Pharmacologic treatment of noncognitive behavioral disturbances in elderly demented patients

Article Abstract:

The efficacy of drug therapy for the symptoms of dementia in 59 elderly patients was evaluated. The subjects consisted of 35 men and 24 women who were residents of a long-term nursing facility who met the Diagnostic and Statistical Manual of Mental Disorder, third edition criteria for dementia. Each patient was evaluated and scored using a Clinical Dementia Rating Scale. The drugs that were administered to these patients for an eight-week period were haloperidol, a neuroleptic; oxazepam, a benzodiazepine; and diphenhydramine, a nonbenzodiazepine sedative-hypnotic. The relative efficacy for relief of the symptoms of agitation, along with the prevalence and severity of side effects, was evaluated in these patients. Thirty-seven patients did not have a systemic, neurological, or psychiatric disorder that accounted for their dementia; the known disorders among the other patients included Korsakoff's syndrome, stroke, and depression; no control group was used. After the first two weeks, five patients were withdrawn from the study; two patients were noncompliant; one patient died from causes unrelated to the drug treatment; these patients were excluded from the analysis of the data. Overall, a modest effect on the relief of the symptoms of behavioral agitation was observed at eight weeks. Haloperidol and diphenhydramine were more effective than oxazepam, but the differences were not statistically significant. The side effects that were observed were comparable for all three drugs. It was concluded that severely demented patients may receive short-term relief of symptoms with these drugs. However, the relative long-term effects have yet to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Drug therapy

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Affective and impulsive personality disorder traits in the relatives of patients with borderline personality disorder

Article Abstract:

Some researchers have hypothesized that borderline personality disorder, marked by affective instability and impulsivity, is linked to a familial history of affective disorder (mood disorder, such as depression or bipolar disorder). However, more recent research suggests that this is only true if the patient with borderline personality disorder also suffers from an affective disorder. Borderline personality disorder and related traits seem to aggregate within families. In the present study, family interviews were used to obtain family history information for 64 patients with personality disorders. Patients completed several scales for personality assessment and data were compared with data from 43 schizophrenics and their families. Of the 64 patients with personality disorders, 29 were diagnosed with borderline personality disorder and 22 had other personality disorders, but possessed three or fewer traits of borderline personality disorder. In all, 129 relatives of borderline personality disorder patients were interviewed, along with 105 relatives of those with other personality disorders and 218 relatives of schizophrenics. Statistical analysis showed that the risks for affective and impulsive personality traits were greatest for family members of those with borderline personality disorder. This suggests that there may be familial transmission of borderline personality disorder characteristics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Disease transmission, Family, Affective disorders, Mood disorders, Psychotherapy patients, Impulsive personality, Impulse control disorders, Personality, Personality (Psychology), Borderline personality disorder

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Dementia with coexistent major depression

Article Abstract:

Dementia is a common problem among the elderly; it is characterized by impaired memory and cognitive (mental) deficits. As many as 50 percent of dementia patients have intermittent depression, and a smaller proportion suffer from sustained depression. Since depression can involve some cognitive dysfunction, it can add to the confusion caused by dementia and increase the disability of the elderly patient. The incidence of major depression among 232 dementia patients was 11 percent. This study compared three groups of elderly subjects hospitalized for psychiatric problems: 33 with major depression, 10 with dementia and major depression, and 10 with dementia only. All subjects were evaluated for degree of depression and cognition/memory function before and after treatment with antidepressant medications. The patients who responded to antidepressants made up 70 percent (7 out of 10) of the dementia/depression group and 73 percent (24 out of 33) of the depression group. The symptoms of depression in these two groups were similar. The presence of depression in demented patients appeared to further impair their cognitive test performance, and antidepressant therapy improved performance, although scores still indicated dementia. In conclusion, depression in these demented patients was treatable, but successful outcome typically required a determined, aggressive approach.

Research, Antidepressants, Depression in old age, Geriatric depression

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