A comparative study of conventional and controlled-release formulations of trazodone in elderly depressed patients.

One hundred sixty-six elderly depressed patients were recruited from six hospital centers and entered in a double-blind, randomized, parallel group comparative study of conventional and controlled-release formulations of trazodone. Patients received a single nighttime dose of 100 mg for 1 week, followed by 3 weeks of 200 mg or less, depending upon tolerance. Efficacy was measured using the modified Hamilton depression rating scale and global assessments of the severity of depression and improvement relative to baseline. Both treatments were equally effective with 39 (68%) patients completing 4 weeks of treatment with the conventional formulation and 41 (77%) patients completing 4 weeks treatment with the controlled-release formulation rated as very much improved. Sleep improved shortly after initiation of treatment in most patients and there were no significant differences between groups. There was a tendency for fewer side effects to be recorded during the first week of treatment in patients receiving the controlled-release formulation but no difference reached statistical significance.

Hypomagnesium in the elderly.

The range of plasma concentrations in 177 and erythrocyte magnesium concentrations in 104 elderly patients was found to be similar to that for healthy adults. No significant difference was observed between the sexes or between patients taking diuretics and those not receiving diuretic therapy. The latter finding is contrary to some previously reported studies.

Hyponatraemia in the elderly.

A study of hyponatraemia in the in-patients of a Geriatric Department during a 10-month period showed that 77 patients (11.3%) had plasma sodium concentrations below 130 mmol/l. Thirty-one patients (4.5%) had severe hyponatraemia of less than 125 mmol/l. Seventy-three per cent of hyponatraemias were iatrogenic caused by diuretic or intravenous fluid therapy. Hydrochlorothiazide/amiloride combination has the greatest tendency to produce hyponatraemia compared to all other diuretics (P less than 0.01). Clinical features attributable to hyponatraemia were present in 61%. Nine patients needed hospital admission solely due to hyponatraemia. The mortality rate for hyponatraemia was twice the overall rate for the unit.

Euthyroid "thyroxine toxicosis".

A survey was made of thyroid function tests on 1,153 patients screened for thyroid disease during a two-year period in a Geriatric Department; 13 percent of the test results fell outside the normal range. Of 88 patients who showed above-normal results, only 12 presented with clinical features of thyrotoxicosis. In 37 patients, the biochemical findings indicated euthyroid "thyroxine toxicosis"; high values were found for serum thyroxine (T4) and the free thyroxine index (FT4I) but there were no clinical signs or symptoms of thyrotoxicosis; the values reverted to normal within one to three weeks. This pattern was seen also in 7 examples of T4-treated hypothyroidism. (Overall, the test findings indicated 61 cases of hypothyroidism.) The significance of this transient increase in T4 and FT4I values is discussed. The false positive results suggest that, when laboratory findings are not compatible with the clinical signs, the thyroid function tests should be repeated after another two weeks.

d-Amphetamine in elderly patients refractory to rehabilitation procedures.

This report concerns the use of d-amphetamine in 88 elderly inpatients who initially failed to respond to rehabilitation procedures. These patients exhibited characteristics of the Poor Motivation Syndrome (PMS), not associated with depression or dementia. The syndrome was seen five times more frequently in women. d-Amphetamine was given for three weeks in increasing dosage (2.5--10.0 mg twice daily). The responses were scored according to mobility, self-care and motivation. Of the 88 patients, 48 improved and another 28 were discharged who would otherwise have remained dependent nursing cases. An unexpected finding was that 17 patients showed an age-related resistance to the effects of the drug (P less than 0.05). The likelihood of a beneficial response also diminished with increasing age (P less than 0.01). Side effects were in the psychiatric sphere; they occurred in 23 patients early in treatment and were not age-related; the drug was withdrawn. Thus treatment with d-amphetamine should be restricted to selected patients who satisfy the diagnostic criteria of PMS, and administration should be carefully supervised. With these safeguards, a substantial proportion of patients previously refractory to rehabilitation will show improvement, become more independent and may be discharged from the hospital in a much more active, less dependent state of mine and body.

Cardiac effects of carotid sinus massage in old age.

The effects of carotid sinus massage in aged subjects with a high incidence of arteriosclerosis are described. In 71 men and 315 women tested, a slowing of more than 10 per cent of the heart rate was found in 25 per cent of the men and 19 per cent of the women, which is not of statistical significance in relation to sex. Only men showed a significant increase with age and the women had a significant preponderance of a right-sided response. The technique was found to be safe, although a review of reported side-effects suggests care is advisable and carotid compression must not occur. The findings are discussed in relation to those reported in younger subjects and in carotid sinus syndrome with syncope. The fact that men have an acquired increase in response in old age, which is not seen in women, may be a factor of importance in the explanation of why carotid sinus syncope is almost always seen in men. Carotid sinus sensitivity appears to diminish in old age and some of the ageing factors which might influence the carotid sinus reflex are examined.

Diogenes syndrome. A clinical study of gross neglect in old age.

A study of elderly patients (fourteen men, sixteen women) who were admitted to hospital with acute illness and extreme self-neglect revealed common features which might be called Diogenes syndrome. All had dirty, untidy homes and a filthy personal appearance about which they showed no shame. Hoarding of rubbish (syllogomania) was sometimes seen. All except two lived alone, but poverty and poor housing standards were not a serious problem. All were known to the social-services departments and a third had persistently refused offers of help. An acute presentation with falls or collapse was common, and several physical diagnoses could be made. Multiple deficiency states were found--including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium. The mortality, especially for women, was high (46%); most of the survivors responded well and were discharged. Half showed no evidence of psychiatric disorder and possessed higher than average intelligence. Many had led successful professional and business lives, with good family backgrounds and upbringing. Personality characteristics showed them to tend to be aloff, suspicious, emotionally labile, aggressive, group-dependent, and reality-distorting individuals. It is suggested that this syndrome may be a reaction late in life to stress in a certain type of personality.