ARTICLES FROM OUR MEDICAL DIRECTOR – November

Can Med Assoc J. 1980 March 8; 122(5): 525-32, 540.

PMCID: PMC1801942

Depression in the elderly.

D. Wasylenki, Copyright and License information

Copyright notice

This article has been cited by other articles in PMC.

Abstract

Depression in the elderly is very common and may be difficult to diagnose. Because of its varied presentation and its frequent association with physical illness it will be encountered increasingly by all physicians as the elderly population expands. Depression, though treatable, is often not treated, and suicide rates are high among depressed elderly persons. Diagnostic difficulties lie in distinguishing depression from organic brain syndromes, from so-called masked depressions and from normal grief reactions. Pharmacologic treatment is effective, but care must be taken to recognize side effects and to use adequate doses. Psychologic approaches should focus on reducing feelings of helplessness and failing self-esteem. The importance of the losses borne by elderly persons in the pathogenesis of depression continues to be of theoretical and practical interest.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.0M),

Six- and Twelve-Month Abstinence Rates in Inpatient Alcoholics Treated with Aversion

Therapy Compared with Matched Inpatients from a Treatment Registry

Alcoholism: Clinical and Experimental Research Vol. 15. No. 5 Sept/Oct 1991

Printed in the USA. All rights reserved.

Copyright © 1991 by The Research Society on Alcoholism.

James W. Smith, P. Joseph Frawley, and Lincoln Polisser

Treatment Outcome of 600 Chemically Dependent Patients Treated in a Multimodal Inpatient

Program Including Aversion Therapy and Pentothal Interviews

Journal of Substance Abuse Treatment, Vol. 10, pp. 359-369, 1993

Printed in the USA. All rights reserved.

Copyright © 1993 Pergamon Press Ltd.

James W. Smith, MD, and P. Joseph Frawley, MD

Schick Health Services, Seattle, Washington, and Schick Shadel Hospital, Santa Barbara, California

Abstract

A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an independent research organization with 427 of the patients (71.2%). Of these, 65.1% were totally abstinent for 1 year after treatment and 60.2% were abstinent until follow-up a mean of 14.7 months later.  Fifty-two percent of the alcoholics were using or dependent on other drugs at admission. Seventy five of these treated for cocaine dependence and 47 treated for marijuana dependence. The cocaine 12 month and “total” abstinence (mean 14.7 most) rates for the 49 contacted patients were 83.7% and 81.6%, respectively. The marijuana 12 month and “total” abstinence (mean 14.7 most) rates for the 30 contacted patients was 70.0% for both groups. Abstinence rates for alcohol and/or other drugs were also calculated including non-contacted patients who had chart documented evidence of relapse. The most powerful predictor of success was whether or not all urges to drink or use had been eliminated (presumably by aversion therapy). Of additional importance was the use of support groups and reinforcement treatments after completion of the initial hospitalization. The two most prominent factors initiating a relapse were “intrapersonal determinants” such as stress from work or marriage/family relationships and “interpersonal determinants” such as being around others who were drinking/using or being at a celebration or special event. The two factors were of equal importance in the alcoholics. However, interpersonal determinants were far more important in the cocaine and marijuana treated patients. Increased utilization of reinforcement treatments was associated with decreased urges to drink/use and increased abstinence rates. In contrast, increased frequency of support group utilization was associated with increased urges to drink/use and lower abstinence rates. This suggests the need to take seriously patient reports of “urges” in the first year after treatment and to carefully assess the cause and initiate or update an individualized plan of treatment. Such treatment may include increased reinforcement treatments, treatment of depression, and additional assistance in coping with intrapersonal and nterpersonal determinants of relapse.