In This Issue

Atypical antipsychotics are widely used to treat delusions,aggression, and agitation in people with dementia. Some clin-ical trials have not shown efficacy and concerns have beenraised about adverse events. Schneider et al. (page 191), intheir study, statistically combined the 15 placebo-controlledtrials of atypicals by meta-analysis. The resulting small effectsizes support efficacy for aripiprazole and risperidone. Incom-plete reporting limited our ability to estimate response rates.Adverse events, however, limit effectiveness. Atypicals can beconsidered within the context of medical need and the efficacyand safety of alternatives.

Koenig (page 211) examined differences between depressedmedical inpatients with congestive heart failure (CHF)(n�174) and with chronic pulmonary disease (CPD) (n�527)that could impact the cause and management of depression inthis setting. Consecutive patients aged 50 or over werescreened for depressive disorder. CHF patients had greatermedical comorbidity and more severe medical illnesses. CPDpatients had more psychological risk factors such as a pastpsychiatric history, comorbid psychiatric illness and stressfullife events.

Unawareness of emotion is a phenomenon associated withright hemisphere stroke and is one of the factors measured bythe Toronto Alexithymia Scale. Following eight weeks of treat-ment with antidepressant medication, patients with alexithy-mia had a significant improvement in their ability to identifyand describe feelings, but not in their externally orientedthinking. Functional activities of daily living and depressivesymptoms improved in both alexithymic and nonalexithymicpatients. Spelletta et al.’s (page 220) study is the first to showthat the ability to identify and describe emotion followingstroke may be improved by antidepressants.

Francoeur et al. (page 228), in their article, state that screeningfor depression using a single item with a ‘yes/no’ forced-choice format may encourage biased responses in inner-cityminorities who find depression stigmatizing or the healthcaresystem untrustworthy. In response, an open-choice formatwith a category for ambivalent and missing responses wasadministered during the legitimizing context of an outpatientphysical symptom assessment. Findings suggest depression,apathy, and resignation in older minority men may be hiddenfrom clinicians in the absence of the item.

Norton et al.’s (page 237) study reports rates of first-onsetdepressive episode and first-onset major depression in a com-

munity sample of 2,877 non-demented elderly (ages 65-100years) in Cache County, Utah. Compared to inclusion of self-reported depressive symptoms alone, rates were approxi-mately 150% higher when antidepressant use “for depression”and post-mortem interview data were included. First-onsetmajor depression was approximately 2.5 times as likely amongthose with some prior minor depression. Results did not differby age or gender.

Most patients who recover from depression will have futureepisodes of symptomatic deterioration. In a 12-month fol-low-up study of 901 older adults who had partial or fullrecovery from depression, Katon et al. (page 246) found that40% had an episode of significant depressive symptom dete-rioration. Among those treated in usual primary care, initialseverity of depression and a higher number of residualDSM-IV depressive symptoms were significant predictors ofsymptom deterioration.

This study is the first to investigate the relative effectiveness ofcognitive-behavioral therapy (CBT) compared to a SSRI (ser-traline) for anxiety disorders in older adults. Although bothCBT and sertraline led to significant improvement in anxiety,worry and depressive symptoms both at post-treatment and atthree-month follow-up, sertraline showed superior results onworry symptoms. Schuurman et al.’s (page 255) findings sug-gest that the pharmacological treatment of late-life anxietywith SSRI’s has not been given the proper attention in researchto date.

Kris et al. (page 264) studied 175 caregivers of patients receiv-ing hospice to understand the impact of delayed hospice en-rollment on survivors’ well-being. They find that, adjusted forother predictors of depression, family caregivers of patientswho receive hospice only days before death rather than forlonger periods of time at increased risk of major depression inthe year following their loss. The findings identify a targetgroup for whom bereavement services might be most needed.

Chepenik et al. (page 270) surveyed normal older people,those with major depression, and those with other less severedepressions who completed diaries reporting their mood anddaily events each day for a month. All groups demonstratedsignificant day-to-day variability in negative mood. However,negative mood was least dependent on events in those withmajor depression, and most dependent in those with otherdepressions. Results can be used to develop new ways toevaluate responses to treatment.