Robert F. Prien

Treatment of mixed mania

Mixed mania (i.e., a manic syndrome accompanied by depressive symptoms) and its response to long-term preventive drug treatment was studied as part of a larger NIMH collaborative study. Following recovery from a manic episode, patients received either lithium, imipramine, or the combination of lithium and imipramine for a 2-year period. It was found that patients who had recovered from a mixed manic state were at significantly higher risk for recurrences than patients who had recovered from a pure (non-mixed) manic state. Lithium and the combination of lithium and imipramine were highly effective preventive treatments for the pure manic group and poor treatments for the mixed group. Imipramine was ineffective for both the pure and mixed groups. The need for identifying mixed mania in therapeutic trials and in evaluating alternative treatments for lithium with this subgroup is discussed.

Pharmacologic treatment of elderly patients with organic brain syndrome: A survey of twelve veterans administration hospitals

RGANIC BRAIN SYDROME is one of the most prevalent mental disorders in the United States, affecting an estimated 5%15% of individuals 65 years of age and over.lP3 It is also one of the most difficult disorders to treat. The basic symptoms of organic brain syndrome (memory deficit, disorientation, and impaired intellectual functioning) may be accompanied by a variety of secondary psychiatric disturbances such as depression, anxiety, agitation, withdrawal, and paranoid reactions. These secondary disturbances may be more prominant and disabling than the brain syndrome itself. The treatment of organic brain syndrome is futher complicated by the fact that elderly individuals with this disorder tend to have a high incidence of physical ailments. Thus patients with organic brain syndrome may receive a multiplicity of drugs for a multiplicity of disorders. Despite the prevalence of organic brain syndrome and the wide range of drugs used to treat the disorder, psychopharmacological research in this area has been relatively neglected. Most medications used to treat organic brain syndrome and other psychiatric disorders in the elderly have been evaluated primarily with younger subjects who are less prone to side effects and may have different dosage requirements than their elderly counterparts. Thus guidelines must often be modified for the aged through clinical intuition or trial and error. Chemotherapeutic research in organic brain syndrome is hampered by several problems. One problem is the lack of valid rating scales specifically designed for this disorder. Another is the absence of diagnostic precision, particularly in differentiating organic brain syndrome from the so-called “functional disorders” (e.g. primary depression and schizophrenia). A third problem, and the one to which this report is directed, is the absence of adequate survey data on the use of drugs in organic brain syndrome. Apart from the few surveys of nursing home populations, there is little information on the drug prescription practices actually employed in the treatment of organic brain syndrome. This makes it difficult to evaluate the appropriateness of chemotherapeutic programs or even define areas that require evaluation. To obtain information on the use of drugs in organic brain syndrome and other disorders in elderly patients, the Central Neuropsychiatric Research Laboratory of the Veterans Administration conducted a survey of all patients 60 years of age