RESUMO
BACKGROUND: As the age of the population in China rises, the occurrence of first-episode of schizophrenia in elderly persons is also gradually increasing. However, studies examining selection of therapeutic drugs for this population are relatively few. OBJECTIVE: To examine the therapeutic efficacy and metabolic influence on blood-glucose and serum lipid of ziprasidone in the treatment of elderly patients with first-episode schizophrenia. METHODS: Using randomized grouping, 38 elderly patients with first-episode schizophrenia were randomly divided into the ziprasidone treatment group (i.e. the study group) and the olanzapine treatment group (i.e. the control group), with 19 cases in either group respectively. The positive and negative symptoms scale (PANSS) was used to evaluate the efficacy, and adverse drug reaction scale (TESS) was used to evaluate adverse drug reactions, at the points prior to the treatment, at the end of 4th, 8th, and 12th weeks of treatment, respectively. Fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), and low density lipoprotein (LDL-c) were also measured. RESULTS: There was no significant difference between the two groups in PANSS score at the end of week 4, week 8 and week 12. The curative effect on the two groups was similar. The results of repeated measure ANOVA showed that there were significant differences in FBG (Ftime×group=7.539, p=0.001), TC(Ftime×group=32.194, p<0.001), TG(Ftime×group=488.312, p<0.001), and LDL-c (Ftime×group=9.380, p<0.001)between the study group and the control group across the different time points. CONCLUSION: Ziprasidone in the treatment of first episode schizophrenia in elderly patients has efficacy and less effect on blood-glucose and serum lipid metabolism.
RESUMO
BACKGROUND: Co-occurring cognitive impairment in geriatric depression may not improve with antidepressant treatment and it may progress to dementia. AIM: Assess the relationship between changes in cognitive and depressive symptoms among patients with geriatric depression and their association with the APOE epsilon 4 allele before and after antidepressant treatment. METHODS: The presence of the APOE epsilon 4 allele was assessed in 64 incident cases of geriatric depression and 31 elderly individuals without depression and the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), digit span test, and Trail Making Tests A and B (TMT-A, TMT-B) were administered to these subjects at baseline and 12 months after baseline, during which time the depressed group received standardized treatment with selective serotonin reuptake inhibitors (SSRIs). RESULTS: Prior to treatment patients with geriatric depression had significantly worse cognitive functioning than control subjects and 31 (48%) met criteria for mild cognitive impairment (MCI). After treatment depressed patients with and without comorbid MCI both had significant improvements in their depressive and cognitive symptoms, but those with MCI had more residual symptoms. The severity of cognitive symptoms was not associated with the severity of depressive symptoms at baseline, but they were positively correlated at the 12-month follow-up. The APOE epsilon 4 allele was identified in 14% (9/64) of the patients and in 3% (1/31) of the controls (Fisher's Exact Test, p=0.158). Compared to depressed patients without the allele, depressed patients with the allele had more severe cognitive deficits both before and after treatment, though only some of these differences were statistically significant. CONCLUSIONS: There is substantial cognitive impairment in elderly individuals with geriatric depression. Both the depressive and cognitive symptoms improve with standard SSRI treatment, but individuals with comorbid MCI have more residual depressive and cognitive symptoms after treatment. The APOE epsilon 4 allele is associated with greater cognitive impairment in geriatric depressed patients and may be associated with less responsiveness of cognitive symptoms to antidepressant treatment.