Drug Aging
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Dementia, delirium and depression are the 3 most prevalent mental disorders in the elderly. While dementia and depression are prevalent in the community, hospitals and nursing homes, delirium is seen most often in acute care hospitals. Much of the management of these syndromes is undertaken by primary care physicians rather than psychiatrists. ⋯ Although no current medications have been shown to have a significant effect on the functional status of patients with the 2 most common causes of dementia, Alzheimer's disease and multi-infarct dementia, the management of concomitant illness in these patients may result in improved function for as long as a year. Tacrine, an anticholinesterase inhibitor, improves cognitive function slightly in selected patients with Alzheimer's disease over short periods. Finally, the treatment of depression with medications or electroconvulsive therapy (ECT) results in significant reductions in mortality and morbidity.
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Post-herpetic neuralgia (PHN) is a disease caused by having had herpes zoster; it is not a continuation of shingles. Up to 50% of elderly patients who have had shingles may develop PHN. PHN is defined as pain recurring or continuing at the site of shingles, 1 or more months after the onset of the rash. ⋯ If patients with acute shingles are given low dose amitriptyline from the onset, only half as many are in pain at 6 months as a group not so treated, irrespective of the antiviral treatments given. The most effective treatment of established PHN to date consists of adrenergically active antidepressants. There is a strict correlation with the brevity of the interval between acute shingles and initiation of such treatment. 75% of patients starting treatment with antidepressants within 3 to 6 months after shingles obtain pain relief, whereas if antidepressants are not started for 2 years, only 25% obtain pain relief.(ABSTRACT TRUNCATED AT 250 WORDS)