Cognitive-behavioral therapy in geriatric depression: reply to Riskind, Beck, and Steer.
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Biomedical subjects
Publications and source records attributed to L F Jarvik.
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Male, monozygotic twins (six pairs) were repeatedly tested before and after d-amphetamine, l-amphetamine, or placebo administration. Drug effects on cognitive, psychomotor, personality, mood, and pain variables were assessed. Members of a twin pair tended to respond similarly on several tests under placebo conditions, indicating genetic determination of the behavioral variables. In addition, cotwins tended to show similar responses to amphetamine as measured by one test of cognitive function, by several mood and personality variables (hostility, autonomic arousal, friendliness, feelings of tension and loss of control), and tended to have similar plasma levels of both amphetamine isomers. Although shared environmental effects cannot be ruled out, the results are consistent with genetic mediation of a variety of behavioral effects of amphetamines.
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The philothermal response, i.e., the tendency of polymorphonuclear leukocytes (PMNs) to migrate along a temperature gradient toward warmer temperatures, was evaluated in 11 patients with a clinical diagnosis of dementia of the Alzheimer type (DAT) and compared to 11 age and sex-matched mentally normal individuals. While the total number of migrating PMNs did not differ significantly between these two groups, there was a significant difference in the spatial distribution of the responding cell population. The numerical parameter, R, has been introduced to provide a quantitative measure of the distribution of populations characterized by differences in motile behavior. This R value was unusually high for 10 of the DAT patients but only one of the comparison individuals. No relation between R and duration of illness, age, or sex was detected. These preliminary findings, based on a small number of clinically diagnosed DAT patients, suggest that the philothermal response may represent a biological marker with diagnostic usefulness for at least one subgroup of DAT patients.
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Two concurrent studies of geriatric outpatients who received diagnoses of depression were conducted. In the first, patients were treated with one of two tricyclic antidepressants or with a placebo. In the second, patients were assigned to groups receiving either psychodynamic group therapy or cognitive-behavioral group therapy. Patients in the placebo group showed the least improvement; most patients receiving group psychotherapy showed some improvement, but only 12% had full remissions; by contrast, 45% of patients receiving imipramine or doxepin had full remissions, while 36% of them experienced little or no benefit. An early response to tricyclic antidepressant drugs was a reliable predictor of continued improvement.
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The geriatric patient has a high incidence of cardiovascular and psychiatric illness; treatment of either may lead to emergence or aggravation of the other. Toxic side effects can frequently be managed by a reduction in dose or a change in medication. In general, the psychiatric problems of elderly patients, including patients with cardiovascular disease, can be managed despite the cardiovascular toxicity of most psychotropic drugs. Psychiatrists who treat geriatric patients need an understanding of psychopharmacology and clinical manifestations of the cardiovascular system in order to provide well-rounded care.
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