Six patients with a family history of Huntington's chorea (HC) participated in a double blind crossover trial involving four treatments--lithium carbonate, haloperidol, lithium carbonate and haloperidol, and placebo. Each treatment was administered for three weeks and, at the end of each treatment period, assessments were made of chorea and a number of psychological variables. None of the treatments significantly affected chorea measurements. With regard to the psychological variables, the levels of irritability, the frequency of angry outbursts and depression did appear to be affected in some patients by the treatment. Three patients improved on a combination of lithium carbonate and haloperidol while the remaining three did not. Haloperidol alone significantly raised depression ratings above levels for other treatments including placebo. It is suggested that lithium carbonate and haloperidol together should be seriously considered in the treatment of HC when patients are excessively irritable and impulsive.
Objective: To assess the relationship of psychiatric morbidity, morale, physical activity and the presence of pain in older people.
Method: Older people attending senior citizens' clubs were administered the 28‐item General Health Questionnaire (GHQ‐28), the Revised Philadelphia Geriatric Centre Scale (RPGCS) and five self‐report questions from the Brief Disability Questionnaire. They also rated the presence of pain on a five‐point scale. Multiple and logistic regression were used to adjust for socio‐demographic factors and identify variables independently associated with psychological status and morale.
Results: Of 112 people approached, 86% agreed to take part (n=96). The sample showed a wide range in total GHQ scores (mean=2.9, range=0–19) and RPGCS scores (mean=2.3, range=1.1–3.0). Twenty‐one per cent had psychological distress as defined by a score of >6 on the GHQ‐28 (n=19). Fifty‐four respondents (56%) reported low morale as defined by a score <2 on the RPGCS. There was a close relationship between psychological distress, low morale on the RPGCS (OR=5.5 [1.5–20.5]) and moderate to severe pain (OR=5.3 [1.8–15.9]). When adjusted odds ratios were calculated to control for confounding factors, moderate to severe pain remained independently associated with psychological distress (OR=1.6 [1.3‐2.4] p=0.02), and limitations in daily activities with low morale (OR=3.64 (1.001–8.4) p=0.05).
Conclusions: There is a close relationship between physical disability, low morale and psychological distress.
Implications: An increased index of suspicion for psychological distress is warranted in all older people with physical disability, particularly in the presence of moderate to severe pain.
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