Faculty Bibliography

Discusses the article 'Open-label Pilot Study of Ziprasidone for Refractory Generalized Anxiety Disorder' by S. H. Snyderman et al (see record 2005-11734-018). Thirteen adults (7 men, 6 women) with refractory generalized anxiety disorder (GAD) entered this 7-week ziprasidone monotherapy study. During the first week, all subjects received ziprasidone 20 mg/day. Subsequently, depending on response and tolerability, the dose could be increased in 20 mg/week increments to a maximum of 80 mg/week. The preliminary data from this short-term, open-label study suggest that ziprasidone at a dosage range of 20-80 mg/day may be of benefit to GAD patients who have not achieved sufficient improvement with serotonin reuptake inhibitors, buspirone, or benzodiazepines. Double-blind, placebo-controlled trials utitilizing a more stringent criterion for treatment resistance are needed to confirm these initial findings.

Depression affects 6.5 million of the 35 million Americans >=65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80-90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment; and physical illness including disability.

Depression affects 6.5 million of the 35 million Americans >=65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80-90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly (see record 2005-10992-010) in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment (see record 2005-10992-011); and physical illness including disability (see record 2005-10992-012); and treatment of late-life depression (see record 2005-10992-013).

In addition to the psychological and medical health risks associated with lack of adequate sleep, effects of insomnia include impaired daytime functioning and decreased quality of life. Many patients experience delayed sleep onset, frequent awakenings, early waking, or nonrestorative sleep. Longitudinal data on insomnia indicate that the prevalence of persistent/chronic insomnia is high and appears to be characterized by multiple symptoms related to initiating or maintaining sleep. Physiologic studies indicate that short-term sleep restriction can cause physiologic problems that lead to long-term health consequences, such as high blood pressure, impaired glucose tolerance, and systemic inflammation. Epidemiologic studies have shown that sleep deprivation is independently associated with increased risk of cardiovascular disease, diabetes, obesity, and mortality. While the available agents are effective, those with a long half life may have carryover effects while short-acting agents may not provide enough sleep continuity. Pharmacologic therapies available for patients who suffer from insomnia include immediate-release nonbenzodiazepine hypnotics, which have a positive benefit/risk profile compared to the benzodiazepines. Modified-release (MR) formulations of these agents may offer the additional benefit of improving sleep continuity throughout the night without sacrificing the rapid elimination properties that minimize next-day residual effects. MR agents in development include zolpidem MR and indiplon MR. Paper from this symposium are by M. K. Erman (see records 2005-10992-016 and 2005-10992-020), T. Young see records 2005-10992-017), S. R. Patel see records 2005-10992-018), and D. N. Neubauer see records 2005-10992-019).