Jen-Ping Hwang

The efficacy and safety of olanzapine for the treatment of geriatric psychosis

Elderly psychiatric patients often present with psychotic symptoms that need antipsychotic treatment. Olanzapine is one of the atypical antipsychotics with efficacy for psychotic symptoms and a safer side-effect profile than typical antipsychotics. This study was conducted to assess the efficacy and safety of olanzapine for treatment of geriatric psychosis. The sample population comprised 94 acute-ward patients who were 65 years of age or older. Clinical assessment was conducted at baseline and also at 4 weeks after commencement of olanzapine treatment, with use of the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Improvement (CGI-I) instruments. A 4-week therapeutic evaluation was completed for 80 patients, 73 of whom (91.3%) experienced mild to substantial improvement as determined from the CGI-I. A mean 52.6% reduction from baseline was also determined from the BPRS. The mean daily dosage of olanzapine in the fourth week was 10.1 ± 5.3 mg/d (range, 2.5–20.0). Higher olanzapine dosages were administered for patients with functional psychoses than for an analogous group with organic mental disorders. Adverse effects were monitored for all 94 patients, the most common of which were somnolence (18.1%), dizziness (18.1%), and weakness of legs or bradykinesia (16.0%). Body weight and fasting triglyceride and sugar levels were significantly elevated after olanzapine treatment (2.2, 39.9, and 8.9% from baseline, respectively). It seems reasonable to suggest that olanzapine is efficacious for geriatric patients with psychosis and that the dosage should be diagnosis-dependent.

Physical aggression and associated factors in probable Alzheimer disease

Summary:Aggressive behavior is thought to be pervasive among and devastating to demented patients and their caregivers. This study investigated the prevalence of physical aggression in demented inpatients with Alzheimer disease (AD). Additionally, the characteristics and psychiatric symptoms that may be associated with aggression were tested. Forty-seven patients with probable AD were included in this study. Physical aggression was reported in 27 (57.4%) of the patients. These patients were older, had a later onset of dementia, and had a higher prevalence of misidentification, activity disturbances, and day/ night disturbance. The relationship between these factors and physical aggression needs further clarification, which may help provide effective predictors and treatment of the aggressive behavior.

Severe cardiovascular side effects of olanzapine in an elderly patient: case report.

Olanzapine, an atypical antipsychotic, is often regarded as a safe choice for psychosis management [1]. We hereby report an aged case that presented with conscious depression, bradycardia, hypotension, miosis and hypothermia. Olanzapine was thought to be the offending agent. His condition improved with supportive therapy.

The efficacy and safety of risperidone for the treatment of geriatric psychosis.

Risperidone is an atypical antipsychotic drug which has been suggested to be beneficial for the treatment of elderly patients with psychotic symptoms. In this study, we assessed the short-term efficacy and the safety of risperidone in geropsychiatric inpatients with psychotic symptoms. The sample population included 110 elderly inpatients with psychotic disorders. Assessment for drug efficacy using the Brief Psychiatric Rating Scale, Sandoz Clinical Assessment-Geriatric scale, and Clinical Global Impression scale was conducted at baseline and also at 4 weeks subsequent to risperidone treatment commencement. Subsequent to commencing risperidone treatment, 80 patients completed a 4-week therapeutic evaluation. Seventy (87.5%) of the 80 patients experienced mild to substantial improvement using the Clinical Global Impression scale. Adverse effects were monitored in all 110 patients. The most commonly detected adverse effects were weakness of legs or walking problems (43/110; 39.1%) and dizziness (32/110; 29.1%). Peripheral edema was noted in 18 (16.4%) patients. Risperidone, in low doses, appeared to have been effective in this sample of patients older than 65 years with psychotic symptoms. The mean dose (2.1 ± SD 1.4 mg/day) applied was lower then that suggested for young patients and was related to the each specific patient diagnosis. Peripheral edema and walking problems were commonly observed adverse effects for these elderly patients, such problems having not been seen to the same extent in previous studies of young patients.

Repetitive Phenomena in Dementia

Objective: Both repetitive talk and behaviors (repetitive phenomena) are common in demented patients and are bothersome to their caregivers and families. The purpose of this preliminary report was to explore these repetitive phenomena in demented patients admitted to a geropsychiatric ward. Method: The sample population consisted of 141 demented patients. Patients caregivers were asked if patients had presented a repetitive fixed pattern of physical action or talk since the onset of dementia. Results: Of the 141 demented patients included in the study, seventy-nine had repetitive phenomena. Patients with these phenomena had various presentations and developed them in the early stage of dementia. Conclusions: Repetitive phenomena are widespread in dementia, especially for older patients, and may be an early sign of dementia. The characteristics of repetitive phenomena and some likely underlying mechanisms are discussed.

The Clinical Applications of Mini-Mental State Examination in Geropsychiatric Inpatients

Objective: This study investigated the association between Mini-Mental State Examination (MMSE) scores and diagnosis, computerized tomographic scans or electroencephalogram findings in geropsychiatric inpatients (age 65). Method: We analyzed the MMSE records of patients sixty-five and older who had been hospitalized in our psychiatric ward during a nine-year period. Case data were collected by review of chart records. Results: In these patients, MMSE scores were significantly different among the seven diagnostic groups included. Demented patients had the lowest MMSE scores. Patients who had abnormal findings on computerized tomographic scans or electroencephalogram had lower MMSE than patients with normal findings. Conclusion: Our findings suggest that the MMSE is a useful screening instrument for organicity in the geropsychiatric inpatients. However, because of the lower average MMSE score in geropsychiatric inpatients, the optimal cut-off point of MMSE for dementia should be lower than those used in other populations.

Mortality in Geriatric Psychiatric Inpatients

Objective: This study investigated the deaths of patients sixty-five and older on a psychiatric ward to determine the mortality rate, the characteristics of illness, and the cause of death. Methods: We analyzed the case record of patients sixty-five and older who had died during hospitalization on a psychiatric ward during a seventeen-year period. Case data was collected by review of chart records. Results: The mortality rate in the patients sixty-five and older was 18/1208 (1.5%). Eight of these eighteen patients died of pneumonia. Mortality in the acutely ill geropsychiatric inpatients was difficult to predict. Age, sex, and diagnosis did not predict mortality. Conclusions: To reduce mortality, especially in male veterans, management of geropsychiatric patients should include early recognition of pneumonia symptoms, especially for patients with history of pulmonary disease.

TYPES AND PHENOMENOLOGIC SUBTYPES OF DEMENTIA IN TAIWAN: A PSYCHIATRIC INPATIENT STUDY

An investigation of 91 consecutive psychiatric inpatients with suspected dementia was designed to evaluate the relative frequency of different types and phenomenologic subtypes of dementia in Taiwan. The type of dementia was reviewed to determine different aetiologies. Phenomenologic subtypes of dementia were investigated according to the classifications of theDiagnostic and Statistical Manual of Mental Disorders. In contrast to previous studies in Taiwan, dementia of the Alzheimers type (59.3%) was more frequent than vascular dementia (26.4%). The relative frequencies of phenomenologic subtypes were as follows; uncomplicated, 43%; with delusion, 38%; with delirium, 14%; with depression, 5%. This is the first report regarding the clinical subtypes of psychiatric demented inpatients in Taiwan. In spite of correct aetiological diagnosis of dementia, this report highlights the non‐cognitive problems of dementia.