Gerda E Gomez

Depression IN THE ELDERLY

1. Depression in the elderly is a major health concern that can be life threatening if not recognized and treated. An untreated depression may result in needless suffering, institutionalization, and suicide. Lack of treatment may occur because the signs and symptoms of depression in the elderly are different from those in the young, and because depressive symptoms may be viewed by the older person, the family, and the physician as a normal part of aging. 2. Depression can occur secondarily to physical illness. Because physical illnesses occur frequently in the older population, the combination of physical illness and depression is common. 3. Through noninvasive procedures, such as positron emission tomography (PET), a greater understanding of depression will be achieved that will result in development of more specific and effective treatment. Accurate and early diagnosis and adequate treatment favor a good prognosis.

The teaching of psychomotor skills in nursing.

A model and review of current learning-teaching theories of psychomotor skill acquisition are presented with emphasis on those that may be most helpful to nurse educators involved with the practice of technical, motor skills.

Electroconvulsive Therapy: Present and Future

Electroconvulsive therapy (ECT) has been used to treat patients for 60 years. It is a humane and effective treatment. It is now firmly established as an important and effective method of treating certain severe forms of depression. Still, very little is known about its mode of action. Research in the refinement of administration has reduced undesirable side effects. There are almost no absolute contraindications to its administration. Nurses are involved directly with patients before, during, and after treatment.

The Use of Antidepressants With Elderly Patients

If we are to prevent treatment failures, we should eliminate the schism between psychosocial and biological treatments. Most depressed patients require both psychosocial and biological treatments. The patient who responds to biological treatment but does not make appropriate corrections regarding current environmental factors is at an increased risk for relapse. A strong support system can have an important preventive effect without the risks involved in long-term medication maintenance therapy. After a correct diagnosis of a major depressive disorder is made in elderly patients, the dosage of antidepressants should only be about half of the standard adult dose. Preference should be given to those antidepressants with a therapeutic profile appropriate to each particular patient. The antidepressant should have few side effects. Although antidepressant drugs are effective in treating depression, their demonstrable efficacy is surprisingly limited. Because of suicide risk and physical illnesses, older patients are more likely to require electroconvulsive therapy than younger patients. The presence of somatic delusion is a good predictor of positive response. Newer antidepressants have not been proven more effective than the older agents, such as imipramine or amitriptyline, in treating mild or severe depressions. However, they have fewer or varied side effects and therefore they are better tolerated by elderly patients (Figure 6). The consideration of side effects is a major determinant in choosing an antidepressant for a specific elderly patient. Research into the effectiveness of antidepressants has been limited by the existence of heterogeneous groups of depression and by the different therapeutic responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Los mecanismos de defensa y el misterio de la creatividad

Se presenta tres procesos mentales, internalizacion, sublimacion y compensacion, por su importancia en el desarrollo de la personalidad y su papel en la actividad creativa. En circunstancias extraordinarias, como en el caso de Beethoven, Dostoievski y Mariategui, trascienden su funcion de mecanismos de defensa en el sentido freudiano. (AU)

Psicoterapia de apoyo en el entrenamiento de psiquiatras

Como modalidad de tratamiento, la psicoterapia de apoyo es mas compleja de lo que se piensa. Demanda la integracion de una gran variedad de componentes. La psicoterapia de apoyo puede definirse como una modalidad electica integrativa. A pesar de su gran utilidad en el tratamiento de pacientes psiquiatricos y en el entrenamiento de residentes, en psiquiatria no se le estudia en forma sistematica, conceptual o empirica.(AU)

Lithium Treatment: Present and Future

1. Lithium remains unmatched for long-term effectiveness against the morbidity and mortality associated with bipolar I and II disorders. 2. Lithium is the first choice for bipolar depression. 3. Recent studies suggest that long-term lithium treatment may have mortality-lowering and anti-suicidal effects. 4. Chronic lithium, or valproate, administration has been shown to have a neuroprotective effect on rat and human cultured neurons.

The Use of Psychotropic Drugs to Treat Anxiety in the Elderly

Great care in prescribing and monitoring psychotropic medications for elderly patients must be taken because of their increased sensitivity to toxic side effects; their decreased physical resiliency, as compared to younger patients; and the risk of dependency and withdrawal when taking psychotropic medication. Psychosocial and psychotherapeutic interventions should be administered concurrently if pharmacotherapy is needed. When psychotropic medication is called for, the agent of choice should be that which results in the least amount of autonomic nervous system toxicity and sedation. Short half-life benzodiazepines in low doses are generally the best options for elderly patients in need of psychotropic medication. Unlike benzodiazepines with longer half-lives, they cause no metabolite accumulation and have a lower potential for toxicity.