inpatients

ABSTRACT— The frequency of an abnormal response to the dexamethasone suppression test (DST) was examined in 38 geriatric patients hospitalized for medical illnesses and affected by depressive disorders diagnosed according to the DSM III, and in 18 medical patients (used as controls) hospitalized in the same ward. Only 11% of the controls and 11% of those affected by dysthymic disorder had an abnormal DST vs 73% of the patients with major depressive disorder (MDD). The sensitivity of the DST for MDD, in this particular setting, was found to be about 73% and the specificity 89%. The importance of this clinical adjunct in diagnosing the severe depressive disorders is discussed.

Use of Psychotropic Drugs in General Medical Geriatric Inpatients

The authors have evaluated the psychotropic drug use patterns and psychological distress (with the Symptom Distress Checklist, SCL-90) amongst 331 elderly medical inpatients. Forty-two percent of the

Pharmacological Treatment of Suicidal Behavior

One of the most important problems the clinician has to cope with is the prevention of suicide. In fact, about half of the people who commit suicide have seen a doctor in the few weeks prior to their death and often use prescribed medications to end their lives (Barraclough et al. 1974). It has been suggested that physicians see at least six seriously suicidal patients each year, but only one is detected, since the psychiatric diagnosis has been overlooked or the illness undertreated (Murphy, 1972; Oyehagen, 199 1). Given the frequency with which psychotropic drugs are prescribed (mostly by general practitioners and not by specialists) in this therapeutic area, it seems worthwhile to review the pharmacological strategies aimed at preventing suicidal behavior.