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Cardiac tolerability of trimipramine in the elderly
0 -3 Psychogeriatrics
6 periventricular and subcortical white matter lesions. No significant electrophysiological or cognitive differences were found between the patient groups. However, compared with controls, the whole patient group had reduced contingent negative variation (CNV) magnitudes, slower reaction times, longer P300 latencies and greater slow wave activity. These correlated well with cognit ive tests which showed a modest global cognitive impairment in all patients. Comment: The MRI results suggest that brain atrophy and white matter lesions have aetiological significance in late-onset depression. Evoked potentials and neuropsychological tests reveal an impairment in higher cerebral functioning persisting after improvement in mood which may not be mediated by structural brain abnormalities.
I0-3-31 Outcome of Depression in Elderly Patients Changed from Tricyclic and otherAntidepressants to Fluoxetine
C. McWilliam, M. Hanna. University of Keele, UnitedKingdom Since the introduction of SSRls, use of tricyclic antidepressants by General Practitioners in the elderly has fallen although many patients may be treated with sub-therapeutic doses. This study was undertaken as part of a study of 193 elderly depressed patients. 68 patients initially taking tricyclics or other antidepressants and changed to Fluoxetine were entered. Dosage. reason for discont inuation, medication and physical illness were noted. Progress was monitored using the CGI scale either at 6 months or at discontinuation. Results were collated each year to monitor any change in the first choice of antidepressant by GPs. Results show that the percentage of elderly patients on non SSRI antidepressant at referral has fallen from 70% in 1989 to about 10-1 2% currently. Only IOpatients (15%) were receiving the recommend ed therapeutic dose of tricyclic. Discontinuation was due to lack of efficacy, side effects, presence of a condition contraindicating tricyclic therapy or some combination of these factors. Only 9% of the men and 17% of the women were free of a physical illness contraindicating tricyclic therapy and only 29% of the women and 36% of the men were taking no medication which might interact with tricyclics. On completion 68% had CGI score of I & 2. 29% 3, 4 or 5 and 3% a score or 6 or 7. Patients who had the poorest outcome tended to be those with chronic physical illness such as severe arthritis, CVA etc (21%) . This study appears to confirm that sub-therapeutic dosage is common in the elderl y depre ssed many of whom may be rendered "unfit for treatment" with tricyclics by virtue of existing physical illness or drug therapy. Fluoxetine appears effective in treating depression in these patients but overall improvement as measured by CGI may be less due to the symptoms related to the associated chronic physical illness.
I0-3-4 1 Cardiac Tolerability of Trimipramine in the Elderly U. Maisch J. K. Jager J• B. Schwalb 2, W. Fischer 2. I Depts. of Neurology and InternalMedicine, AUg. Krankenhaus Ochsenzoll, Hamburg; 2 Dept. a/Clin ical Research, RhOne-Poulenc Rorer, Cologne, FRG Elderly patients (age > 65 years) frequently suffer from cardiac disorders; therefore. in the treatment of depression in this population tricyclic antidepressants are only prescribed with reservation. Preference is often given to tetracyclics or other newer antidepressant drugs, e.g. SSRI's, with a better cardiac tolerabilit y. However, the antidepressant effect of these drugs in elderly patients still requires further confirmation. Therefore, because of its receptor profile different from that of other tricyclic antidepressants, the tricyclic antidepressant trimipramine might be a valuable alternative in treating depressed elderly patients. The aim of this randomized double-blind study was to investigate the efficacy and cardiac tolerability of trimipramine (T) versus mianserine (M) in depressed elderly inpatients (> 65 years). The patients received T (100 mg/d) or M (60 mg/d) for 42 days. Efficacy was assessed weekly by the HAMD- and CGI-scales. Cardiac tolerability was assessed by ECG (every 2 weeks ) and echocardiography (Days I and 21). Fourty patients (mean age = 74 ± 6 years) with major depression or dysthymic disorder were included in the study. Regarding antidepressant efficacy no differences were noted between the two drugs (reduction in HAMD-score :
with T from 30 ± 3 to 10 ± 7 and with M from 29 ± 3 to 13 ± 8). The CGI revealed a similar trend. Based on the ECG. there were no differences between T and M. Judging by the parameters ejection fraction and fractional shortening of the echocardiogram, no deterioration was verifiable with the two drugs, even though the recorded values were in the lower normal range. Summarizing. the study results suggest that the tricyclic antidepressant trimipram ine has a good antidepressant effect in elderly patients, and is not associated with cardiac side effects. Therefore , trimipramine seems to be equivalent to tetracyclics or newer drugs. such as the SSRI's.
I0-3-51 TheDepression-Anxiety Syndrome in Dementia A. Wallin, I. Karlsson. University of Goteborg, Institute of Clinical Neuroscience, Deptof Psychiatry and Neurochemistry. Molndal, Sweden Depression in dementia has the picture of a depression-anxiety syndrome . This syndrome comprises depressed mood, anxiety, reduced self-esteem, suicidal thoughts, feelings of guilt, depressively tinged paranoid illusions, hypochondric symptoms, and increased inellectual decline. In a cross-sectional study of patients with Alzheimer' s disease (AD ; n = 105), frontal lobe dementia (FLD; n = 20), and vascular dementia (VAD; n = 50) at our department, depressed mood and anxiety were the most common symptoms of the depression-anxiety syndrome. Depressed mood or anxiety appeared in 37% of the AD patients. 39% of the FLD patients. and in 31% of the VAD patients. These findings will be discussed in relation to symptoms related to various brain regions and to cerebrospinal fluid markers for depression.
1
0-3-6 1 Effects of Electroconvulsive Therapy on Cognitive Function in Geriatric Patients withDepression
T. Ohta. Y. Morokawa, H. Watanabe, N. Yamaguchi, A. Aoba.
Department ofNeuropsychiatry, St. Marianna University School of Medicine, Japan Nineteen inpatients at SI. Marianna University Hospital with a diagnosis of major depressive disorder according to DSM-IV criteria and 8 normal volunteers (control group: CTL ) were studied to clarify the effects of electroconvulsive therapy (ECT) on various cognitive functions using cognitive function tests. Depressed patients were divided into an ECT group (N 9) and an antidepressant (ADT) group (N 10). In the immediate verbal recall and delayed verbal recall tests, numbers of words recalled were significantly lower in the ECT group than the ADT and CTL groups. The results of delayed verbal recognition were significantly lower in the ECT and ADT groups than the CTL group ; however, no significant differences between the ECT and ADT groups were found. The number of errors in the letter cancellation task was significantly higher in the ECT group than the ADT and CTL groups . Number of errors increased with number of testing sessions and returned to the baseline value 7 days after the final EeT administration. These results suggest that ECT administration impairs only some specific functions among various cognitive functions. Namely, it is possible that ECT produces transient dysfunction of retrieval in verbal memo ry and memory search ability of information processing.
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10 -3-8 1 Sleep and Psychotropic Drug Consumption: Relationships with Aging M.M. Ohayon, M. Caulet, P. Lemoine. Centre de Recherche Philippe
Pinel de Montreal, Montreat, Quebec, Canada The aging population in western countries and the increase in longevity make the problem of recognition and treatment of sleep disorders more acute in the elderly population. The risk of evolution of sleep disorders in the elderly leads to a greater weakness of their physical health, a greater dependence on their environment, and finally to more frequent recourse to institutionalization. We investigated sleep habits and psychotropic drug consumption in a representative sample of the general population of France (n 5622).
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6 periventricular and subcortical white matter lesions. No significant electrophysiological or cognitive differences were found between the patient groups. However, compared with controls, the whole patient group had reduced contingent negative variation (CNV) magnitudes, slower reaction times, longer P300 latencies and greater slow wave activity. These correlated well with cognit ive tests which showed a modest global cognitive impairment in all patients. Comment: The MRI results suggest that brain atrophy and white matter lesions have aetiological significance in late-onset depression. Evoked potentials and neuropsychological tests reveal an impairment in higher cerebral functioning persisting after improvement in mood which may not be mediated by structural brain abnormalities.
I0-3-31 Outcome of Depression in Elderly Patients Changed from Tricyclic and otherAntidepressants to Fluoxetine
C. McWilliam, M. Hanna. University of Keele, UnitedKingdom Since the introduction of SSRls, use of tricyclic antidepressants by General Practitioners in the elderly has fallen although many patients may be treated with sub-therapeutic doses. This study was undertaken as part of a study of 193 elderly depressed patients. 68 patients initially taking tricyclics or other antidepressants and changed to Fluoxetine were entered. Dosage. reason for discont inuation, medication and physical illness were noted. Progress was monitored using the CGI scale either at 6 months or at discontinuation. Results were collated each year to monitor any change in the first choice of antidepressant by GPs. Results show that the percentage of elderly patients on non SSRI antidepressant at referral has fallen from 70% in 1989 to about 10-1 2% currently. Only IOpatients (15%) were receiving the recommend ed therapeutic dose of tricyclic. Discontinuation was due to lack of efficacy, side effects, presence of a condition contraindicating tricyclic therapy or some combination of these factors. Only 9% of the men and 17% of the women were free of a physical illness contraindicating tricyclic therapy and only 29% of the women and 36% of the men were taking no medication which might interact with tricyclics. On completion 68% had CGI score of I & 2. 29% 3, 4 or 5 and 3% a score or 6 or 7. Patients who had the poorest outcome tended to be those with chronic physical illness such as severe arthritis, CVA etc (21%) . This study appears to confirm that sub-therapeutic dosage is common in the elderl y depre ssed many of whom may be rendered "unfit for treatment" with tricyclics by virtue of existing physical illness or drug therapy. Fluoxetine appears effective in treating depression in these patients but overall improvement as measured by CGI may be less due to the symptoms related to the associated chronic physical illness.
I0-3-4 1 Cardiac Tolerability of Trimipramine in the Elderly U. Maisch J. K. Jager J• B. Schwalb 2, W. Fischer 2. I Depts. of Neurology and InternalMedicine, AUg. Krankenhaus Ochsenzoll, Hamburg; 2 Dept. a/Clin ical Research, RhOne-Poulenc Rorer, Cologne, FRG Elderly patients (age > 65 years) frequently suffer from cardiac disorders; therefore. in the treatment of depression in this population tricyclic antidepressants are only prescribed with reservation. Preference is often given to tetracyclics or other newer antidepressant drugs, e.g. SSRI's, with a better cardiac tolerabilit y. However, the antidepressant effect of these drugs in elderly patients still requires further confirmation. Therefore, because of its receptor profile different from that of other tricyclic antidepressants, the tricyclic antidepressant trimipramine might be a valuable alternative in treating depressed elderly patients. The aim of this randomized double-blind study was to investigate the efficacy and cardiac tolerability of trimipramine (T) versus mianserine (M) in depressed elderly inpatients (> 65 years). The patients received T (100 mg/d) or M (60 mg/d) for 42 days. Efficacy was assessed weekly by the HAMD- and CGI-scales. Cardiac tolerability was assessed by ECG (every 2 weeks ) and echocardiography (Days I and 21). Fourty patients (mean age = 74 ± 6 years) with major depression or dysthymic disorder were included in the study. Regarding antidepressant efficacy no differences were noted between the two drugs (reduction in HAMD-score :
with T from 30 ± 3 to 10 ± 7 and with M from 29 ± 3 to 13 ± 8). The CGI revealed a similar trend. Based on the ECG. there were no differences between T and M. Judging by the parameters ejection fraction and fractional shortening of the echocardiogram, no deterioration was verifiable with the two drugs, even though the recorded values were in the lower normal range. Summarizing. the study results suggest that the tricyclic antidepressant trimipram ine has a good antidepressant effect in elderly patients, and is not associated with cardiac side effects. Therefore , trimipramine seems to be equivalent to tetracyclics or newer drugs. such as the SSRI's.
I0-3-51 TheDepression-Anxiety Syndrome in Dementia A. Wallin, I. Karlsson. University of Goteborg, Institute of Clinical Neuroscience, Deptof Psychiatry and Neurochemistry. Molndal, Sweden Depression in dementia has the picture of a depression-anxiety syndrome . This syndrome comprises depressed mood, anxiety, reduced self-esteem, suicidal thoughts, feelings of guilt, depressively tinged paranoid illusions, hypochondric symptoms, and increased inellectual decline. In a cross-sectional study of patients with Alzheimer' s disease (AD ; n = 105), frontal lobe dementia (FLD; n = 20), and vascular dementia (VAD; n = 50) at our department, depressed mood and anxiety were the most common symptoms of the depression-anxiety syndrome. Depressed mood or anxiety appeared in 37% of the AD patients. 39% of the FLD patients. and in 31% of the VAD patients. These findings will be discussed in relation to symptoms related to various brain regions and to cerebrospinal fluid markers for depression.
1
0-3-6 1 Effects of Electroconvulsive Therapy on Cognitive Function in Geriatric Patients withDepression
T. Ohta. Y. Morokawa, H. Watanabe, N. Yamaguchi, A. Aoba.
Department ofNeuropsychiatry, St. Marianna University School of Medicine, Japan Nineteen inpatients at SI. Marianna University Hospital with a diagnosis of major depressive disorder according to DSM-IV criteria and 8 normal volunteers (control group: CTL ) were studied to clarify the effects of electroconvulsive therapy (ECT) on various cognitive functions using cognitive function tests. Depressed patients were divided into an ECT group (N 9) and an antidepressant (ADT) group (N 10). In the immediate verbal recall and delayed verbal recall tests, numbers of words recalled were significantly lower in the ECT group than the ADT and CTL groups. The results of delayed verbal recognition were significantly lower in the ECT and ADT groups than the CTL group ; however, no significant differences between the ECT and ADT groups were found. The number of errors in the letter cancellation task was significantly higher in the ECT group than the ADT and CTL groups . Number of errors increased with number of testing sessions and returned to the baseline value 7 days after the final EeT administration. These results suggest that ECT administration impairs only some specific functions among various cognitive functions. Namely, it is possible that ECT produces transient dysfunction of retrieval in verbal memo ry and memory search ability of information processing.
=
=
10 -3-8 1 Sleep and Psychotropic Drug Consumption: Relationships with Aging M.M. Ohayon, M. Caulet, P. Lemoine. Centre de Recherche Philippe
Pinel de Montreal, Montreat, Quebec, Canada The aging population in western countries and the increase in longevity make the problem of recognition and treatment of sleep disorders more acute in the elderly population. The risk of evolution of sleep disorders in the elderly leads to a greater weakness of their physical health, a greater dependence on their environment, and finally to more frequent recourse to institutionalization. We investigated sleep habits and psychotropic drug consumption in a representative sample of the general population of France (n 5622).
=