Psychotherapeutic treatments for older depressed people.

BACKGROUND: Despite a number of reviews advocating psychotherapy for the treatment of depression, there is relatively little evidence based on randomised controlled trials that specifically examines its efficacy in older people. OBJECTIVES: To examine the efficacy of psychotherapeutic treatments for depression in older people. SEARCH STRATEGY: CCDANCTR-Studies and CCDANCTR-References were searched on 11/9/2006. The International Journal of Geriatric Psychiatry and Irish Journal of Psychiatry were handsearched. Reference lists of previous published systematic reviews, included/excluded trial articles and bibliographies were scrutinised. Experts in the field were contacted.. SELECTION CRITERIA: All randomised controlled trials that included older adults diagnosed as suffering from depression (ICD or DSM criteria) were included. All types of psychotherapeutic treatments were included, categorised into cognitive behavioural therapies (CBT), psychodynamic therapy, interpersonal therapy and supportive therapies. DATA COLLECTION AND ANALYSIS: Meta-analysis was performed, using odds ratios for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95% confidence intervals. Primary outcomes were a reduction in severity of depression, usually measured by clinician rated rating scales. Secondary outcomes, including dropout and life satisfaction, were also analysed. MAIN RESULTS: The search identified nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided sufficient data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment effect indicated between the two types of psychotherapeutic treatment. Based on three trials with usable data, CBT was superior to active control interventions when using the Hamilton Depression Rating Scale (WMD -5.69, 95% CI -11.04 to -0.35), but equivalent when using the Geriatric Depression Scale (WMD -2.00, 95% CI -5.31 to 1.32). AUTHORS' CONCLUSIONS: Only a small number of studies and patients were included in the meta-analysis. If taken on their own merit, the findings do not provide strong support for psychotherapeutic treatments in the management of depression in older people. However, the findings do reflect those of a larger meta-analysis that included patients with broader age ranges, suggesting that CBT may be of potential benefit.

Elderly depressed patients: what are their views on treatment options?

The aim of this study was to explore attitudes of elderly patients with depression receiving secondary psychiatric care towards different types of treatment for depression. One hundred patients, recruited from a large teaching hospital in Birmingham, were subjected to structured interviews at which their attitudes towards the effectiveness, likelihood of causing side-effects and acceptability of anti-depressant medication, ECT and psychotherapy were measured on a five-point Likert scale. Psychotherapy was considered both effective and acceptable by our patients although it is not widely available across the UK. Anti-depressants were also considered to be effective and acceptable although likely to cause side-effects. However, our patients did not think highly of ECT, either in its effectiveness or acceptability.

Telling the truth: what do general practitioners say to patients with dementia or terminal cancer?

A questionnaire was sent to all general practitioners (GPs) in Cambridgeshire asking them about their practice in telling patients with dementia or terminal cancer their diagnosis. Although the majority of GPs would always or often tell patients of a diagnosis of terminal cancer, this was not the case in dementia; uncertainty of diagnosis was cited as the most important factor in not giving the diagnosis. The implications of these findings are discussed in the light of the GP's role in dementia and the development of new anti-Alzheimer's drugs.

Suicide in Avon. Life stress, alcohol misuse and use of services.

BACKGROUND: Suicide rates among young men are rising. Further information about their contacts with services and possible associated stressful life events is necessary. METHOD: The sample consisted of all cases where the coroner in the County of Avon had given an inquest verdict of suicide over a 20-month period, together with those who were categorised as suicide by a panel of psychiatrists even though they had received open or accidental inquest verdicts. The coroner's dossiers and hospital notes were examined and the relevant general practitioners interviewed. RESULTS: Interpersonal stress in the last 72 hours was much higher in younger suicides. Young male suicide were also much less likely than others to seek help. Levels of alcohol misuse were no higher in younger than older suicide. CONCLUSIONS: Various subgroups of suicide behave differently in the way they seek and utilise help. The implications of these findings for suicide prevention and service strategy are discussed.

Managing suicide risk in the general ward.

In this paper we look first at those groups and situations which denote a high risk for suicide. Thorough assessment, which is the first essential step in approaching any clinical problem, is then addressed. Finally we consider the many potential hazards that may complicate assessment and management of individuals at risk of killing themselves.

Differentiating life stresses prior to admission to hospital for appendicectomy and parasuicide.

Life events were collected (using the Bedford College method) in 78 women patients aged 15-40 yr, of whom 39 were admitted for the removal of an appendix which proved to be normal at operation and in whom no organic cause for their pain was found, and a matched group of 39 parasuicide patients. Utilizing measures derived from previous life event studies the parasuicide group were characterized as having recently experienced life stressors containing threat, uncertainty, impaired relationships and choice of action. They were likely to have played some part in bringing about these stressors and to have had poor social supports. In contrast 'normal appendix' patients had recently experienced life stressors characterized by threat and uncertainty. These stressors were unlikely to have been brought about by the subject and the patients had good social supports.

Parasuicide and appendicectomy.

A retrospective case-note study of young women admitted for appendicectomy showed that in those patients who had a normal appendix removed, there was a significantly higher rate of admission for parasuicide, before and after the index admission; 27/184 (approximately 15%) compared with 17/368 (approximately 5%) for patients who had an inflamed appendix removed.