Biomedical subjects
S E Goldstein
Publications and source records attributed to S E Goldstein.
Grandparents and their children.
Old age brings about radical changes in the relationship between the elderly and their children. The latter are part of the "sandwich generation." At a time when their own children are making increasing emotional, physical and financial demands, they must cope with the increased dependence of their parents. The alteration in the equilibrium of needs between the various generations leads to difficulties for which those involved are rarely prepared. To be truly helpful, the geriatrician or gerontologist must be cognizant of the changes in family dynamics.
Nomifensine in the treatment of depressed geriatric patients.
In a randomized double-blind study, the efficacy and safety of nomifensine and amitriptyline were compared in 33 geriatric patients with endogenous and reactive depression. Significant improvement was noted over the 4-week study period for all groups on the Clinical Global Impression, Hamilton, and Plutchik rating scales. There was significantly more improvement among the patients with reactive depression treated with nomifensine and among the patients with endogenous depression treated with amitriptyline, as assessed by the Plutchik Geriatric Rating Scale.
Social issues in geriatric psychiatry.
In the past decade significant advances have been made in caring for the emotional problems of the elderly. The evolution of the multidisciplinary team and easier access to health care play important roles. Of seminal importance is the emergence of the psychogeriatrician and the establishment of psychogeriatric units. Treatment of the elderly should extend beyond the confines of the hospital to include families, community agencies and community resources.
Pre-menstrual tension and mood change.
Pre-menstrual tension has been studied intensively for many years. A review of relevant literature was undertaken to try to clarify the admixture of fact and fiction which has accumulated. The bulk of research noted has been done using self-reporting scales of physiological and psychological discomfort. This research has been criticized on methodological grounds. There seems little question that mood changes do occur during the menstrual cycle. It would appear that, irrespective of personality factors and psychopatholoy, such changes can be correlated with levels of progesterone and estrogen. Gonadal hormones affect cerebral MAO levels and catecholamine metabolism. High levels of estrogen have been related to increased feelings of well-being and low levels of depression. Studies have attempted to explain differences in menstrual mood changes to the psychological impact this process may have. While this cannot be discounted, it is likely that there is an interaction between psychological and physiological factors. Clarification of this is an important challenge for future research.
The psychogeriatrician in the community.
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Depression in the elderly.
Depression in the elderly is difficult to classify and may be more of a symptom than a disease entity. The core problem with the elderly is inability to handle multiple losses. Feelings of helplessness and reduced self-esteem are significant. The resultant depression often appears mild but the risk of suicide cannot be ignored. The family physician is the key person in the diagnosis of depression. The close relationship between physical factors and depression may make differentiation difficult. Treatment involves a sympathetic but firm approach, particularly when dealing with the hypochondriacal patient. Regression in the elderly is a serious problem that requires staff teamwork. Reactivation techniques which combat feelings of helplessness and hopelessness are of particular importance. When the patient no longer responds well to appropriate drugs, electroconvulsive treatment may be of value. Family and marital therapy should not be overlooked. The nihilist has no place in geriatric medicine.
Nylidrin HCL in the treatment of symptoms of the aged: a double-blind placebo controlled study.
This study was designed to assess the effectiveness and the safety of nylidrin HCL in the geriatric patient and mild to moderate symptoms of cognitive, emotional and physical impairment. Following a 3 week placebo washout, 60 patients received either nylidrin HCL or placebo for 12 weeks. Efficacy evaluations were made utilizing the Sandoz Clinical Assessment Geriatric (SCAG) Scale, a nurse's rating of ward behavior (SCASNO), the Hamilton Psychiatric Rating Scale for Depression, and 2 of the Katz Adjustment Scales. Significant improvement in symptom severity was demonstrated in the nylidrin group as compared to the placebo group. There were no abnormalities of clinical significance in the safety measurements and few side effects were reported.
Comparison of oxazepam, flurazepam and chloral hydrate as hypnotic sedatives in geriatric patients.
In a four-week study, a comparison was made of oxazepam, flurazepam and chloral hydrate as hypnotic sedatives in 17 geriatric patients. Each drug was given alone for six nights, with a two-night placebo interval following each phase. Each patient completed an additional placebo phase (up to six nights) before each drug phase. The number of awakenings per night and the sleep latency (time required to fall asleep) were determined from the patients' reports and from the reports of a nurse-observer. Only for oxazepam was the number of patient-reported awakenings per night significantly less than for placebo, although with both oxazepam and flurazepam the awakenings were fewer than with chloral hydrate. According to the patient-reports, sleep latency was significantly lower with flurazepam than with placebo; for oxazepam and chloral hydrate the latencies were not significantly different from those for flurazepam or placebo. Only for oxazepam were the patients' ratings of sleep quality significantly greater than for placebo. The objective assessment of sleep by the nurse-observer usually confirmed the patients' assessments. Morning drowsiness was the most common side effect, reported equally for placebo and for the active drugs. Drowsiness during the day was reported less frequently for oxazepam than for flurazepam, chloral hydrate or placebo. It is concluded that oxazepam is safe and efficacious for the short-term management of insomnia in the elderly.
Evolution of an active psychogeriatric day hospital.
A geriatric day hospital was established as part of the psychogeriatric unit of the Royal Ottawa Hospital. While initially this day hospital was integrated with day hospital programs of other units, it became apparent that a separate facility was desirable. The activities and programs of the psychogeriatric day hospital, run by one registered nurse, were integrated with those of the geriatric inpatient unit. It was found to be advantageous for inpatients and day hospital patients to share the same physical facilities. The majority of day hospital patients came from the inpatient unit; almost all had affective disorders. The emphasis was on reintegration into the community. During the 1st year of operation there were 75 patients in the program; only 3 needed admission to the inpatient unit and 1 was readmitted after discharge.
Piperacetazine versus thioridazine in the treatment of organic brain disease: a controlled double-blind study.
In a double-blind cross-over study, 50 geriatric patients with organic brain disease were divided into two groups. One group first received piperacetazine for 15 days and then thioridazine for 15 days. For the other group the sequence was reversed. Piperacetazine proved to be at least as effective as thioridazine and seemed to be more effective against certain target symptoms; side effects were less common and less severe.
Hypochondriasis and the elderly.
Hypochondriasis is poorly understood and poorly treated. Attempts to classify it have been unsatisfactory except for Pilowsky's division into primary and secondary groups. Twenty consecutive cases of hypochondriasis in elderly patients were studied; 4 were of the primary type and 16 of the secondary type. For the primary group, neither family therapy nor hospitalization was needed, and the prognosis was good. In contrast, hospitalization was always advised for the secondary group, and such patients improved while in the hospital. Psychotropic drugs, a therapeutic milieu, and often electroshock therapy were needed to treat depression. After discharge, successful treatment necessitated Day Care programs and the long-term use of family therapy. Treatment was unsuccessful in 8 patients characterized by refusal to become involved in post-discharge Day Care programs and family therapy.
Psychiatric needs of geriatric patients.
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The use of mesoridazine in geriatrics.
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Community liaison with a mental hospital.
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