St. John's wort and antidepressant drug interactions in the elderly.

There is increasing interest in and use of the herbal preparation St. John's wort. Hypericin, the major active ingredient, has many psychoactive properties. The agent is sold in the US as a nutritional supplement and is recommended for numerous conditions, including depression, anxiety, insomnia, and inflammation. We report a series of five cases of clinically diagnosed central serotonergic syndrome among elderly patients who combined prescription antidepressants with St. John's wort. Older adults are large consumers of both over-the-counter and prescription medications. They are particularly vulnerable to interactions between medications and products sold as nutritional or herbal supplements. St. John's wort requires further evaluation due to potential for drug interactions with central nervous system agents and for more definitive therapeutic indications.

The Wellness Group: a novel intervention for coping with disruptive behavior among [corrected] elderly nursing home residents.

Elderly nursing home residents face the challenge of coping with the loss of independence, reduced physical abilities, feelings of isolation, anxiety, depression, and helplessness. Maintaining one's integrity within the nursing home is a challenge easily lost. Issues of coping with disability, change in body image, the promotion of self-empowerment, and autonomy are critical to preserving the personhood of a nursing home resident. Current emphasis on the management of behavior has focused entirely on the control of disruption rather than the promotion of resident strengths and abilities. We developed a group therapy program designed to enhance self-awareness, self-esteem, and body awareness among the demented elderly. Techniques of meditation, relaxation, sensory awareness and guided imagery were introduced and reinforced. This group is easily reproducible and offers benefits to both residents and interdisciplinary staff.

A ten-year review of the effect of OBRA-87 on psychotropic prescribing practices in an academic nursing home.

OBJECTIVE: The Omnibus Budget Reconciliation Act of 1987 (OBRA-87) included provisions for regulating the use of psychotropic medication, particularly antipsychotics, in long-term-care facilities. The study examined the effect of OBRA-87 on patterns of prescribing of psychotropic medication in a 514-bed nursing home affiliated with a large medical school. METHODS: Computerized pharmacy records for the ten-year period from March 1984 through July 1994 were retrospectively reviewed to identify orders written for psychotropic medications and to determine the percentage of nursing home residents who received prescriptions for those agents and the average daily dose of the most frequently prescribed agents. RESULTS: During the period before implementation of the regulations, the percentages of residents who received antidepressants, anxiolytic and sedative-hypnotic medications, and antipsychotic medications were stable. After implementation, prescription of antidepressants increased significantly, coinciding with a reduction in prescription of anxiolytics and sedative-hypnotics and a substantial decrease in prescription of antipsychotics. The total number of residents who received any type of psychotropic medication decreased, and over time a trend toward prescription of agents recommended for geriatric use, such as short-acting benzodiazepines and tertiary tricyclic antidepressants, emerged. CONCLUSIONS: The changes that resulted from the OBRA-87 regulations reffect both the restrictions placed on classes of medication and the prevalence of psychiatric disorders in the nursing home. In this facility, OBRA-87 appears to have served as an impetus for clinical review and change in practice style.

Treatment of impulsivity and aggression in a patient with vascular dementia.

This case illustrates how treatment with divalproex sodium, an agent approved for use as an anticonvulsant and mood stabilizer, led to a reduction in overt aggression, diminished impulsivity, and improved functional status in a patient with vascular dementia. Improved receptivity to care and reduced hostility also led to an increased quality of life for the family caregivers. The daughter also benefited greatly from participation in a family support group.