Successful cerebral aging: clinical and pharmacological approaches to the aging brain.

The author first defines what he means by "successful cerebral aging." He then discusses how major depression and dementia can interfere with this process and describes how what he terms "chronic stress dysphoria" can contribute to neuronal damage and mental impairment. The author then reviews a number of types of chronic stress, including health problems, loneliness, loss of autonomy, inactivity, and low self-esteem, and suggests possible solutions for minimizing their effect on successful aging.

The history of the psychopharmacology of schizophrenia.

OBJECTIVE: To review the historical development of the psychopharmacological treatment of schizophrenia. METHOD: A chronological literature review of the clinical practices and theoretical models that have controlled drug treatment of schizophrenia at different times. RESULTS: Effective treatment of schizophrenia was achieved only after the introduction of antipsychotic drugs, in the 1950s, and is still progressing. CONCLUSION: Close collaboration between basic neuroscience and careful and informed clinical practice are likely to lead to continued progress.

An 11-year follow-up study of 110 depressed patients.

In 1972 the World Health Organization organized a cross-cultural five-centre study of depressive disorders. This report is concerned with data collected, after an 11-year follow-up period, in the sample of 110 depressed patients in Montreal, Canada. Eighty-five percent were traced and 59% were interviewed. Of 93 patients, 20 were dead at the follow-up date, 11 by suicide. Fifty-two percent of patients were receiving psychiatric treatment at follow-up, but there was no relation between psychiatric morbidity and treatment-seeking. Moderate or severe impairment of social functioning was present in 32%; in women, a trend linking the presence of social impairment and the time spent in episodes was observed. Of the episodes of psychiatric illness recorded after the index episode, 86% were diagnosed as depressive, 14% as unspecified affective disorder. The mean durations of the index and four subsequent episodes were 10, 11, 7, 11, and 2 months respectively. At least one recurrence after the index episode was reported by 78%, at least four recurrences by 19%. Episodes lasted at least one year in 5%, 4%, 6%, and 6% in the first, second, third and fourth episodes respectively. Sixteen percent were depressed for at least one year and 31% for at least 2 years. There was a marked trend from inpatient to outpatient treatment and from ECT to drug therapy over time. Twenty-two percent reported either moderate or severe problems with alcohol or substance abuse. There was a statistically significant association between the amount of time patients spent in depressive episodes and the number of life events they reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Depression: the evolution of modern paradigms and concepts.

We have presently three paradigms of depression: the psychoanalytic, the cognitive-behavioral, and the biological. The biological has so far produced the most effective treatment, but this theoretical structure is still the least cohesive; it is also less connected with its associated therapies than the two other paradigms. The search for unifying concepts and for indicators that may point to more specific therapeutic approaches to depression, goes on. It is an exciting search, but we must guard against the danger of losing contact between the rapidly progressing neurosciences and clinical research-the contact that should remain a precious "therapeutic alliance."

[A special flicker fusion frequency method for detection of the effects of gerontopharmaceuticals exemplified by the L-eburnamonine study]. / Eine spezielle Flimmerverschmelzungs-frequenz-Methode zur Erfassung von Gerontopharmaka-Wirkungen am Beispiel einer L-Eburnamonine-Studie.

A clear difference between active drug and placebo is not always found when using the ascending and descending thresholds of the critical flicker fusion test (CFF). We selected a test requiring attention and concentration and performed again the CFF after this 6-minute concentration-test (reactive CFF). This reactive CFF was then used in a double-blind study in 30 ambulant patients with cerebro-vascular arteriosclerosis treated for 8 weeks with 80 mg/day cervoxan or placebo. After the treatment period the reaction of the CFF after the 6-minute concentration-test demonstrated a significantly more frequent improvement of the vigilance in the Cervoxan group compared to the placebo group.

Early organiform impairment test (OFIT). A new performance test for assessment of early cognitive impairment.

No satisfactory tests are available to a) document and b) monitor the short term effects of various pharmacological agents on early, and hopefully reversible, organic cognitive impairment in otherwise healthy individuals. A new test battery, Organiform Impairment Test (OFIT), is based on the clinical observation that impairment of the ability to operate simultaneously with a number of mental sets and stimuli is one of the first clinical manifestations in the early stages of organic brain pathology. This battery can be administered in 20-30 minutes and is partly automated. It has been standardized on 167 normal subjects in age ranges from 15 to 80 years. Any score below 50 on the battery in subjects under 80 years of age should be regarded with suspicion.

The clinician's view of anxiety and depression.

The definitions and treatment of clinical depressive and anxiety states and their distinction from the normal human experiences of fear, worry, and sadness are reviewed. The importance of determining whether anxiety or depression is primary in patients with both types of symptoms is stressed, as is the differential diagnosis of normal grief reactions and reactions to stress from depressive states requiring pharmacotherapeutic intervention.

Clinical evaluation and natural course of depression.

Without antidepressant therapy, episodes of clinical depression last from 2 months to several years, with an average of around 5 to 6 months. One-third of the patients recover within a year; probably one out of four untreated episodes may last more than 2 years. Depressive episodes occur, on the average, every 2 to 3 years. ECT and antidepressant drug therapy greatly reduce the duration of episodes and significantly decrease the morbidity and mortality of affective disorders. With modern treatment, during a 5-year follow-up, about one quarter of depressed patients had no recurrent episodes, more than half recovered in less than 2 or 3 months, and about one in seven patients developed chronic depression (episodes lasting longer than 2 years). Suicide attempts were made by one fifth of this group of patients, and 6% committed suicide. However, three-fourths of the patients were well three-fourths of the time. Age and culture seem to influence the course of depression. In addition to the classified clinical depressions, there is a considerable prevalence in the general population of depressive symptomatology and dysphoric states, apparently related to genetic factors, age, and stress. Little is known about the course and indications for treatment of these latter conditions, which should be the target for more systematic study and research in the ever widening fields of the phenomenology and therapy of depression.

[From Binet and Wundt to neuropsychological measurements and behavior scales]. / De Binet et Wundt aux mesures neuropsychologiques et aux échelles de comportement.

Experimental psychology was the first form of scientific psychology and saw its beginnings in Wundt's laboratory toward the end of the 19th century. Psychometric measures of cognitive functions were introduced, at about the same time, by Binet, while Galton was pioneering in studies of personality profiles. Most of the systematic work, both in the theory and practice of psychology, was focused on standardization of norms, or types and measures of normal mental functions. With the establishment of psychopharmacology as a new discipline with an important role in clinical psychiatry, there emerged an urgent need for scales that indicate the presence and measure the extent and severity of psychopathology. The AMDP scales, created in the context of the European tradition in psychopathology, are some of the most prominent and promising scales of this type.