AAGP Annual Meeting

LOS ANGELES – Most older adults have sleep-related complaints, and most use some form of sleep aid, according to findings from the Successful Aging Evaluation study.

A large number of subjects reported using sleep aids that could have deleterious effects, such as alcohol and over-the-counter remedies.

Of 1,300 subjects included in the Successful Aging Evaluation (SAGE) study, 92.4% had sleep complaints, including waking feeling unrefreshed, early awakening, difficulty falling asleep, and middle of the night awakening. Each of these complaints was reported by between 75% and 79% of subjects, Dr. Nicolas Badre reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

©Nastasic/iStockphoto.com

More than half (55.5%) of the subjects reported using one or more forms of treatment for sleep disturbance: 8.1% reported using complementary or alternative treatments, 10% reported using alcohol, 14.8% reported using prescription medications, 21.3% reported using over-the-counter remedies, and 39% reported using behavioral techniques, according to Dr. Badre of the University of California, San Diego.

The use of any treatment for sleep was significantly associated with a higher number of doctor visits in the past year, lower Satisfaction With Life Scale scores, a lower average number of hours of sleep per night, depression as measured by the nine-item Patient Health Questionnaire, and reduced physical functioning as measured using the 36-Item Short Form Health Survey.

Clinical depression was associated with a significantly increased odds of any use of treatment for sleep (odds ratio, 2.4), and use of prescription treatment for sleep (OR, 3.3), Dr. Badre noted.

No significant association was seen between the use of any treatment for sleep and cognitive impairment.

The SAGE study was a structured, multicohort population-based study designed to assess successful aging. The survey included a 25-minute phone interview followed by a self-report survey of various domains of functioning. Respondents had a mean age of 77.3 years.

"Results from the SAGE investigation confirm the high prevalence of insomnia and its treatment in older adults," Dr. Badre wrote, noting that decreased activity of the suprachiasmatic nucleus and prescriptions often given to older adults – including stimulants, antihypertensives, respiratory medications, chemotherapy, and decongestants – are among the causes of sleep disturbance in older adults.

The high correlation between the use of any treatment for sleep and depression appears to be a significant risk factor for patients being prescribed medication for sleep, and the high rates of alcohol use and over-the-counter remedies as sleep aids are of concern, he said.

Dr. Badre reported having no relevant financial disclosures.

LOS ANGELES – Most older adults have sleep-related complaints, and most use some form of sleep aid, according to findings from the Successful Aging Evaluation study.

A large number of subjects reported using sleep aids that could have deleterious effects, such as alcohol and over-the-counter remedies.

Of 1,300 subjects included in the Successful Aging Evaluation (SAGE) study, 92.4% had sleep complaints, including waking feeling unrefreshed, early awakening, difficulty falling asleep, and middle of the night awakening. Each of these complaints was reported by between 75% and 79% of subjects, Dr. Nicolas Badre reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

©Nastasic/iStockphoto.com

More than half (55.5%) of the subjects reported using one or more forms of treatment for sleep disturbance: 8.1% reported using complementary or alternative treatments, 10% reported using alcohol, 14.8% reported using prescription medications, 21.3% reported using over-the-counter remedies, and 39% reported using behavioral techniques, according to Dr. Badre of the University of California, San Diego.

The use of any treatment for sleep was significantly associated with a higher number of doctor visits in the past year, lower Satisfaction With Life Scale scores, a lower average number of hours of sleep per night, depression as measured by the nine-item Patient Health Questionnaire, and reduced physical functioning as measured using the 36-Item Short Form Health Survey.

Clinical depression was associated with a significantly increased odds of any use of treatment for sleep (odds ratio, 2.4), and use of prescription treatment for sleep (OR, 3.3), Dr. Badre noted.

No significant association was seen between the use of any treatment for sleep and cognitive impairment.

The SAGE study was a structured, multicohort population-based study designed to assess successful aging. The survey included a 25-minute phone interview followed by a self-report survey of various domains of functioning. Respondents had a mean age of 77.3 years.

"Results from the SAGE investigation confirm the high prevalence of insomnia and its treatment in older adults," Dr. Badre wrote, noting that decreased activity of the suprachiasmatic nucleus and prescriptions often given to older adults – including stimulants, antihypertensives, respiratory medications, chemotherapy, and decongestants – are among the causes of sleep disturbance in older adults.

The high correlation between the use of any treatment for sleep and depression appears to be a significant risk factor for patients being prescribed medication for sleep, and the high rates of alcohol use and over-the-counter remedies as sleep aids are of concern, he said.

Dr. Badre reported having no relevant financial disclosures.

LOS ANGELES – Most older adults have sleep-related complaints, and most use some form of sleep aid, according to findings from the Successful Aging Evaluation study.

A large number of subjects reported using sleep aids that could have deleterious effects, such as alcohol and over-the-counter remedies.

Of 1,300 subjects included in the Successful Aging Evaluation (SAGE) study, 92.4% had sleep complaints, including waking feeling unrefreshed, early awakening, difficulty falling asleep, and middle of the night awakening. Each of these complaints was reported by between 75% and 79% of subjects, Dr. Nicolas Badre reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

©Nastasic/iStockphoto.com

More than half (55.5%) of the subjects reported using one or more forms of treatment for sleep disturbance: 8.1% reported using complementary or alternative treatments, 10% reported using alcohol, 14.8% reported using prescription medications, 21.3% reported using over-the-counter remedies, and 39% reported using behavioral techniques, according to Dr. Badre of the University of California, San Diego.

The use of any treatment for sleep was significantly associated with a higher number of doctor visits in the past year, lower Satisfaction With Life Scale scores, a lower average number of hours of sleep per night, depression as measured by the nine-item Patient Health Questionnaire, and reduced physical functioning as measured using the 36-Item Short Form Health Survey.

Clinical depression was associated with a significantly increased odds of any use of treatment for sleep (odds ratio, 2.4), and use of prescription treatment for sleep (OR, 3.3), Dr. Badre noted.

No significant association was seen between the use of any treatment for sleep and cognitive impairment.

The SAGE study was a structured, multicohort population-based study designed to assess successful aging. The survey included a 25-minute phone interview followed by a self-report survey of various domains of functioning. Respondents had a mean age of 77.3 years.

"Results from the SAGE investigation confirm the high prevalence of insomnia and its treatment in older adults," Dr. Badre wrote, noting that decreased activity of the suprachiasmatic nucleus and prescriptions often given to older adults – including stimulants, antihypertensives, respiratory medications, chemotherapy, and decongestants – are among the causes of sleep disturbance in older adults.

The high correlation between the use of any treatment for sleep and depression appears to be a significant risk factor for patients being prescribed medication for sleep, and the high rates of alcohol use and over-the-counter remedies as sleep aids are of concern, he said.

Dr. Badre reported having no relevant financial disclosures.

LOS ANGELES – Antidepressant medications have a robust effect in older patients with a long duration of major depressive disorder that is at least moderately severe, according to findings from a meta-analysis of data from seven trials.

Since patients with a long duration of disease are also at increased risk for recurrence, and since the efficacy of antidepressant medications for relapse prevention is well established, antidepressant treatment should be considered in these patients, Dr. J. Craig Nelson said at the annual meeting of the American Association for Geriatric Psychiatry.

©Dundanim/shutterstock.com

Several prior studies have demonstrated that all classes of antidepressants generally are better than placebo for the treatment of depression in older adults, and that they have similar effectiveness, but the effects are modest, said Dr. Nelson, a professor of psychiatry at the University of California, San Francisco.

For example, in a 2008 meta-analysis of data from 10 studies that included adults aged 60 years and older with major depressive disorder, the response rates in the antidepressant and placebo groups were 44.4% vs. 34.7%, respectively (odds ratio, 1.40), and the remission rates were 34.6% vs. 26.5%, respectively (OR, 1.27), he said (Am. J. Geriatr. Psychiatry 2008;16:558-67).

The findings raised the question of whether moderators associated with a more robust response could be identified, he said, noting that several open studies have suggested that those with high levels of anxiety have lower responses to drug treatment, and several other moderators, such as disease severity and recurrent depression, appear to predict worse outcomes.

To look more closely at such moderators, Dr. Nelson and his colleagues revisited the 10 studies included in their 2008 meta-analysis, and obtained trial-level data from 8 of the studies for which complete information was available. They found no difference in outcomes between anxious and nonanxious depressed patients treated with antidepressants (Int. J. Geriatr. Psychiatry 2009;24:539-44).

The investigators decided to take an even closer look at possible moderators of response by performing a meta-analysis using patient-level data from seven of those trials for which complete information was available. These trials included 2,283 patients (mean age, 71.4 years), a mean duration of major depressive disorder of 11.8 years, and a mean baseline Hamilton Depression Rating Scale (HDRS) score of 21.5. About two-thirds (64.6%) were women, and nearly three-fourths (73.9%) had recurrent depression.

The findings, which were pending publication in the American Journal of Psychiatry at the time of Dr. Nelson’s presentation, showed significant linearity for the relationship between duration of illness and response in the placebo group, but not in the drug group (z scores, –3.81 and –0.92, respectively), and baseline depression severity was significantly associated with response in the drug group but not in the placebo group (z scores, 3.40 and –0.40, respectively).

On multivariate analysis, the strongest independent predictor of response was duration of illness, followed by severity of depression. An interaction between severity and duration also was noted.

"It turned out that among patients with longer duration of depression, severity did have a more significant relationship with drug-placebo difference. Among patients with a long duration of depression, patients with severity of at least moderate intensity – a Hamilton score of 21 or greater – showed the greatest drug effects," Dr. Nelson said.

Among patients with depression duration of less than 10 years and an HDRS score of less than 21, the response rates were 46.3% and 41.5% in the drug treatment vs. placebo groups, respectively, with a number needed to treat of 21; among patients with depression duration greater than 10 years and an HDRS score of 21 or greater, the response rates were 58% and 31.4% in the groups, respectively, with a number needed to treat of 4.

Of note, while disease duration and severity appear to identify patients who are more drug responsive, they also identify patients who have a pretty good response to placebo, he added.

That is, patients with a shorter duration of depression and less severe disease tend to have a good placebo response. Such a response is seen in 40%-50% of such patients.

"But of course, this is not just placebo. These are patients who are being seen, usually, on a weekly basis for the first month and then maybe every other week for the remainder of the trial," he explained, noting that the clinical management remains an important aspect of care.

Given that many trials include extensive clinical management along with drug treatment, it cannot be concluded that drug treatment without such management would lead to improvement, he said.

"So is it a mistake to give these patients an antidepressant? I think the mistake is not that you give an antidepressant; the mistake may be [thinking that is] all you need to do," he said. He added: "If clinical management is really accounting for most of the change, you can’t just give an antidepressant and walk away, and not do the clinical management."

A caveat, however, is that the about 50% of patients with short-duration and late-onset depression who do not respond to placebo with clinical management will need further treatment, he said.

Dr. Nelson disclosed that he has received honoraria from Korea Otsuka International Asia Arab Co. and has served as a paid consultant or advisory board member for Bristol-Myers Squibb, Cenestra Health, and other companies. He also has received research support from the National Institute of Mental Health and the Health Resources and Services Administration.

LOS ANGELES – Antidepressant medications have a robust effect in older patients with a long duration of major depressive disorder that is at least moderately severe, according to findings from a meta-analysis of data from seven trials.

Since patients with a long duration of disease are also at increased risk for recurrence, and since the efficacy of antidepressant medications for relapse prevention is well established, antidepressant treatment should be considered in these patients, Dr. J. Craig Nelson said at the annual meeting of the American Association for Geriatric Psychiatry.

©Dundanim/shutterstock.com

Several prior studies have demonstrated that all classes of antidepressants generally are better than placebo for the treatment of depression in older adults, and that they have similar effectiveness, but the effects are modest, said Dr. Nelson, a professor of psychiatry at the University of California, San Francisco.

For example, in a 2008 meta-analysis of data from 10 studies that included adults aged 60 years and older with major depressive disorder, the response rates in the antidepressant and placebo groups were 44.4% vs. 34.7%, respectively (odds ratio, 1.40), and the remission rates were 34.6% vs. 26.5%, respectively (OR, 1.27), he said (Am. J. Geriatr. Psychiatry 2008;16:558-67).

The findings raised the question of whether moderators associated with a more robust response could be identified, he said, noting that several open studies have suggested that those with high levels of anxiety have lower responses to drug treatment, and several other moderators, such as disease severity and recurrent depression, appear to predict worse outcomes.

To look more closely at such moderators, Dr. Nelson and his colleagues revisited the 10 studies included in their 2008 meta-analysis, and obtained trial-level data from 8 of the studies for which complete information was available. They found no difference in outcomes between anxious and nonanxious depressed patients treated with antidepressants (Int. J. Geriatr. Psychiatry 2009;24:539-44).

The investigators decided to take an even closer look at possible moderators of response by performing a meta-analysis using patient-level data from seven of those trials for which complete information was available. These trials included 2,283 patients (mean age, 71.4 years), a mean duration of major depressive disorder of 11.8 years, and a mean baseline Hamilton Depression Rating Scale (HDRS) score of 21.5. About two-thirds (64.6%) were women, and nearly three-fourths (73.9%) had recurrent depression.

The findings, which were pending publication in the American Journal of Psychiatry at the time of Dr. Nelson’s presentation, showed significant linearity for the relationship between duration of illness and response in the placebo group, but not in the drug group (z scores, –3.81 and –0.92, respectively), and baseline depression severity was significantly associated with response in the drug group but not in the placebo group (z scores, 3.40 and –0.40, respectively).

On multivariate analysis, the strongest independent predictor of response was duration of illness, followed by severity of depression. An interaction between severity and duration also was noted.

"It turned out that among patients with longer duration of depression, severity did have a more significant relationship with drug-placebo difference. Among patients with a long duration of depression, patients with severity of at least moderate intensity – a Hamilton score of 21 or greater – showed the greatest drug effects," Dr. Nelson said.

Among patients with depression duration of less than 10 years and an HDRS score of less than 21, the response rates were 46.3% and 41.5% in the drug treatment vs. placebo groups, respectively, with a number needed to treat of 21; among patients with depression duration greater than 10 years and an HDRS score of 21 or greater, the response rates were 58% and 31.4% in the groups, respectively, with a number needed to treat of 4.

Of note, while disease duration and severity appear to identify patients who are more drug responsive, they also identify patients who have a pretty good response to placebo, he added.

That is, patients with a shorter duration of depression and less severe disease tend to have a good placebo response. Such a response is seen in 40%-50% of such patients.

"But of course, this is not just placebo. These are patients who are being seen, usually, on a weekly basis for the first month and then maybe every other week for the remainder of the trial," he explained, noting that the clinical management remains an important aspect of care.

Given that many trials include extensive clinical management along with drug treatment, it cannot be concluded that drug treatment without such management would lead to improvement, he said.

"So is it a mistake to give these patients an antidepressant? I think the mistake is not that you give an antidepressant; the mistake may be [thinking that is] all you need to do," he said. He added: "If clinical management is really accounting for most of the change, you can’t just give an antidepressant and walk away, and not do the clinical management."

A caveat, however, is that the about 50% of patients with short-duration and late-onset depression who do not respond to placebo with clinical management will need further treatment, he said.

Dr. Nelson disclosed that he has received honoraria from Korea Otsuka International Asia Arab Co. and has served as a paid consultant or advisory board member for Bristol-Myers Squibb, Cenestra Health, and other companies. He also has received research support from the National Institute of Mental Health and the Health Resources and Services Administration.

LOS ANGELES – Antidepressant medications have a robust effect in older patients with a long duration of major depressive disorder that is at least moderately severe, according to findings from a meta-analysis of data from seven trials.

Since patients with a long duration of disease are also at increased risk for recurrence, and since the efficacy of antidepressant medications for relapse prevention is well established, antidepressant treatment should be considered in these patients, Dr. J. Craig Nelson said at the annual meeting of the American Association for Geriatric Psychiatry.

©Dundanim/shutterstock.com

Several prior studies have demonstrated that all classes of antidepressants generally are better than placebo for the treatment of depression in older adults, and that they have similar effectiveness, but the effects are modest, said Dr. Nelson, a professor of psychiatry at the University of California, San Francisco.

For example, in a 2008 meta-analysis of data from 10 studies that included adults aged 60 years and older with major depressive disorder, the response rates in the antidepressant and placebo groups were 44.4% vs. 34.7%, respectively (odds ratio, 1.40), and the remission rates were 34.6% vs. 26.5%, respectively (OR, 1.27), he said (Am. J. Geriatr. Psychiatry 2008;16:558-67).

The findings raised the question of whether moderators associated with a more robust response could be identified, he said, noting that several open studies have suggested that those with high levels of anxiety have lower responses to drug treatment, and several other moderators, such as disease severity and recurrent depression, appear to predict worse outcomes.

To look more closely at such moderators, Dr. Nelson and his colleagues revisited the 10 studies included in their 2008 meta-analysis, and obtained trial-level data from 8 of the studies for which complete information was available. They found no difference in outcomes between anxious and nonanxious depressed patients treated with antidepressants (Int. J. Geriatr. Psychiatry 2009;24:539-44).

The investigators decided to take an even closer look at possible moderators of response by performing a meta-analysis using patient-level data from seven of those trials for which complete information was available. These trials included 2,283 patients (mean age, 71.4 years), a mean duration of major depressive disorder of 11.8 years, and a mean baseline Hamilton Depression Rating Scale (HDRS) score of 21.5. About two-thirds (64.6%) were women, and nearly three-fourths (73.9%) had recurrent depression.

The findings, which were pending publication in the American Journal of Psychiatry at the time of Dr. Nelson’s presentation, showed significant linearity for the relationship between duration of illness and response in the placebo group, but not in the drug group (z scores, –3.81 and –0.92, respectively), and baseline depression severity was significantly associated with response in the drug group but not in the placebo group (z scores, 3.40 and –0.40, respectively).

On multivariate analysis, the strongest independent predictor of response was duration of illness, followed by severity of depression. An interaction between severity and duration also was noted.

"It turned out that among patients with longer duration of depression, severity did have a more significant relationship with drug-placebo difference. Among patients with a long duration of depression, patients with severity of at least moderate intensity – a Hamilton score of 21 or greater – showed the greatest drug effects," Dr. Nelson said.

Among patients with depression duration of less than 10 years and an HDRS score of less than 21, the response rates were 46.3% and 41.5% in the drug treatment vs. placebo groups, respectively, with a number needed to treat of 21; among patients with depression duration greater than 10 years and an HDRS score of 21 or greater, the response rates were 58% and 31.4% in the groups, respectively, with a number needed to treat of 4.

Of note, while disease duration and severity appear to identify patients who are more drug responsive, they also identify patients who have a pretty good response to placebo, he added.

That is, patients with a shorter duration of depression and less severe disease tend to have a good placebo response. Such a response is seen in 40%-50% of such patients.

"But of course, this is not just placebo. These are patients who are being seen, usually, on a weekly basis for the first month and then maybe every other week for the remainder of the trial," he explained, noting that the clinical management remains an important aspect of care.

Given that many trials include extensive clinical management along with drug treatment, it cannot be concluded that drug treatment without such management would lead to improvement, he said.

"So is it a mistake to give these patients an antidepressant? I think the mistake is not that you give an antidepressant; the mistake may be [thinking that is] all you need to do," he said. He added: "If clinical management is really accounting for most of the change, you can’t just give an antidepressant and walk away, and not do the clinical management."

A caveat, however, is that the about 50% of patients with short-duration and late-onset depression who do not respond to placebo with clinical management will need further treatment, he said.

Dr. Nelson disclosed that he has received honoraria from Korea Otsuka International Asia Arab Co. and has served as a paid consultant or advisory board member for Bristol-Myers Squibb, Cenestra Health, and other companies. He also has received research support from the National Institute of Mental Health and the Health Resources and Services Administration.

LOS ANGELES – Several types of psychotherapy are effective for late-life depression, studies show. However, the type of control used in those studies plays an important role in the magnitude of the effect size, findings from a systematic review and meta-analysis suggest.

The findings underscore the value of the supportive aspects of care and the importance of good clinical management in late-life depression, regardless of whether medication is used as part of treatment, Dr. Alice X. Huang said at the annual meeting of the American Association for Geriatric Psychiatry.

Several prior reviews have examined the efficacy of psychotherapy for late-life depression. In a 2005 review that included prior reviews and 17 trials, the investigators concluded that cognitive-behavioral therapy, reminiscence therapy, brief dynamic therapy, and combined medication and interpersonal therapy all are "acutely efficacious" for the treatment of major depression in ambulatory adults (Psychiatr. Clin. N. Am. 2005;28:805-20).

Authors of a 2006 review and meta-analysis that included 25 studies concluded, based on the comparable effect size of various types of psychological treatments, that all types of treatment are equally effective (Int. J. Geriatr. Psychiatry 2006;21:1139-49). Meanwhile, authors of a 2009 Cochrane Review and meta-analysis concluded that their findings were constrained by the heterogeneity of trials and the diversity of control conditions used in the various studies (Cochrane Database Syst. Rev. 2008 Jan 23;(1):CD004853).

Taken together, these studies support the use of various types of psychotherapy for late-life depression. But interestingly, no review has looked at the impact of the type of control group used in clinical trials of psychotherapy, which vary widely, including waitlist, treatment as usual, attention control, supportive therapy, and placebo, said Dr. Huang, a third-year psychiatry resident at the University of California, San Francisco.

In their own review and meta-analysis of 27 trials, including 37 psychotherapy vs. control contrasts, Dr. Huang and her colleagues found that the type of control group used in trials of psychotherapy was related to the effect size of the psychotherapy being tested. The standard mean differences (SMDs) were statistically significant between psychotherapy and waitlist control, treatment-as-usual control, attention control, and supportive therapy control, but not placebo control; the SMDs were lower for the supportive therapy, placebo control, and treatment-as-usual groups, compared with the waitlist control and attention control groups.

The findings are in line with the hypothesis that effect sizes would be larger when psychotherapy is compared with less active treatments, and smaller when it is compared with a control that includes significant clinical management, she explained.

Supportive therapy as a control, and placebo, which included extensive clinical management in the studies that were reviewed, both captured many of the elements of psychotherapy that are effective, she noted.

Studies included in the current review and meta-analysis were conducted between 1981 and 2011, and involved a total of 2,229 patients (mean age, 66-81 years). The studies included lasted anywhere from 4 to 28 weeks (median, 8 weeks). Psychotherapies included in the studies were cognitive-behavioral therapy, cognitive therapy, behavioral therapy, problem solving therapy, interpersonal therapy, brief dynamic therapy, bibliotherapy, reminiscence therapy, and variants of these treatments, she said.

The findings suggest that many nonspecific elements of psychotherapy, which are estimated to account for a large percentage of the effect of psychotherapy in older adults according to prior psychotherapy research, are captured by supportive psychotherapy, and this provides evidence for improved clinical management and supportive care in this population, regardless of whether a specific psychotherapy is indicated, she concluded.

Dr. Huang reported having no financial disclosures.

LOS ANGELES – Several types of psychotherapy are effective for late-life depression, studies show. However, the type of control used in those studies plays an important role in the magnitude of the effect size, findings from a systematic review and meta-analysis suggest.

The findings underscore the value of the supportive aspects of care and the importance of good clinical management in late-life depression, regardless of whether medication is used as part of treatment, Dr. Alice X. Huang said at the annual meeting of the American Association for Geriatric Psychiatry.

Several prior reviews have examined the efficacy of psychotherapy for late-life depression. In a 2005 review that included prior reviews and 17 trials, the investigators concluded that cognitive-behavioral therapy, reminiscence therapy, brief dynamic therapy, and combined medication and interpersonal therapy all are "acutely efficacious" for the treatment of major depression in ambulatory adults (Psychiatr. Clin. N. Am. 2005;28:805-20).

Authors of a 2006 review and meta-analysis that included 25 studies concluded, based on the comparable effect size of various types of psychological treatments, that all types of treatment are equally effective (Int. J. Geriatr. Psychiatry 2006;21:1139-49). Meanwhile, authors of a 2009 Cochrane Review and meta-analysis concluded that their findings were constrained by the heterogeneity of trials and the diversity of control conditions used in the various studies (Cochrane Database Syst. Rev. 2008 Jan 23;(1):CD004853).

Taken together, these studies support the use of various types of psychotherapy for late-life depression. But interestingly, no review has looked at the impact of the type of control group used in clinical trials of psychotherapy, which vary widely, including waitlist, treatment as usual, attention control, supportive therapy, and placebo, said Dr. Huang, a third-year psychiatry resident at the University of California, San Francisco.

In their own review and meta-analysis of 27 trials, including 37 psychotherapy vs. control contrasts, Dr. Huang and her colleagues found that the type of control group used in trials of psychotherapy was related to the effect size of the psychotherapy being tested. The standard mean differences (SMDs) were statistically significant between psychotherapy and waitlist control, treatment-as-usual control, attention control, and supportive therapy control, but not placebo control; the SMDs were lower for the supportive therapy, placebo control, and treatment-as-usual groups, compared with the waitlist control and attention control groups.

The findings are in line with the hypothesis that effect sizes would be larger when psychotherapy is compared with less active treatments, and smaller when it is compared with a control that includes significant clinical management, she explained.

Supportive therapy as a control, and placebo, which included extensive clinical management in the studies that were reviewed, both captured many of the elements of psychotherapy that are effective, she noted.

Studies included in the current review and meta-analysis were conducted between 1981 and 2011, and involved a total of 2,229 patients (mean age, 66-81 years). The studies included lasted anywhere from 4 to 28 weeks (median, 8 weeks). Psychotherapies included in the studies were cognitive-behavioral therapy, cognitive therapy, behavioral therapy, problem solving therapy, interpersonal therapy, brief dynamic therapy, bibliotherapy, reminiscence therapy, and variants of these treatments, she said.

The findings suggest that many nonspecific elements of psychotherapy, which are estimated to account for a large percentage of the effect of psychotherapy in older adults according to prior psychotherapy research, are captured by supportive psychotherapy, and this provides evidence for improved clinical management and supportive care in this population, regardless of whether a specific psychotherapy is indicated, she concluded.

Dr. Huang reported having no financial disclosures.

LOS ANGELES – Several types of psychotherapy are effective for late-life depression, studies show. However, the type of control used in those studies plays an important role in the magnitude of the effect size, findings from a systematic review and meta-analysis suggest.

The findings underscore the value of the supportive aspects of care and the importance of good clinical management in late-life depression, regardless of whether medication is used as part of treatment, Dr. Alice X. Huang said at the annual meeting of the American Association for Geriatric Psychiatry.

Several prior reviews have examined the efficacy of psychotherapy for late-life depression. In a 2005 review that included prior reviews and 17 trials, the investigators concluded that cognitive-behavioral therapy, reminiscence therapy, brief dynamic therapy, and combined medication and interpersonal therapy all are "acutely efficacious" for the treatment of major depression in ambulatory adults (Psychiatr. Clin. N. Am. 2005;28:805-20).

Authors of a 2006 review and meta-analysis that included 25 studies concluded, based on the comparable effect size of various types of psychological treatments, that all types of treatment are equally effective (Int. J. Geriatr. Psychiatry 2006;21:1139-49). Meanwhile, authors of a 2009 Cochrane Review and meta-analysis concluded that their findings were constrained by the heterogeneity of trials and the diversity of control conditions used in the various studies (Cochrane Database Syst. Rev. 2008 Jan 23;(1):CD004853).

Taken together, these studies support the use of various types of psychotherapy for late-life depression. But interestingly, no review has looked at the impact of the type of control group used in clinical trials of psychotherapy, which vary widely, including waitlist, treatment as usual, attention control, supportive therapy, and placebo, said Dr. Huang, a third-year psychiatry resident at the University of California, San Francisco.

In their own review and meta-analysis of 27 trials, including 37 psychotherapy vs. control contrasts, Dr. Huang and her colleagues found that the type of control group used in trials of psychotherapy was related to the effect size of the psychotherapy being tested. The standard mean differences (SMDs) were statistically significant between psychotherapy and waitlist control, treatment-as-usual control, attention control, and supportive therapy control, but not placebo control; the SMDs were lower for the supportive therapy, placebo control, and treatment-as-usual groups, compared with the waitlist control and attention control groups.

The findings are in line with the hypothesis that effect sizes would be larger when psychotherapy is compared with less active treatments, and smaller when it is compared with a control that includes significant clinical management, she explained.

Supportive therapy as a control, and placebo, which included extensive clinical management in the studies that were reviewed, both captured many of the elements of psychotherapy that are effective, she noted.

Studies included in the current review and meta-analysis were conducted between 1981 and 2011, and involved a total of 2,229 patients (mean age, 66-81 years). The studies included lasted anywhere from 4 to 28 weeks (median, 8 weeks). Psychotherapies included in the studies were cognitive-behavioral therapy, cognitive therapy, behavioral therapy, problem solving therapy, interpersonal therapy, brief dynamic therapy, bibliotherapy, reminiscence therapy, and variants of these treatments, she said.

The findings suggest that many nonspecific elements of psychotherapy, which are estimated to account for a large percentage of the effect of psychotherapy in older adults according to prior psychotherapy research, are captured by supportive psychotherapy, and this provides evidence for improved clinical management and supportive care in this population, regardless of whether a specific psychotherapy is indicated, she concluded.

Dr. Huang reported having no financial disclosures.

LOS ANGELES – Older adults who screen positive for social disconnectedness in the primary care setting have high levels of depressive symptom severity and a high likelihood of suicide ideation and behavior during their lifetime, according to findings from a survey of 153 patients.

A smaller proportion of the subjects screened positive for current death and suicide ideation, Kimberly A. Van Orden, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

The findings suggest that social disconnectedness is a form of distress that might indicate an elevated suicide risk, according to Dr. Van Orden of the University of Rochester (N.Y.).

The study subjects, mean age 71 years, screened positive for social disconnectedness based on responses to the 9-item Patient Health Questionnaire, or PHQ-9 (a measure of depression symptom severity), the Interpersonal Needs Questionnaire, (a measure of belongingness and perceived burdensomeness), the Geriatric Suicide Ideation Scale, or GSIS (a measure of meaning in life, suicide ideation, and death ideation), and the Paykel Scale (a measure of "worst point" lifetime suicide ideation and behaviors). Substantial proportions of patients indicated having experienced suicide ideation and behaviors, based on the Paykel Scale.

For example, 52% had felt that life was not worth living, 41% had wished they were dead, 41% had thought of taking their own life, 26% had seriously considered suicide or made plans to commit suicide, and 19% had attempted suicide. Furthermore, PHQ-9 responses indicated that 7% of respondents had current death/suicide ideation.

Similarly, GSIS responses indicated that 6% of subjects had wanted to end their life, 6% reported that they would end their life "if things get much worse," 4% said they had recently been thinking a great deal about specific ways to end their life, and 2% said they might end their life if they "could only muster the energy to do so."

The findings are important, because although social disconnectedness is a known risk factor for mental illness and increased risk for suicide in later life, it is not well characterized among older adult primary care patients.

This is a key gap in the literature, particularly given that older adults with depression and other mental health problems are likely to seek treatment through primary care, Dr. Van Orden noted.

Patients in the current study underwent screening in the primary care setting and an in-home baseline psychosocial interview as part of a baseline evaluation for a randomized trial of peer companionship.

The findings underscore the importance of social disconnectedness in older adults, and suggest a possible role for screening and intervention in those affected by it, she said.

"Social disconnectedness is malleable via psychosocial intervention," she concluded. "Thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behavior, and indicate a target for intervention."

This study was funded by grants from the Centers for Disease Control and Prevention, the National Institute of Mental Health, and the National Institutes of Health.

LOS ANGELES – Older adults who screen positive for social disconnectedness in the primary care setting have high levels of depressive symptom severity and a high likelihood of suicide ideation and behavior during their lifetime, according to findings from a survey of 153 patients.

A smaller proportion of the subjects screened positive for current death and suicide ideation, Kimberly A. Van Orden, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

The findings suggest that social disconnectedness is a form of distress that might indicate an elevated suicide risk, according to Dr. Van Orden of the University of Rochester (N.Y.).

The study subjects, mean age 71 years, screened positive for social disconnectedness based on responses to the 9-item Patient Health Questionnaire, or PHQ-9 (a measure of depression symptom severity), the Interpersonal Needs Questionnaire, (a measure of belongingness and perceived burdensomeness), the Geriatric Suicide Ideation Scale, or GSIS (a measure of meaning in life, suicide ideation, and death ideation), and the Paykel Scale (a measure of "worst point" lifetime suicide ideation and behaviors). Substantial proportions of patients indicated having experienced suicide ideation and behaviors, based on the Paykel Scale.

For example, 52% had felt that life was not worth living, 41% had wished they were dead, 41% had thought of taking their own life, 26% had seriously considered suicide or made plans to commit suicide, and 19% had attempted suicide. Furthermore, PHQ-9 responses indicated that 7% of respondents had current death/suicide ideation.

Similarly, GSIS responses indicated that 6% of subjects had wanted to end their life, 6% reported that they would end their life "if things get much worse," 4% said they had recently been thinking a great deal about specific ways to end their life, and 2% said they might end their life if they "could only muster the energy to do so."

The findings are important, because although social disconnectedness is a known risk factor for mental illness and increased risk for suicide in later life, it is not well characterized among older adult primary care patients.

This is a key gap in the literature, particularly given that older adults with depression and other mental health problems are likely to seek treatment through primary care, Dr. Van Orden noted.

Patients in the current study underwent screening in the primary care setting and an in-home baseline psychosocial interview as part of a baseline evaluation for a randomized trial of peer companionship.

The findings underscore the importance of social disconnectedness in older adults, and suggest a possible role for screening and intervention in those affected by it, she said.

"Social disconnectedness is malleable via psychosocial intervention," she concluded. "Thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behavior, and indicate a target for intervention."

This study was funded by grants from the Centers for Disease Control and Prevention, the National Institute of Mental Health, and the National Institutes of Health.

LOS ANGELES – Older adults who screen positive for social disconnectedness in the primary care setting have high levels of depressive symptom severity and a high likelihood of suicide ideation and behavior during their lifetime, according to findings from a survey of 153 patients.

A smaller proportion of the subjects screened positive for current death and suicide ideation, Kimberly A. Van Orden, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

The findings suggest that social disconnectedness is a form of distress that might indicate an elevated suicide risk, according to Dr. Van Orden of the University of Rochester (N.Y.).

The study subjects, mean age 71 years, screened positive for social disconnectedness based on responses to the 9-item Patient Health Questionnaire, or PHQ-9 (a measure of depression symptom severity), the Interpersonal Needs Questionnaire, (a measure of belongingness and perceived burdensomeness), the Geriatric Suicide Ideation Scale, or GSIS (a measure of meaning in life, suicide ideation, and death ideation), and the Paykel Scale (a measure of "worst point" lifetime suicide ideation and behaviors). Substantial proportions of patients indicated having experienced suicide ideation and behaviors, based on the Paykel Scale.

For example, 52% had felt that life was not worth living, 41% had wished they were dead, 41% had thought of taking their own life, 26% had seriously considered suicide or made plans to commit suicide, and 19% had attempted suicide. Furthermore, PHQ-9 responses indicated that 7% of respondents had current death/suicide ideation.

Similarly, GSIS responses indicated that 6% of subjects had wanted to end their life, 6% reported that they would end their life "if things get much worse," 4% said they had recently been thinking a great deal about specific ways to end their life, and 2% said they might end their life if they "could only muster the energy to do so."

The findings are important, because although social disconnectedness is a known risk factor for mental illness and increased risk for suicide in later life, it is not well characterized among older adult primary care patients.

This is a key gap in the literature, particularly given that older adults with depression and other mental health problems are likely to seek treatment through primary care, Dr. Van Orden noted.

Patients in the current study underwent screening in the primary care setting and an in-home baseline psychosocial interview as part of a baseline evaluation for a randomized trial of peer companionship.

The findings underscore the importance of social disconnectedness in older adults, and suggest a possible role for screening and intervention in those affected by it, she said.

"Social disconnectedness is malleable via psychosocial intervention," she concluded. "Thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behavior, and indicate a target for intervention."

This study was funded by grants from the Centers for Disease Control and Prevention, the National Institute of Mental Health, and the National Institutes of Health.

LOS ANGELES – Perceived social support plays an important role in antidepressant medication adherence among older African American adults, particularly women, according to findings from a study of more than 450 patients.

Among the total study population of adults aged over 60 years with significant depression, no significant relationship was seen between perceived social support and 4-month medication adherence (odds ratio, 0.92), but after stratification of results by race, a significant relationship emerged between race, social support and treatment adherence, Dr. Lauren B. Gerlach reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Adherence rates for those with impaired social support were 40% for African American women, 78% for white women, 51% for African American men, and 74% for white men. Adherence rates for those with adequate social support were 52%, 69%, 56%, and 72% for the groups, respectively, according to Dr. Gerlach of the University of Michigan, Ann Arbor.

After adjustment for demographic, illness, site of care, and functional status variables, the differences in adherence between African American women with impaired social support and white women and men with impaired social support remained statistically significant (odds ratios for adherence for white women and men, compared with African American women, 4.82 and 3.50, respectively).

The study comprised 183 subjects recruited from 13 primary care clinics at the University of Michigan, and 269 subjects recruited from primary care or psychiatry outpatient clinics at four Veterans Affairs medical centers in Michigan. They had a mean age of 66 years, and all had a score of at least 5 on the Geriatric Depression Scale and had been given a new antidepressant prescription by their primary care provider or a psychiatrist. Nearly half (46%) had impaired social support on a subscale of the Duke Social Support Index.

Adherence to medication was assessed via the Brief Medication Questionnaire.

"African Americans with impaired social support had the lowest levels of antidepressant medical adherence and may represent a vulnerable population in regards to medication treatment adherence. Factors such as racial perspectives towards mental health care, views on antidepressant medication efficacy, and access to care may be underlying our findings," Dr. Gerlach wrote.

The findings suggest a need for racially sensitive targeted interventions to improve treatment compliance in individuals with low levels of social support, she concluded, noting that such interventions may include social skills training, assessment of quality and quantity of relationships, and encouragement of participation in community and patient advocacy groups.

This study was supported by grants from the National Institute of Mental Health and the VA Health Services Research and Development Service.

LOS ANGELES – Perceived social support plays an important role in antidepressant medication adherence among older African American adults, particularly women, according to findings from a study of more than 450 patients.

Among the total study population of adults aged over 60 years with significant depression, no significant relationship was seen between perceived social support and 4-month medication adherence (odds ratio, 0.92), but after stratification of results by race, a significant relationship emerged between race, social support and treatment adherence, Dr. Lauren B. Gerlach reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Adherence rates for those with impaired social support were 40% for African American women, 78% for white women, 51% for African American men, and 74% for white men. Adherence rates for those with adequate social support were 52%, 69%, 56%, and 72% for the groups, respectively, according to Dr. Gerlach of the University of Michigan, Ann Arbor.

After adjustment for demographic, illness, site of care, and functional status variables, the differences in adherence between African American women with impaired social support and white women and men with impaired social support remained statistically significant (odds ratios for adherence for white women and men, compared with African American women, 4.82 and 3.50, respectively).

The study comprised 183 subjects recruited from 13 primary care clinics at the University of Michigan, and 269 subjects recruited from primary care or psychiatry outpatient clinics at four Veterans Affairs medical centers in Michigan. They had a mean age of 66 years, and all had a score of at least 5 on the Geriatric Depression Scale and had been given a new antidepressant prescription by their primary care provider or a psychiatrist. Nearly half (46%) had impaired social support on a subscale of the Duke Social Support Index.

Adherence to medication was assessed via the Brief Medication Questionnaire.

"African Americans with impaired social support had the lowest levels of antidepressant medical adherence and may represent a vulnerable population in regards to medication treatment adherence. Factors such as racial perspectives towards mental health care, views on antidepressant medication efficacy, and access to care may be underlying our findings," Dr. Gerlach wrote.

The findings suggest a need for racially sensitive targeted interventions to improve treatment compliance in individuals with low levels of social support, she concluded, noting that such interventions may include social skills training, assessment of quality and quantity of relationships, and encouragement of participation in community and patient advocacy groups.

This study was supported by grants from the National Institute of Mental Health and the VA Health Services Research and Development Service.

LOS ANGELES – Perceived social support plays an important role in antidepressant medication adherence among older African American adults, particularly women, according to findings from a study of more than 450 patients.

Among the total study population of adults aged over 60 years with significant depression, no significant relationship was seen between perceived social support and 4-month medication adherence (odds ratio, 0.92), but after stratification of results by race, a significant relationship emerged between race, social support and treatment adherence, Dr. Lauren B. Gerlach reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Adherence rates for those with impaired social support were 40% for African American women, 78% for white women, 51% for African American men, and 74% for white men. Adherence rates for those with adequate social support were 52%, 69%, 56%, and 72% for the groups, respectively, according to Dr. Gerlach of the University of Michigan, Ann Arbor.

After adjustment for demographic, illness, site of care, and functional status variables, the differences in adherence between African American women with impaired social support and white women and men with impaired social support remained statistically significant (odds ratios for adherence for white women and men, compared with African American women, 4.82 and 3.50, respectively).

The study comprised 183 subjects recruited from 13 primary care clinics at the University of Michigan, and 269 subjects recruited from primary care or psychiatry outpatient clinics at four Veterans Affairs medical centers in Michigan. They had a mean age of 66 years, and all had a score of at least 5 on the Geriatric Depression Scale and had been given a new antidepressant prescription by their primary care provider or a psychiatrist. Nearly half (46%) had impaired social support on a subscale of the Duke Social Support Index.

Adherence to medication was assessed via the Brief Medication Questionnaire.

"African Americans with impaired social support had the lowest levels of antidepressant medical adherence and may represent a vulnerable population in regards to medication treatment adherence. Factors such as racial perspectives towards mental health care, views on antidepressant medication efficacy, and access to care may be underlying our findings," Dr. Gerlach wrote.

The findings suggest a need for racially sensitive targeted interventions to improve treatment compliance in individuals with low levels of social support, she concluded, noting that such interventions may include social skills training, assessment of quality and quantity of relationships, and encouragement of participation in community and patient advocacy groups.

This study was supported by grants from the National Institute of Mental Health and the VA Health Services Research and Development Service.

LOS ANGELES – Strong associations exist between depression and chronic medical comorbidities in older adults, according to an analysis of 2009-2010 data from the National Health and Nutrition Examination Survey.

The findings have important implications for treating the aging ill, Dr. Margaret A. Ege reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Among the 2,063 adults aged 60 years and older from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), 5% had major depression and 72.9% had at least one chronic medical comorbidity, including osteoporosis, arthritis, coronary artery disease, gout, diabetes, stroke, asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure. The prevalence of depression was only 1.2% in those with no medical comorbidities, compared with 5.9% in those with at least one comorbidity, according to Dr. Ege of the University of Arkansas for Medical Sciences, Little Rock.

After adjustment for age, race, and gender, the odds ratio for depression in those with one or more comorbidities was 3.4.

The prevalence of depression by medical comorbidity was 7.4% for osteoporosis, 7.1% for arthritis, 7.5% for coronary artery disease, 6.7% for gout, 9.3% for diabetes, 8.9% for stroke, 10% for asthma, 11.9% for COPD, and 11.7% for congestive heart failure.

NHANES participants were screened using questions derived from the nine-item Patient Health Questionnaire (PHQ-9), along with additional questions about multiple medical comorbidities.

"When using a conservative cut-off to make a diagnosis of depression, individuals with arthritis, congestive heart failure, COPD, asthma, and diabetes were all significantly more likely to be depressed. When using a less stringent cut-off, individuals post stroke were also significantly more likely to be depressed," Dr. Ege explained, noting that, in general, higher numbers of chronic medical illnesses were associated with a higher prevalence of comorbid depression.

The findings are important, given the high prevalence of both depression and chronic medical illness in older adults. By some estimates, more than 10% of adults over age 60 years and nearly a third of older adults in residential care meet DSM-IV criteria for major depressive disorder. Even higher rates have been reported among those in nursing homes.

"Many patients and care providers assume that depression is a normal part of aging or a normal consequence of chronic medical illness, leading to less emphasis placed on the diagnosis and treatment of depression in older adults," Dr. Ege wrote.

Depression, however, has been shown to increase mortality in medical conditions such as COPD, end-stage renal disease, and coronary artery disease, she added.

Although the current findings are limited by the cross-sectional nature of the NHANES data and by the self-report of medical comorbidities – which precludes any determination about causality with respect to depression and medical comorbidities – they do suggest a strong association between the two and they underscore the importance of implementing depression screenings in medical clinics, particularly in patients with chronic medical conditions, she concluded.

Dr. Ege had no disclosures.

LOS ANGELES – Strong associations exist between depression and chronic medical comorbidities in older adults, according to an analysis of 2009-2010 data from the National Health and Nutrition Examination Survey.

The findings have important implications for treating the aging ill, Dr. Margaret A. Ege reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Among the 2,063 adults aged 60 years and older from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), 5% had major depression and 72.9% had at least one chronic medical comorbidity, including osteoporosis, arthritis, coronary artery disease, gout, diabetes, stroke, asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure. The prevalence of depression was only 1.2% in those with no medical comorbidities, compared with 5.9% in those with at least one comorbidity, according to Dr. Ege of the University of Arkansas for Medical Sciences, Little Rock.

After adjustment for age, race, and gender, the odds ratio for depression in those with one or more comorbidities was 3.4.

The prevalence of depression by medical comorbidity was 7.4% for osteoporosis, 7.1% for arthritis, 7.5% for coronary artery disease, 6.7% for gout, 9.3% for diabetes, 8.9% for stroke, 10% for asthma, 11.9% for COPD, and 11.7% for congestive heart failure.

NHANES participants were screened using questions derived from the nine-item Patient Health Questionnaire (PHQ-9), along with additional questions about multiple medical comorbidities.

"When using a conservative cut-off to make a diagnosis of depression, individuals with arthritis, congestive heart failure, COPD, asthma, and diabetes were all significantly more likely to be depressed. When using a less stringent cut-off, individuals post stroke were also significantly more likely to be depressed," Dr. Ege explained, noting that, in general, higher numbers of chronic medical illnesses were associated with a higher prevalence of comorbid depression.

The findings are important, given the high prevalence of both depression and chronic medical illness in older adults. By some estimates, more than 10% of adults over age 60 years and nearly a third of older adults in residential care meet DSM-IV criteria for major depressive disorder. Even higher rates have been reported among those in nursing homes.

"Many patients and care providers assume that depression is a normal part of aging or a normal consequence of chronic medical illness, leading to less emphasis placed on the diagnosis and treatment of depression in older adults," Dr. Ege wrote.

Depression, however, has been shown to increase mortality in medical conditions such as COPD, end-stage renal disease, and coronary artery disease, she added.

Although the current findings are limited by the cross-sectional nature of the NHANES data and by the self-report of medical comorbidities – which precludes any determination about causality with respect to depression and medical comorbidities – they do suggest a strong association between the two and they underscore the importance of implementing depression screenings in medical clinics, particularly in patients with chronic medical conditions, she concluded.

Dr. Ege had no disclosures.

LOS ANGELES – Strong associations exist between depression and chronic medical comorbidities in older adults, according to an analysis of 2009-2010 data from the National Health and Nutrition Examination Survey.

The findings have important implications for treating the aging ill, Dr. Margaret A. Ege reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Among the 2,063 adults aged 60 years and older from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), 5% had major depression and 72.9% had at least one chronic medical comorbidity, including osteoporosis, arthritis, coronary artery disease, gout, diabetes, stroke, asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure. The prevalence of depression was only 1.2% in those with no medical comorbidities, compared with 5.9% in those with at least one comorbidity, according to Dr. Ege of the University of Arkansas for Medical Sciences, Little Rock.

After adjustment for age, race, and gender, the odds ratio for depression in those with one or more comorbidities was 3.4.

The prevalence of depression by medical comorbidity was 7.4% for osteoporosis, 7.1% for arthritis, 7.5% for coronary artery disease, 6.7% for gout, 9.3% for diabetes, 8.9% for stroke, 10% for asthma, 11.9% for COPD, and 11.7% for congestive heart failure.

NHANES participants were screened using questions derived from the nine-item Patient Health Questionnaire (PHQ-9), along with additional questions about multiple medical comorbidities.

"When using a conservative cut-off to make a diagnosis of depression, individuals with arthritis, congestive heart failure, COPD, asthma, and diabetes were all significantly more likely to be depressed. When using a less stringent cut-off, individuals post stroke were also significantly more likely to be depressed," Dr. Ege explained, noting that, in general, higher numbers of chronic medical illnesses were associated with a higher prevalence of comorbid depression.

The findings are important, given the high prevalence of both depression and chronic medical illness in older adults. By some estimates, more than 10% of adults over age 60 years and nearly a third of older adults in residential care meet DSM-IV criteria for major depressive disorder. Even higher rates have been reported among those in nursing homes.

"Many patients and care providers assume that depression is a normal part of aging or a normal consequence of chronic medical illness, leading to less emphasis placed on the diagnosis and treatment of depression in older adults," Dr. Ege wrote.

Depression, however, has been shown to increase mortality in medical conditions such as COPD, end-stage renal disease, and coronary artery disease, she added.

Although the current findings are limited by the cross-sectional nature of the NHANES data and by the self-report of medical comorbidities – which precludes any determination about causality with respect to depression and medical comorbidities – they do suggest a strong association between the two and they underscore the importance of implementing depression screenings in medical clinics, particularly in patients with chronic medical conditions, she concluded.

Dr. Ege had no disclosures.

LOS ANGELES – Anhedonia is typically thought of as part of depression, but findings from a study of patients with Alzheimer’s disease suggest that this common but poorly understood aspect of AD is a dissociable construct.

If confirmed in larger trials, the findings suggest that parsing anhedonia as a separate construct could allow for the condition to be treated separately, potentially enriching affected patients’ quality of life, Laura E. Natta reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

"Mood symptoms can adversely affect executive functioning, especially working memory, which has ramifications for successful management of day-to-day activities," she explained.

Of 87 patients with mild to moderate AD who were included in the study, 8 had both depression and anhedonia, 12 had only anhedonia, 25 had only depression, and 34 had neither condition. Eight participants were excluded due to their inability to complete the full neuropsychological battery. Those with both depression and anhedonia had significantly poorer working memory as measured with the Wechsler Adult Intelligence Scale-III Digit Span Backwards test (WAIS-III DSB) than did those with only depression and those with neither condition (mean scores of 2.4, 5.1, and 4.1 digits, respectively). Those with only anhedonia had significantly poorer working memory than did those with only depression (mean scores of 3.7 and 5.1 digits, respectively), said Ms. Natta of the Brain Behavior and Aging Research Center of the Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles.

"Although not significant, on DSB the group with anhedonia performed better than the group with both depression and anhedonia. There was no significant difference between the anhedonia group and the group with neither depression nor anhedonia on the DSB," she said.

The findings demonstrate that the effect of combined depression and anhedonia on working memory is greater than the effect of anhedonia alone, and that anhedonia, via its effect on working memory, may contribute to difficulties with activities of daily living among patients with AD.

Though limited by a small sample size, a limited measure of anhedonia, and a lack of adjustment for other cognitive symptoms, the findings supplement those from other recent studies demonstrating that nondemented depressed patients with anhedonia have a cognitive profile that differs substantially from nondemented depressed patients without anhedonia, suggesting this is also the case in patients with AD, Ms. Natta noted.

The study comprised 17 women and 70 men, mean age 79 years. All underwent clinical assessment via the Mini Mental State Exam, the Mattis Dementia Rating Scale, and the WAIS-III Digit Span Forwards and Digit Span Backwards. Global symptoms of depression were assessed with the Hamilton Depression Scale or the Cornell Scale for Depression in Dementia. Anhedonia was assessed with the global specific rating on the Social-Emotional Withdrawal Scale on the Assessment of Negative Symptoms in AD.

Further clarification of the nature and influence of anhedonia in patients with and without depression is needed, given the potentially important diagnostic and treatment implications of the findings, not only for patients with AD, but for those with various other psychiatric and neurological disorders as well, she concluded.

Support for this study was provided by the National Institute of Mental Health. Support was also provided by Merit Review and CDA to individual authors.

LOS ANGELES – Anhedonia is typically thought of as part of depression, but findings from a study of patients with Alzheimer’s disease suggest that this common but poorly understood aspect of AD is a dissociable construct.

If confirmed in larger trials, the findings suggest that parsing anhedonia as a separate construct could allow for the condition to be treated separately, potentially enriching affected patients’ quality of life, Laura E. Natta reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

"Mood symptoms can adversely affect executive functioning, especially working memory, which has ramifications for successful management of day-to-day activities," she explained.

Of 87 patients with mild to moderate AD who were included in the study, 8 had both depression and anhedonia, 12 had only anhedonia, 25 had only depression, and 34 had neither condition. Eight participants were excluded due to their inability to complete the full neuropsychological battery. Those with both depression and anhedonia had significantly poorer working memory as measured with the Wechsler Adult Intelligence Scale-III Digit Span Backwards test (WAIS-III DSB) than did those with only depression and those with neither condition (mean scores of 2.4, 5.1, and 4.1 digits, respectively). Those with only anhedonia had significantly poorer working memory than did those with only depression (mean scores of 3.7 and 5.1 digits, respectively), said Ms. Natta of the Brain Behavior and Aging Research Center of the Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles.

"Although not significant, on DSB the group with anhedonia performed better than the group with both depression and anhedonia. There was no significant difference between the anhedonia group and the group with neither depression nor anhedonia on the DSB," she said.

The findings demonstrate that the effect of combined depression and anhedonia on working memory is greater than the effect of anhedonia alone, and that anhedonia, via its effect on working memory, may contribute to difficulties with activities of daily living among patients with AD.

Though limited by a small sample size, a limited measure of anhedonia, and a lack of adjustment for other cognitive symptoms, the findings supplement those from other recent studies demonstrating that nondemented depressed patients with anhedonia have a cognitive profile that differs substantially from nondemented depressed patients without anhedonia, suggesting this is also the case in patients with AD, Ms. Natta noted.

The study comprised 17 women and 70 men, mean age 79 years. All underwent clinical assessment via the Mini Mental State Exam, the Mattis Dementia Rating Scale, and the WAIS-III Digit Span Forwards and Digit Span Backwards. Global symptoms of depression were assessed with the Hamilton Depression Scale or the Cornell Scale for Depression in Dementia. Anhedonia was assessed with the global specific rating on the Social-Emotional Withdrawal Scale on the Assessment of Negative Symptoms in AD.

Further clarification of the nature and influence of anhedonia in patients with and without depression is needed, given the potentially important diagnostic and treatment implications of the findings, not only for patients with AD, but for those with various other psychiatric and neurological disorders as well, she concluded.

Support for this study was provided by the National Institute of Mental Health. Support was also provided by Merit Review and CDA to individual authors.

LOS ANGELES – Anhedonia is typically thought of as part of depression, but findings from a study of patients with Alzheimer’s disease suggest that this common but poorly understood aspect of AD is a dissociable construct.

If confirmed in larger trials, the findings suggest that parsing anhedonia as a separate construct could allow for the condition to be treated separately, potentially enriching affected patients’ quality of life, Laura E. Natta reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

"Mood symptoms can adversely affect executive functioning, especially working memory, which has ramifications for successful management of day-to-day activities," she explained.

Of 87 patients with mild to moderate AD who were included in the study, 8 had both depression and anhedonia, 12 had only anhedonia, 25 had only depression, and 34 had neither condition. Eight participants were excluded due to their inability to complete the full neuropsychological battery. Those with both depression and anhedonia had significantly poorer working memory as measured with the Wechsler Adult Intelligence Scale-III Digit Span Backwards test (WAIS-III DSB) than did those with only depression and those with neither condition (mean scores of 2.4, 5.1, and 4.1 digits, respectively). Those with only anhedonia had significantly poorer working memory than did those with only depression (mean scores of 3.7 and 5.1 digits, respectively), said Ms. Natta of the Brain Behavior and Aging Research Center of the Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles.

"Although not significant, on DSB the group with anhedonia performed better than the group with both depression and anhedonia. There was no significant difference between the anhedonia group and the group with neither depression nor anhedonia on the DSB," she said.

The findings demonstrate that the effect of combined depression and anhedonia on working memory is greater than the effect of anhedonia alone, and that anhedonia, via its effect on working memory, may contribute to difficulties with activities of daily living among patients with AD.

Though limited by a small sample size, a limited measure of anhedonia, and a lack of adjustment for other cognitive symptoms, the findings supplement those from other recent studies demonstrating that nondemented depressed patients with anhedonia have a cognitive profile that differs substantially from nondemented depressed patients without anhedonia, suggesting this is also the case in patients with AD, Ms. Natta noted.

The study comprised 17 women and 70 men, mean age 79 years. All underwent clinical assessment via the Mini Mental State Exam, the Mattis Dementia Rating Scale, and the WAIS-III Digit Span Forwards and Digit Span Backwards. Global symptoms of depression were assessed with the Hamilton Depression Scale or the Cornell Scale for Depression in Dementia. Anhedonia was assessed with the global specific rating on the Social-Emotional Withdrawal Scale on the Assessment of Negative Symptoms in AD.

Further clarification of the nature and influence of anhedonia in patients with and without depression is needed, given the potentially important diagnostic and treatment implications of the findings, not only for patients with AD, but for those with various other psychiatric and neurological disorders as well, she concluded.

Support for this study was provided by the National Institute of Mental Health. Support was also provided by Merit Review and CDA to individual authors.

LOS ANGELES – Hallucinations in patients with schizophrenia do not appear to remain stable in later life, a longitudinal cohort study has shown.

The findings also suggest that the disappearance and reemergence of hallucinations in later life are modulated by negative symptoms and community integration, Dr. Audra Yadack reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

The point prevalence of hallucinations was fairly low among the 103 patients in the study who were followed for a mean of 52 months, with only 33% of patients affected at baseline and 26% affected at follow-up, but because of symptom fluctuations, 43% had hallucinations during the study period.

"Notably, only 16% of patients had hallucinations at both [baseline] and [follow-up], 57% never had hallucinations, 10% developed hallucinations, and 17% no longer had hallucinations [at follow-up]," wrote Dr. Yadack of the State University of New York Downstate Medical Center, Brooklyn.

Four baseline factors were found on logistic regression analysis to be significant predictors of hallucinations at follow-up, including the presence of hallucinations (odds ratio, 9.66); nonremitting negative symptoms, as indicated by a Positive and Negative Syndrome Scale score of greater than 3 on all seven negative symptoms (OR, 9.07); a lower Community Integration Questionnaire score (OR, 0.50); and use of more mental health services (OR, 1.04).

Furthermore, the presence of hallucinations at baseline did not significantly correlate with any clinical variables at follow-up, and higher Community Integration Questionnaire scores and more confidantes at baseline were significantly associated with the disappearance of hallucinations between baseline and follow-up, she noted.

Patients included in this analysis were a mean age of 61 years and developed schizophrenia prior to age 45 years. The presence of hallucinations was assessed using self-reports of auditory, visual, or olfactory symptoms on a semistructured questionnaire.

The findings, which are important given the paucity of data on the prevalence of, course of, and factors associated with hallucinations in older adults with schizophrenia, highlight several predictors of hallucinations that could serve as points for clinical intervention, according to Dr. Yadack.

"One key measure, community integration – a measure of independent living, life quality, and social engagement – seemed to have a bidirectional relationship with hallucinations," she wrote, explaining that community integration predicted hallucinations at baseline, and hallucinations at baseline predicted lower community integration at follow-up.

Negative symptoms at baseline also were predictors of hallucinations at follow-up – a finding that is consistent with those in younger samples showing that negative and positive symptoms might co-occur, she noted, adding that "total mental health services were associated with a greater likelihood of hallucinations, suggesting that identifying age-appropriate and targeted strategies for enhancing community integration and diminishing negative symptoms may help increase the likelihood of the remission of hallucinations."

This study was funded by grants from the National Institute of General Medical Sciences.

LOS ANGELES – Hallucinations in patients with schizophrenia do not appear to remain stable in later life, a longitudinal cohort study has shown.

The findings also suggest that the disappearance and reemergence of hallucinations in later life are modulated by negative symptoms and community integration, Dr. Audra Yadack reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

The point prevalence of hallucinations was fairly low among the 103 patients in the study who were followed for a mean of 52 months, with only 33% of patients affected at baseline and 26% affected at follow-up, but because of symptom fluctuations, 43% had hallucinations during the study period.

"Notably, only 16% of patients had hallucinations at both [baseline] and [follow-up], 57% never had hallucinations, 10% developed hallucinations, and 17% no longer had hallucinations [at follow-up]," wrote Dr. Yadack of the State University of New York Downstate Medical Center, Brooklyn.

Four baseline factors were found on logistic regression analysis to be significant predictors of hallucinations at follow-up, including the presence of hallucinations (odds ratio, 9.66); nonremitting negative symptoms, as indicated by a Positive and Negative Syndrome Scale score of greater than 3 on all seven negative symptoms (OR, 9.07); a lower Community Integration Questionnaire score (OR, 0.50); and use of more mental health services (OR, 1.04).

Furthermore, the presence of hallucinations at baseline did not significantly correlate with any clinical variables at follow-up, and higher Community Integration Questionnaire scores and more confidantes at baseline were significantly associated with the disappearance of hallucinations between baseline and follow-up, she noted.

Patients included in this analysis were a mean age of 61 years and developed schizophrenia prior to age 45 years. The presence of hallucinations was assessed using self-reports of auditory, visual, or olfactory symptoms on a semistructured questionnaire.

The findings, which are important given the paucity of data on the prevalence of, course of, and factors associated with hallucinations in older adults with schizophrenia, highlight several predictors of hallucinations that could serve as points for clinical intervention, according to Dr. Yadack.

"One key measure, community integration – a measure of independent living, life quality, and social engagement – seemed to have a bidirectional relationship with hallucinations," she wrote, explaining that community integration predicted hallucinations at baseline, and hallucinations at baseline predicted lower community integration at follow-up.

Negative symptoms at baseline also were predictors of hallucinations at follow-up – a finding that is consistent with those in younger samples showing that negative and positive symptoms might co-occur, she noted, adding that "total mental health services were associated with a greater likelihood of hallucinations, suggesting that identifying age-appropriate and targeted strategies for enhancing community integration and diminishing negative symptoms may help increase the likelihood of the remission of hallucinations."

This study was funded by grants from the National Institute of General Medical Sciences.

LOS ANGELES – Hallucinations in patients with schizophrenia do not appear to remain stable in later life, a longitudinal cohort study has shown.

The findings also suggest that the disappearance and reemergence of hallucinations in later life are modulated by negative symptoms and community integration, Dr. Audra Yadack reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

The point prevalence of hallucinations was fairly low among the 103 patients in the study who were followed for a mean of 52 months, with only 33% of patients affected at baseline and 26% affected at follow-up, but because of symptom fluctuations, 43% had hallucinations during the study period.

"Notably, only 16% of patients had hallucinations at both [baseline] and [follow-up], 57% never had hallucinations, 10% developed hallucinations, and 17% no longer had hallucinations [at follow-up]," wrote Dr. Yadack of the State University of New York Downstate Medical Center, Brooklyn.

Four baseline factors were found on logistic regression analysis to be significant predictors of hallucinations at follow-up, including the presence of hallucinations (odds ratio, 9.66); nonremitting negative symptoms, as indicated by a Positive and Negative Syndrome Scale score of greater than 3 on all seven negative symptoms (OR, 9.07); a lower Community Integration Questionnaire score (OR, 0.50); and use of more mental health services (OR, 1.04).

Furthermore, the presence of hallucinations at baseline did not significantly correlate with any clinical variables at follow-up, and higher Community Integration Questionnaire scores and more confidantes at baseline were significantly associated with the disappearance of hallucinations between baseline and follow-up, she noted.

Patients included in this analysis were a mean age of 61 years and developed schizophrenia prior to age 45 years. The presence of hallucinations was assessed using self-reports of auditory, visual, or olfactory symptoms on a semistructured questionnaire.

The findings, which are important given the paucity of data on the prevalence of, course of, and factors associated with hallucinations in older adults with schizophrenia, highlight several predictors of hallucinations that could serve as points for clinical intervention, according to Dr. Yadack.

"One key measure, community integration – a measure of independent living, life quality, and social engagement – seemed to have a bidirectional relationship with hallucinations," she wrote, explaining that community integration predicted hallucinations at baseline, and hallucinations at baseline predicted lower community integration at follow-up.

Negative symptoms at baseline also were predictors of hallucinations at follow-up – a finding that is consistent with those in younger samples showing that negative and positive symptoms might co-occur, she noted, adding that "total mental health services were associated with a greater likelihood of hallucinations, suggesting that identifying age-appropriate and targeted strategies for enhancing community integration and diminishing negative symptoms may help increase the likelihood of the remission of hallucinations."

This study was funded by grants from the National Institute of General Medical Sciences.

LOS ANGELES – Data continue to affirm the efficacy of electroconvulsive therapy, or ECT, for the treatment of major depression and other mood disorders, and numerous studies show that the benefits are particularly pronounced in older patients.

ECT experts at the annual meeting of the American Association for Geriatric Psychiatry shared some of these findings, along with newer data on optimal electrode placement, and an emerging indication for electroconvulsive therapy.

CORE age-related findings

Among adults aged 18-85 who were treated with ECT for unipolar depression in one study, for example, older patients responded better than did younger patients, Dr. Georgios Petrides said.

That study, the first from CORE (the Consortium for Research in Electroconvulsive Therapy), compared ECT with combination antidepressant/antipsychotic pharmacotherapy as a strategy for depression relapse prevention in 201 patients who had remitted after a course of bilateral ECT. Patients from five sites were randomized to receive either 10 continuation ECT treatments or 6 months of treatment with lithium and nortriptyline, said Dr. Petrides of the department of psychiatry at the Albert Einstein College of Medicine, New York, and director of ECT research at the Zucker Hillside Hospital, Glen Oaks, N.Y.

Both groups fared better than a historical placebo control group, but did not differ significantly from each other with respect to remission rates; 46% of patients in both groups remained in remission. Also, no differences were seen between the groups with respect to time to relapse among those who did not remain in remission (Arch. Gen. Psychiatry 2006;63:1337-44).

However, a later analysis of CORE data by age (18-45 years; 46-64 years; and 65 years and older) showed that the remission rates were significantly greater – at up to 90% – for the older patients, compared with the youngest group, Dr. Petrides said.

Of note, relapse rates were lower among patients with psychotic depression, compared with those with non-psychotic depression, and the age-based advantage also was apparent among those with psychotic depression, he said.

Age and electrode placement

A more recent CORE study looking at electrode placement for optimal efficacy and minimal cognitive impairment demonstrated age-based differences in outcomes as well.

In a randomized, controlled, double-blind trial, outcomes in 230 patients with major depression and a mean age of nearly 60 years were found to be similar with a novel bifrontal placement using 1.5 times the seizure threshold, a standard bitemporal placement using 1.5 times the seizure threshold, and with standard right unilateral placement using 6 times seizure threshold, Dr. Charles H. Kellner said.

All placements resulted in clinically and statistically significant improvements, with remission rates, based on strict remission criteria, of 61%, 64%, and 55% for the bifrontal, bitemporal, and right unilateral placements, respectively.

Using less strict criteria for response rather than remission, the rates for the three groups were 79%, 82%, and 73%%, respectively, noted Dr. Kellner, professor of psychiatry and director of the division of geriatric psychiatry at Mount Sinai School of Medicine, New York (Br. J. Psychiatry 2010;196:226-34).

A more rapid decline in symptoms was seen with bitemporal placement.

"So the take-home message there, is that if you have an urgently ill patient, either psychiatrically or medically, than bilateral electrode placement should be considered for them," said Dr. Kellner, who also is director of the ECT service at Mount Sinai Hospital.

Also of note, the remission rate was "remarkably greater" with right unilateral electrode placement in those over age 65 years, compared with younger patients (nearly 75% vs. about 40%-50%), and the remission rate was worse for bifrontal placement in those over age 65 years, compared with younger patient (about 45% vs. 65%).

"If this finding is replicated – and we’ve already partially replicated it (in the Prolonging Remission in Depressed Elderly [PRIDE] study)," he said. "This is good news that for geriatric patients, right unilateral ECT, the more benign form of the treatment, may be preferentially effective."

The finding that certain placements are better or worse in certain patients or age groups underscores the need for making all placements available, and choosing the one that is most appropriate for a patient’s individual circumstances, and the finding that all three electrode placements are effective underscores the argument that "ECT in contemporary practice is not a technical issue." He added, explaining that the data are clear about the effects of ECT, and that it is important to "fight to continue to get it accepted as a standard treatment – to move it up on the treatment algorithm so it is not considered a last resort for treatment."

Among the concerns about ECT that have impeded efforts to "move it up on the treatment algorithm" are those having to do with cognitive effects. Cognitive effects should be considered a tolerability issue rather than a safety issue when it comes to ECT, but regardless, in this study, almost no differences were found with respect to cognitive effects between the three placements studied, he said.

One exception was with reorientation.

"Patients wake up much more easily from right unilateral ECT," he said, noting that this also appears true in the PRIDE study, which is an ongoing evaluation of right unilateral ultrabrief pulse ECT.

Right unilateral ultrabrief pulse ECT

Preliminary data from the PRIDE trial also suggest that right unilateral ultrabrief pulse ECT is extremely effective in elderly patients: Of the first 152 patients from that study, 62% experienced remission, 11% did not, and 27% dropped out of the study.

The patients in that multicenter study have a mean age of 70 years and severe depression.

An interesting finding is that a small percentage of patients "get completely well with a short course of ECT," Dr. Kellner said.

Although most require the usual treatment course and some might require a longer treatment course, some remit very quickly. Thus, it is inappropriate to prescribe a fixed number of treatments in advance.

Also, as has been well documented in other ECT studies, outcomes with right unilateral ultrabrief pulse ECT improve with age.

"The older you get, the better ECT works," he said.

Remission rates were 62%-67% for those aged 70-79 years and 80 years or older, compared with 59% for those aged 60-69 years.

An emerging ECT indication: agitation

Among newer indications for ECT in older patients is agitation in dementia, according to Dr. Robert M. Greenberg.

Dementia is generally not a contraindication to ECT, and although most data on ECT in dementia involve patients with comorbid depression and/or psychosis, many case reports and two small case series suggest that it is effective for agitation alone in patients with dementia, said Dr. Greenberg, director of geriatric services and chief of geriatric psychiatry and ECT services at Lutheran Medical Center, Brooklyn, N.Y.

Behavioral and psychological symptoms, including agitation, occurs at some point in up to 90% of patients with dementia, and agitation and aggression occur in 60%-80% of patients with Alzheimer’s disease. These symptoms account for much of the functional impairment, caregiver burden, hospitalization, and health care costs in dementia patients, and treatment options are limited, he said.

Case reports over the past 2 decades suggest that anywhere from two to eight courses of ECT result in up to 12 months of improvement in symptoms, in some cases with monthly maintenance ECT or repeat courses.

In the largest retrospective case series published to date, 15 of 16 patients who underwent a mean of nine treatments – mostly administered bilaterally – experienced improvement in symptoms, Dr. Greenberg said.

Patients in that study included eight patients with Alzheimer’s disease. Three had mild dementia, eight had moderate-to-severe dementia, and five had severe dementia. Only two patients experienced severe postictal confusion (Am. J. Geriatr. Psychiatry 2012;20:61-72).

Although the evidence base for ECT for agitation in dementia remains fairly weak, the existing data do provide some support for its use. In the cases reported, ECT was usually a last resort after failure of multiple pharmacologic and nonpharmacologic approaches, the impact of behavioral disturbance was severe, and reported benefits were usually of major clinical significance, Dr. Greenberg said, noting also that when addressed, global cognitive function was usually improved following ECT.

Thus, ECT is a reasonable option for dementia with severe agitation in cases after a careful diagnostic evaluation, including assessment for inciting/exacerbating causes, and after failure of behavioral and pharmacologic management.

In patients for whom ECT is deemed appropriate – and for whom proper consent is obtained – Dr. Greenberg recommended starting with titrated unilateral ultrabrief pulse stimulus (in nonemergent cases), and widening the treatment interval if the patients experience significant cognitive worsening.

ECT should be stopped when improvement plateaus, he said.

Also, consider an ECT taper to ensure stability of response and to allow for optimization of continuation pharmacotherapy, he said.

Continuation ECT can be considered if symptoms recur.

Environmental triggers of agitation also should be addressed, he said.

Dr. Petrides and Dr. Greenberg reported having no disclosures relevant to their presentations. Dr. Kellner reported receiving research support from the National Institute of Mental Health. He also reported serving as a paid contributor to UpToDate, a clinical decision support service and as a paid ECT course teacher at Northshore-LIJ Health System.

LOS ANGELES – Data continue to affirm the efficacy of electroconvulsive therapy, or ECT, for the treatment of major depression and other mood disorders, and numerous studies show that the benefits are particularly pronounced in older patients.

ECT experts at the annual meeting of the American Association for Geriatric Psychiatry shared some of these findings, along with newer data on optimal electrode placement, and an emerging indication for electroconvulsive therapy.

CORE age-related findings

Among adults aged 18-85 who were treated with ECT for unipolar depression in one study, for example, older patients responded better than did younger patients, Dr. Georgios Petrides said.

That study, the first from CORE (the Consortium for Research in Electroconvulsive Therapy), compared ECT with combination antidepressant/antipsychotic pharmacotherapy as a strategy for depression relapse prevention in 201 patients who had remitted after a course of bilateral ECT. Patients from five sites were randomized to receive either 10 continuation ECT treatments or 6 months of treatment with lithium and nortriptyline, said Dr. Petrides of the department of psychiatry at the Albert Einstein College of Medicine, New York, and director of ECT research at the Zucker Hillside Hospital, Glen Oaks, N.Y.

Both groups fared better than a historical placebo control group, but did not differ significantly from each other with respect to remission rates; 46% of patients in both groups remained in remission. Also, no differences were seen between the groups with respect to time to relapse among those who did not remain in remission (Arch. Gen. Psychiatry 2006;63:1337-44).

However, a later analysis of CORE data by age (18-45 years; 46-64 years; and 65 years and older) showed that the remission rates were significantly greater – at up to 90% – for the older patients, compared with the youngest group, Dr. Petrides said.

Of note, relapse rates were lower among patients with psychotic depression, compared with those with non-psychotic depression, and the age-based advantage also was apparent among those with psychotic depression, he said.

Age and electrode placement

A more recent CORE study looking at electrode placement for optimal efficacy and minimal cognitive impairment demonstrated age-based differences in outcomes as well.

In a randomized, controlled, double-blind trial, outcomes in 230 patients with major depression and a mean age of nearly 60 years were found to be similar with a novel bifrontal placement using 1.5 times the seizure threshold, a standard bitemporal placement using 1.5 times the seizure threshold, and with standard right unilateral placement using 6 times seizure threshold, Dr. Charles H. Kellner said.

All placements resulted in clinically and statistically significant improvements, with remission rates, based on strict remission criteria, of 61%, 64%, and 55% for the bifrontal, bitemporal, and right unilateral placements, respectively.

Using less strict criteria for response rather than remission, the rates for the three groups were 79%, 82%, and 73%%, respectively, noted Dr. Kellner, professor of psychiatry and director of the division of geriatric psychiatry at Mount Sinai School of Medicine, New York (Br. J. Psychiatry 2010;196:226-34).

A more rapid decline in symptoms was seen with bitemporal placement.

"So the take-home message there, is that if you have an urgently ill patient, either psychiatrically or medically, than bilateral electrode placement should be considered for them," said Dr. Kellner, who also is director of the ECT service at Mount Sinai Hospital.

Also of note, the remission rate was "remarkably greater" with right unilateral electrode placement in those over age 65 years, compared with younger patients (nearly 75% vs. about 40%-50%), and the remission rate was worse for bifrontal placement in those over age 65 years, compared with younger patient (about 45% vs. 65%).

"If this finding is replicated – and we’ve already partially replicated it (in the Prolonging Remission in Depressed Elderly [PRIDE] study)," he said. "This is good news that for geriatric patients, right unilateral ECT, the more benign form of the treatment, may be preferentially effective."

The finding that certain placements are better or worse in certain patients or age groups underscores the need for making all placements available, and choosing the one that is most appropriate for a patient’s individual circumstances, and the finding that all three electrode placements are effective underscores the argument that "ECT in contemporary practice is not a technical issue." He added, explaining that the data are clear about the effects of ECT, and that it is important to "fight to continue to get it accepted as a standard treatment – to move it up on the treatment algorithm so it is not considered a last resort for treatment."

Among the concerns about ECT that have impeded efforts to "move it up on the treatment algorithm" are those having to do with cognitive effects. Cognitive effects should be considered a tolerability issue rather than a safety issue when it comes to ECT, but regardless, in this study, almost no differences were found with respect to cognitive effects between the three placements studied, he said.

One exception was with reorientation.

"Patients wake up much more easily from right unilateral ECT," he said, noting that this also appears true in the PRIDE study, which is an ongoing evaluation of right unilateral ultrabrief pulse ECT.

Right unilateral ultrabrief pulse ECT

Preliminary data from the PRIDE trial also suggest that right unilateral ultrabrief pulse ECT is extremely effective in elderly patients: Of the first 152 patients from that study, 62% experienced remission, 11% did not, and 27% dropped out of the study.

The patients in that multicenter study have a mean age of 70 years and severe depression.

An interesting finding is that a small percentage of patients "get completely well with a short course of ECT," Dr. Kellner said.

Although most require the usual treatment course and some might require a longer treatment course, some remit very quickly. Thus, it is inappropriate to prescribe a fixed number of treatments in advance.

Also, as has been well documented in other ECT studies, outcomes with right unilateral ultrabrief pulse ECT improve with age.

"The older you get, the better ECT works," he said.

Remission rates were 62%-67% for those aged 70-79 years and 80 years or older, compared with 59% for those aged 60-69 years.

An emerging ECT indication: agitation

Among newer indications for ECT in older patients is agitation in dementia, according to Dr. Robert M. Greenberg.

Dementia is generally not a contraindication to ECT, and although most data on ECT in dementia involve patients with comorbid depression and/or psychosis, many case reports and two small case series suggest that it is effective for agitation alone in patients with dementia, said Dr. Greenberg, director of geriatric services and chief of geriatric psychiatry and ECT services at Lutheran Medical Center, Brooklyn, N.Y.

Behavioral and psychological symptoms, including agitation, occurs at some point in up to 90% of patients with dementia, and agitation and aggression occur in 60%-80% of patients with Alzheimer’s disease. These symptoms account for much of the functional impairment, caregiver burden, hospitalization, and health care costs in dementia patients, and treatment options are limited, he said.

Case reports over the past 2 decades suggest that anywhere from two to eight courses of ECT result in up to 12 months of improvement in symptoms, in some cases with monthly maintenance ECT or repeat courses.

In the largest retrospective case series published to date, 15 of 16 patients who underwent a mean of nine treatments – mostly administered bilaterally – experienced improvement in symptoms, Dr. Greenberg said.

Patients in that study included eight patients with Alzheimer’s disease. Three had mild dementia, eight had moderate-to-severe dementia, and five had severe dementia. Only two patients experienced severe postictal confusion (Am. J. Geriatr. Psychiatry 2012;20:61-72).

Although the evidence base for ECT for agitation in dementia remains fairly weak, the existing data do provide some support for its use. In the cases reported, ECT was usually a last resort after failure of multiple pharmacologic and nonpharmacologic approaches, the impact of behavioral disturbance was severe, and reported benefits were usually of major clinical significance, Dr. Greenberg said, noting also that when addressed, global cognitive function was usually improved following ECT.

Thus, ECT is a reasonable option for dementia with severe agitation in cases after a careful diagnostic evaluation, including assessment for inciting/exacerbating causes, and after failure of behavioral and pharmacologic management.

In patients for whom ECT is deemed appropriate – and for whom proper consent is obtained – Dr. Greenberg recommended starting with titrated unilateral ultrabrief pulse stimulus (in nonemergent cases), and widening the treatment interval if the patients experience significant cognitive worsening.

ECT should be stopped when improvement plateaus, he said.

Also, consider an ECT taper to ensure stability of response and to allow for optimization of continuation pharmacotherapy, he said.

Continuation ECT can be considered if symptoms recur.

Environmental triggers of agitation also should be addressed, he said.

Dr. Petrides and Dr. Greenberg reported having no disclosures relevant to their presentations. Dr. Kellner reported receiving research support from the National Institute of Mental Health. He also reported serving as a paid contributor to UpToDate, a clinical decision support service and as a paid ECT course teacher at Northshore-LIJ Health System.

LOS ANGELES – Data continue to affirm the efficacy of electroconvulsive therapy, or ECT, for the treatment of major depression and other mood disorders, and numerous studies show that the benefits are particularly pronounced in older patients.

ECT experts at the annual meeting of the American Association for Geriatric Psychiatry shared some of these findings, along with newer data on optimal electrode placement, and an emerging indication for electroconvulsive therapy.

CORE age-related findings

Among adults aged 18-85 who were treated with ECT for unipolar depression in one study, for example, older patients responded better than did younger patients, Dr. Georgios Petrides said.

That study, the first from CORE (the Consortium for Research in Electroconvulsive Therapy), compared ECT with combination antidepressant/antipsychotic pharmacotherapy as a strategy for depression relapse prevention in 201 patients who had remitted after a course of bilateral ECT. Patients from five sites were randomized to receive either 10 continuation ECT treatments or 6 months of treatment with lithium and nortriptyline, said Dr. Petrides of the department of psychiatry at the Albert Einstein College of Medicine, New York, and director of ECT research at the Zucker Hillside Hospital, Glen Oaks, N.Y.

Both groups fared better than a historical placebo control group, but did not differ significantly from each other with respect to remission rates; 46% of patients in both groups remained in remission. Also, no differences were seen between the groups with respect to time to relapse among those who did not remain in remission (Arch. Gen. Psychiatry 2006;63:1337-44).

However, a later analysis of CORE data by age (18-45 years; 46-64 years; and 65 years and older) showed that the remission rates were significantly greater – at up to 90% – for the older patients, compared with the youngest group, Dr. Petrides said.

Of note, relapse rates were lower among patients with psychotic depression, compared with those with non-psychotic depression, and the age-based advantage also was apparent among those with psychotic depression, he said.

Age and electrode placement

A more recent CORE study looking at electrode placement for optimal efficacy and minimal cognitive impairment demonstrated age-based differences in outcomes as well.

In a randomized, controlled, double-blind trial, outcomes in 230 patients with major depression and a mean age of nearly 60 years were found to be similar with a novel bifrontal placement using 1.5 times the seizure threshold, a standard bitemporal placement using 1.5 times the seizure threshold, and with standard right unilateral placement using 6 times seizure threshold, Dr. Charles H. Kellner said.

All placements resulted in clinically and statistically significant improvements, with remission rates, based on strict remission criteria, of 61%, 64%, and 55% for the bifrontal, bitemporal, and right unilateral placements, respectively.

Using less strict criteria for response rather than remission, the rates for the three groups were 79%, 82%, and 73%%, respectively, noted Dr. Kellner, professor of psychiatry and director of the division of geriatric psychiatry at Mount Sinai School of Medicine, New York (Br. J. Psychiatry 2010;196:226-34).

A more rapid decline in symptoms was seen with bitemporal placement.

"So the take-home message there, is that if you have an urgently ill patient, either psychiatrically or medically, than bilateral electrode placement should be considered for them," said Dr. Kellner, who also is director of the ECT service at Mount Sinai Hospital.

Also of note, the remission rate was "remarkably greater" with right unilateral electrode placement in those over age 65 years, compared with younger patients (nearly 75% vs. about 40%-50%), and the remission rate was worse for bifrontal placement in those over age 65 years, compared with younger patient (about 45% vs. 65%).

"If this finding is replicated – and we’ve already partially replicated it (in the Prolonging Remission in Depressed Elderly [PRIDE] study)," he said. "This is good news that for geriatric patients, right unilateral ECT, the more benign form of the treatment, may be preferentially effective."

The finding that certain placements are better or worse in certain patients or age groups underscores the need for making all placements available, and choosing the one that is most appropriate for a patient’s individual circumstances, and the finding that all three electrode placements are effective underscores the argument that "ECT in contemporary practice is not a technical issue." He added, explaining that the data are clear about the effects of ECT, and that it is important to "fight to continue to get it accepted as a standard treatment – to move it up on the treatment algorithm so it is not considered a last resort for treatment."

Among the concerns about ECT that have impeded efforts to "move it up on the treatment algorithm" are those having to do with cognitive effects. Cognitive effects should be considered a tolerability issue rather than a safety issue when it comes to ECT, but regardless, in this study, almost no differences were found with respect to cognitive effects between the three placements studied, he said.

One exception was with reorientation.

"Patients wake up much more easily from right unilateral ECT," he said, noting that this also appears true in the PRIDE study, which is an ongoing evaluation of right unilateral ultrabrief pulse ECT.

Right unilateral ultrabrief pulse ECT

Preliminary data from the PRIDE trial also suggest that right unilateral ultrabrief pulse ECT is extremely effective in elderly patients: Of the first 152 patients from that study, 62% experienced remission, 11% did not, and 27% dropped out of the study.

The patients in that multicenter study have a mean age of 70 years and severe depression.

An interesting finding is that a small percentage of patients "get completely well with a short course of ECT," Dr. Kellner said.

Although most require the usual treatment course and some might require a longer treatment course, some remit very quickly. Thus, it is inappropriate to prescribe a fixed number of treatments in advance.

Also, as has been well documented in other ECT studies, outcomes with right unilateral ultrabrief pulse ECT improve with age.

"The older you get, the better ECT works," he said.

Remission rates were 62%-67% for those aged 70-79 years and 80 years or older, compared with 59% for those aged 60-69 years.

An emerging ECT indication: agitation

Among newer indications for ECT in older patients is agitation in dementia, according to Dr. Robert M. Greenberg.

Dementia is generally not a contraindication to ECT, and although most data on ECT in dementia involve patients with comorbid depression and/or psychosis, many case reports and two small case series suggest that it is effective for agitation alone in patients with dementia, said Dr. Greenberg, director of geriatric services and chief of geriatric psychiatry and ECT services at Lutheran Medical Center, Brooklyn, N.Y.

Behavioral and psychological symptoms, including agitation, occurs at some point in up to 90% of patients with dementia, and agitation and aggression occur in 60%-80% of patients with Alzheimer’s disease. These symptoms account for much of the functional impairment, caregiver burden, hospitalization, and health care costs in dementia patients, and treatment options are limited, he said.

Case reports over the past 2 decades suggest that anywhere from two to eight courses of ECT result in up to 12 months of improvement in symptoms, in some cases with monthly maintenance ECT or repeat courses.

In the largest retrospective case series published to date, 15 of 16 patients who underwent a mean of nine treatments – mostly administered bilaterally – experienced improvement in symptoms, Dr. Greenberg said.

Patients in that study included eight patients with Alzheimer’s disease. Three had mild dementia, eight had moderate-to-severe dementia, and five had severe dementia. Only two patients experienced severe postictal confusion (Am. J. Geriatr. Psychiatry 2012;20:61-72).

Although the evidence base for ECT for agitation in dementia remains fairly weak, the existing data do provide some support for its use. In the cases reported, ECT was usually a last resort after failure of multiple pharmacologic and nonpharmacologic approaches, the impact of behavioral disturbance was severe, and reported benefits were usually of major clinical significance, Dr. Greenberg said, noting also that when addressed, global cognitive function was usually improved following ECT.

Thus, ECT is a reasonable option for dementia with severe agitation in cases after a careful diagnostic evaluation, including assessment for inciting/exacerbating causes, and after failure of behavioral and pharmacologic management.

In patients for whom ECT is deemed appropriate – and for whom proper consent is obtained – Dr. Greenberg recommended starting with titrated unilateral ultrabrief pulse stimulus (in nonemergent cases), and widening the treatment interval if the patients experience significant cognitive worsening.

ECT should be stopped when improvement plateaus, he said.

Also, consider an ECT taper to ensure stability of response and to allow for optimization of continuation pharmacotherapy, he said.

Continuation ECT can be considered if symptoms recur.

Environmental triggers of agitation also should be addressed, he said.

Dr. Petrides and Dr. Greenberg reported having no disclosures relevant to their presentations. Dr. Kellner reported receiving research support from the National Institute of Mental Health. He also reported serving as a paid contributor to UpToDate, a clinical decision support service and as a paid ECT course teacher at Northshore-LIJ Health System.

LOS ANGELES – Certain cognitive measures predict functional ability in older adults with schizophrenia, according to findings from a study involving 110 patients over age 50.

Cognitive deficits are a common and core feature of schizophrenia and are known to be a strong predictor of function in younger adults with the disease. These findings, which indicate that the same is true in older adults, highlight deficits that might be targets for intervention, Angel Y. Liu reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Three of seven tests that are part of the MATRICS Consensus Cognitive Battery – the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), the Hopkins Verbal Learning Test Revised (HVLT-R), and the Trail Making Test (TMT) – were found on regression analysis to be more predictive of functional ability in 76 patients than in 34 healthy controls, said Ms. Liu of the University of Toronto and the Centre for Addiction and Mental Health, Toronto.

Specifically, the MSCEIT, a measure of social cognition, predicted scores for communication on the University of San Diego Performance-Based Skills Assessment–Brief (UPSA), which was used in the study to assess functional competence; the HVLT-R, a measure of verbal memory, predicted scores for finances on the UPSA and on the Medication Management Ability Assessment (MMAA), which also was used to assess functional competence; and the TMT predicted total MMAA score.

Patients in the study were clinically stable community-dwelling adults with a current diagnosis of schizophrenia, and controls were community-dwelling adults who did not meet the criteria for any mental disorder. The patients were more impaired than were controls on all clinical measures, including the Positive and Negative Syndrome Scale (mean scores of 55.3 v.32.8), the Abnormal Involuntary Movement Scale (mean scores of 2.7 vs. 0.5), the Cumulative Illness Rating Scale for Geriatrics (mean scores of 5.9 vs. 2.8), the Simpson Angus Scale (mean scores of 3.6 vs. 0.1), and the Subjective Well-Being on Neuroleptic Medications scale (mean scores of 88.1 vs. 106.5).

"The schizophrenia group was also impaired, compared with the control group, on cognitive and functional measures. While about half of the cognitive measures predicted functional ability in the schizophrenia group, none except one predicted functional ability in the control group," Ms. Liu noted.

Mean scores in the patients vs. controls on MSCEIT, HVLT-R, and the TMT, for example, were 86.8 vs. 98.3, 17.1 vs. 23.0, and 68.3 vs. 45.6, respectively, and mean scores on the UPSA Communication, UPSA Finances, and MMAA total were 127 vs. 16.1, 15.5 vs. 18.4, and 19.6 vs. 24.0, respectively.

Though limited by a ceiling effect in healthy controls, the findings suggest that the MSCEIT, the HVLT-R, and the TMT reveal deficits specific to schizophrenia, she said, noting that targeting these deficits with appropriate interventions could improve function in older patients with schizophrenia.

Identifying methods for improving the care of older patients with schizophrenia is particularly important given the aging of the population; an estimated 20% of patients with schizophrenia will be aged 65 years or older by 2025, she said.

Ms. Liu reported having no disclosures.

[email protected]

LOS ANGELES – Certain cognitive measures predict functional ability in older adults with schizophrenia, according to findings from a study involving 110 patients over age 50.

Cognitive deficits are a common and core feature of schizophrenia and are known to be a strong predictor of function in younger adults with the disease. These findings, which indicate that the same is true in older adults, highlight deficits that might be targets for intervention, Angel Y. Liu reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Three of seven tests that are part of the MATRICS Consensus Cognitive Battery – the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), the Hopkins Verbal Learning Test Revised (HVLT-R), and the Trail Making Test (TMT) – were found on regression analysis to be more predictive of functional ability in 76 patients than in 34 healthy controls, said Ms. Liu of the University of Toronto and the Centre for Addiction and Mental Health, Toronto.

Specifically, the MSCEIT, a measure of social cognition, predicted scores for communication on the University of San Diego Performance-Based Skills Assessment–Brief (UPSA), which was used in the study to assess functional competence; the HVLT-R, a measure of verbal memory, predicted scores for finances on the UPSA and on the Medication Management Ability Assessment (MMAA), which also was used to assess functional competence; and the TMT predicted total MMAA score.

Patients in the study were clinically stable community-dwelling adults with a current diagnosis of schizophrenia, and controls were community-dwelling adults who did not meet the criteria for any mental disorder. The patients were more impaired than were controls on all clinical measures, including the Positive and Negative Syndrome Scale (mean scores of 55.3 v.32.8), the Abnormal Involuntary Movement Scale (mean scores of 2.7 vs. 0.5), the Cumulative Illness Rating Scale for Geriatrics (mean scores of 5.9 vs. 2.8), the Simpson Angus Scale (mean scores of 3.6 vs. 0.1), and the Subjective Well-Being on Neuroleptic Medications scale (mean scores of 88.1 vs. 106.5).

"The schizophrenia group was also impaired, compared with the control group, on cognitive and functional measures. While about half of the cognitive measures predicted functional ability in the schizophrenia group, none except one predicted functional ability in the control group," Ms. Liu noted.

Mean scores in the patients vs. controls on MSCEIT, HVLT-R, and the TMT, for example, were 86.8 vs. 98.3, 17.1 vs. 23.0, and 68.3 vs. 45.6, respectively, and mean scores on the UPSA Communication, UPSA Finances, and MMAA total were 127 vs. 16.1, 15.5 vs. 18.4, and 19.6 vs. 24.0, respectively.

Though limited by a ceiling effect in healthy controls, the findings suggest that the MSCEIT, the HVLT-R, and the TMT reveal deficits specific to schizophrenia, she said, noting that targeting these deficits with appropriate interventions could improve function in older patients with schizophrenia.

Identifying methods for improving the care of older patients with schizophrenia is particularly important given the aging of the population; an estimated 20% of patients with schizophrenia will be aged 65 years or older by 2025, she said.

Ms. Liu reported having no disclosures.

[email protected]

LOS ANGELES – Certain cognitive measures predict functional ability in older adults with schizophrenia, according to findings from a study involving 110 patients over age 50.

Cognitive deficits are a common and core feature of schizophrenia and are known to be a strong predictor of function in younger adults with the disease. These findings, which indicate that the same is true in older adults, highlight deficits that might be targets for intervention, Angel Y. Liu reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Three of seven tests that are part of the MATRICS Consensus Cognitive Battery – the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), the Hopkins Verbal Learning Test Revised (HVLT-R), and the Trail Making Test (TMT) – were found on regression analysis to be more predictive of functional ability in 76 patients than in 34 healthy controls, said Ms. Liu of the University of Toronto and the Centre for Addiction and Mental Health, Toronto.

Specifically, the MSCEIT, a measure of social cognition, predicted scores for communication on the University of San Diego Performance-Based Skills Assessment–Brief (UPSA), which was used in the study to assess functional competence; the HVLT-R, a measure of verbal memory, predicted scores for finances on the UPSA and on the Medication Management Ability Assessment (MMAA), which also was used to assess functional competence; and the TMT predicted total MMAA score.

Patients in the study were clinically stable community-dwelling adults with a current diagnosis of schizophrenia, and controls were community-dwelling adults who did not meet the criteria for any mental disorder. The patients were more impaired than were controls on all clinical measures, including the Positive and Negative Syndrome Scale (mean scores of 55.3 v.32.8), the Abnormal Involuntary Movement Scale (mean scores of 2.7 vs. 0.5), the Cumulative Illness Rating Scale for Geriatrics (mean scores of 5.9 vs. 2.8), the Simpson Angus Scale (mean scores of 3.6 vs. 0.1), and the Subjective Well-Being on Neuroleptic Medications scale (mean scores of 88.1 vs. 106.5).

"The schizophrenia group was also impaired, compared with the control group, on cognitive and functional measures. While about half of the cognitive measures predicted functional ability in the schizophrenia group, none except one predicted functional ability in the control group," Ms. Liu noted.

Mean scores in the patients vs. controls on MSCEIT, HVLT-R, and the TMT, for example, were 86.8 vs. 98.3, 17.1 vs. 23.0, and 68.3 vs. 45.6, respectively, and mean scores on the UPSA Communication, UPSA Finances, and MMAA total were 127 vs. 16.1, 15.5 vs. 18.4, and 19.6 vs. 24.0, respectively.

Though limited by a ceiling effect in healthy controls, the findings suggest that the MSCEIT, the HVLT-R, and the TMT reveal deficits specific to schizophrenia, she said, noting that targeting these deficits with appropriate interventions could improve function in older patients with schizophrenia.

Identifying methods for improving the care of older patients with schizophrenia is particularly important given the aging of the population; an estimated 20% of patients with schizophrenia will be aged 65 years or older by 2025, she said.

Ms. Liu reported having no disclosures.

[email protected]