Biomedical subjects
Publications and source records attributed to G E Gomez.
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.
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.
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.
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)
Research now shows that schizophrenia is a disease of the brain as well as the mind and, as such, must be treated in ways other than by drugs alone. Psychopharmacology is helpful in controlling the positive symptoms, but does not eliminate aspects of the disease such as apathy and withdrawal. Studies show the structure and blood flow of the schizophrenic brain is very different from the normal brain. Families of schizophrenic individuals are forming support groups to share their feelings of suddenly being cast in the role of caregivers. Additionally, the schizophrenic individual needs to be placed in a comfortable social and vocational setting to increase the chance of improvement.
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