By C L E Katona; Gill Livingston
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Extra resources for Drug treatment in old age psychiatry
At present the most consistent and best results in this field are for paroxetine and citalopram. 03 02/09/2002 3 14 pm Page 44 44 Drug Treatment in Old Age Psychiatry Management of depression in people with other physical illnesses The principles of management of depression in older people with comorbid physical illness are essentially the same as for depression in general. The possibility of contraindications, adverse interactions with other drug treatment and side effects being more significant and disabling must be borne in mind.
There may also be excessive reluctance to use potentially dangerous treatments. 03 02/09/2002 3 14 pm Page 37 Co-morbid depression 37 Box 15 The 5-item Geriatric Depression Scale for use in people with comorbid physical illness (From Hoyl et al, 1999) 1. 2. 3. 4. Are you basically satisfied with your life? Y/N Do you often get bored? Y/N Do you often feel helpless? Y/N Do you prefer staying at home rather than going out and doing new things? Y/N 5. Do you feel pretty worthless the way you are now?
Lithium is excreted by the kidney and may accumulate rapidly if renal function is impaired or in the context of sodium depletion. Older people being started on lithium should have a baseline estimation of thyroid, renal and cardiac function. Even if their renal function is within the normal range, they usually require half the dose given to younger adults and are particularly vulnerable to lithium toxicity even at blood levels within the conventional adult ‘therapeutic’ range. 9 mmol/l, as far as possible at the lower end of the range.
Drug treatment in old age psychiatry by C L E Katona; Gill Livingston