Frank Miller

Unrecognized Drug Dependence in Psychiatrically Hospitalized Elderly Patients

The psychiatric in‐patient records of 90 patients ≥65 years of age were reviewed retrospectively to determine the prevalence of chemical dependence and if lack of recognition and treatment of chemical dependence resulted in serious complications. Nineteen of the 90 patients were characterized as drug dependent and ten of these patients were neither recognized nor detoxified. Seven of the ten nondetoxified patients, but only one of the nine detoxified patients, experienced serious medical complications typically requiring transfer to a medical floor or medical intensive care unit. Unrecognized chemically‐dependent patients were significantly more likely to he female benzodiazepine abusers, while recognized chemically dependent patients were significantly more likely to be male alcohol abusers.

Lithium-neuroleptic neurotoxicity is dose dependent.

Lithium-neuroleptic combination treatment was studied retrospectively. Six of 22 manic patients who were administered the combination developed neurotoxicity. The dosage of neuroleptic administered, and not the serum lithium level or lithium dose, predicted which patients became neurotoxic.

Lithium-neuroleptic neurotoxicity in the elderly bipolar patient.

The frequency and clinical characteristics of lithium- and neuroleptic-mediated neurotoxicity were determined in 10 elderly bipolar patients. When lithium was used alone and therapeutic serum lithium levels were achieved, neurotoxicity did not develop. However, when a neuroleptic was added, neurotoxicity developed in 60% (three of five) of patients and was characterized by delirium, extrapyramidal signs, and cerebellar dysfunction. Neurotoxicity occurred despite the use of neuroleptic dosages that are considered safe and useful when administered in the absence of other psychoactive drugs.

Unrecognized drug dependence and withdrawal in the elderly

The clinical diagnosis of drug abuse is frequently omitted from the differential diagnosis of transient fevers, arrhythmias and changes in mental status in the elderly despite the high risk of iatrogenic dependence in this age group. In pursuit of symptomatic relief from unrecognized depressions and from the chronic ailments of advancing age, the elderly receive many medications from numerous physicians. Therapeutic interventions are often duplicated or contradictory and result in the co-administration of tranquilizers, sedatives and analgesics. The result may be dependence which the patient and physician fail to recognize or to diagnose in the presence of withdrawal symptoms. In this report we present two such cases.

Protracted alcohol withdrawal delirium

Protracted alcohol withdrawal delirium is infrequent, but when it occurs significant morbidity can be anticipated. In this report, a case of protracted alcohol withdrawal delirium is presented. The patients course was complicated by intracerebral and subdural hemorrhages, sedative-hypnotic drug synergism resulting in respiratory compromise, the failure of benzodiazepines to prevent delirium or shorten its duration, and the onset of Wernickes encephalopathy.

Suicide Attempts Correlate with Delusional Content in Major Depression

A retrospective analysis of all medically serious suicide attempts made by 45 patients hospitalized consecutively at the Payne Whitney Clinic with the Diagnostic and Statistical Manual III discharge diagnosis of unipolar major depression recurrent with psychotic features was undertaken. Patients with delusions of persecution in combination with delusions of guilt were significantly more likely to make medically serious suicide attempts than patients with single categories of delusions or combinations other than guilt and persecution.

Comparison of TCAs and SSRIs in the Treatment of Major Depression in Hospitalized Geriatric Patients

This study compares a cohort of hospitalized geriatric patients with major depression, treated with tricyclic antidepressants (TCAs), with a cohort of patients treated with selective serotonin reuptake inhibitors (SSRIs). The groups were compared on demographic, treatment, and outcome variables. Demographically, the groups were similar and did not differ on measures of outcome or risk for side effects. We conclude that SSRIs are equal to TCAs in the treatment of major depression in hospitalized geriatric patients.