The Value of Chemotherapy in Senile Mental Disturbances

Abstract

Eighty patients over the age of 60 and suffering from combinations of depression, restless agitation, paranoid ideation, or confusion were assigned in a prearranged sequence to five treatment conditions. Sixteen patients each were given chlorpromazine, reserpine-pipradrol, deodorized tincture of opium, or a placebo (lactose). An additional group of patients were given no special medication.Observations were made at the end of one-, two-, four-, and eight-week intervals by psychiatrists and psychologists who were uninformed about the treatment given any one patient. Anxiety decreased in both the chlorpromazine and placebo groups over the two-month period. The placebo group, however, also gained better spirits and greater spontaneity.Among the group who received no special medication, anxiety increased. No special benefit from the ataractics could be demonstrated in this study. The evidence indicates the importance of a semblance of medication and care in a geriatric ward.THE SERIES of clinical observations on geri¬ atric patients reported here was initiated in 1957. Several highly encouraging clinical reports had just appeared that claimed effectiveness for some of the ataractics in controlling agitation, de¬ lusions, belligerence, anxiety, and behavior disor¬ ders in senile patients. Particularly noteworthy were the studies on chlorpromazine by Howell, Harth, and Dietrich,2 in 1954, followed by a paper by Seager,5 in 1955, and Pollack,4 in 1956. In addi¬ tion, a paper by Martin, Overley, and Krone,' in 1957, offered hope for controlling similar difficulties in geriatric patients by means of a combination of pipradrol hydrochloride (Meratran) and reserpine. This combination of stimulating and tranquilizing effects was alleged to give a balanced medication for both the depression and agitation characteristic of this patient group. In order to evaluate the bene¬ fits of these new medicaments, a standard drug of known characteristics, namely, deodorized tincture of opium (DTO) was employed in this study.Since the wards on which this project was to be carried out were typically understaffed and overpopulated, the suggestive effects of medication had to be carefully controlled. Therefore, two additional treatment conditions were included in our experi¬ mental design. A placebo (P) of lactose was intro¬ duced and its medication schedule matched to the reserpine-pipradrol group. In addition, a compara¬ ble group of patients without any special medica¬ tion (NM) was observed over the same period. The patients in these five groups were all studied while living together on several different geriatric wards.The problems of using a formal double-blind ap-proach were too great to permit its use in this re¬ search study. Therefore, a modification of this method was used which offers many advantages.The medication and ward management of all of the patients in this study were carried out by a medical staff who were informed about the medicine given,

Neuroleptics in the treatment of dementia

“…As can be seen from even a brief survey of the studies summarized, the diagnostic specificity, study design, and outcome measures employed across studies vary tremendously. The diagnostic categories range from senile psychoses (Abse and Dahlstrom, 1960) to multi-infarct dementia (Gotestam et a/., 1981) to primary degenerative dementia (Petrie et al, 1982). While many of the patients in these studies share clinical characteristics, it must be argued from the start that the patient group is a heterogeneous population with numerous underlying etiologies for the cognitive impairments.…”

“…On difficulty in evaluating the use of any medication in treating demented patients is that the population itself has been variably defined over the last two decades. Although this diagnostic problem has been partially resolved with the advent of more specific criteria and the widespread use of DSM 111, older drug studies suffer from vague inclusion criteria and the high probability of mixed treatment populations (Covington, 1975, Abse andDahlstrom, 1960;Hamilton and Bennett, 1962a,b;Cowley and Glen, 1979;Smith et al, 1974;Tsuang et al, 197 1). Nonetheless, certain questions regarding neuroleptic use can still be addressed in a review.…”

Newer Psychotropic Medication Use in Nursing Home Residents

“…For purposes of comparative analysis, the total sample was subdivided into four diagnostic groups. This division included (1) the Alzheimer's disease group (AD; n = 123), composed of patients with Dementia of the Alzheimer's type (DSM‐IV) as a primary psychiatric diagnosis; (2) the Cerebrovascular disease group (CVA; n = 56), composed of patients with a recent (within 1 year) cerebrovascular accident (n = 40) or diagnosis of vascular dementia (VD; n = 16); (3) the Neurological disease group (NEU; n = 37), composed of patients with Parkinson's disease (n = 10), schizophrenia, residual type (n = 9), mild mental retardation (n = 3), or other neurological diagnoses (traumatic head injury (1) multiple sclerosis (1) spinocerebellar degeneration (1), chronic ethanol abuse (2), dementia, mixed type (3) dementia, NOS (3) psychosis, the NOS (2), Pick's disease (1) anoxic encephalopathy (1)); (4) the Affective disease group (AFF; n = 82), composed of nondemented patients with major depressive disorder (n = 54), bipolar disorder, type I (n = 4), anxiety attributable to medical condition (n = 7), and adjustment disorders with either anxious (n = 5) or depressed features (n = 12).…”

“…The use of psychoactive medications in nursing homes has been reported for more than 4 decades 1–4 . With the growing number of pharmacologic agents, expansion into clinical geriatric practice followed, 5 particularly in nursing homes where a majority of residents have psychiatric illnesses 6–9 .…”

Pharmacologic Treatment of Agitation Associated With Dementia

“…Chlorpromazine (150 mg per day) in confused, agitated mental hospital patients with dementia, schizophrenia, or depression was reported to produce behavioral improvement in the majority of patients in all diagnostic groups 32 . However, other studies comparing chlorpromazine with placebo in state hospital patients with organic mental disorders have failed to demonstrate significant behavioral improvement 33 or have actually reported a worsening of symptoms during treatment 34 . In a study of 50 female geriatric hospital patients with organic mental disorders, agitation, overactivity, and noisiness became worse when placebo was substituted for chlorpromazine (average, 138 mg per day) 35 .…”