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Possible changes in cell cycle regulations (eg, cyclins)
Possible changes in extra cellular matrix proteins (eg. Laminin, proteoglycans)
Possible regional decline in cerebral blood flow
Possible regional decline in metabolic rate
Appearance of senile plaque & neurofibrillary tangle
PHARMACODYNAMICS AND AGING Neurotransmitter Pharmacodynamic changes with aging Dopaminergic system Dopamine D 2 receptor in the striatum Cholinergic system Choline acetyl transferase Cholinergic cell numbers Contd...........
Adrenargic system cAMP production in response to beta-agonists Beta – adrenoceptor number Beta – receptor affinity Alpha 2 – adrenoceptor responsiveness Gabaminergic system Psychomotor performance in response to benzodiazepines ? Post – synaptic receptor response to GABA. Contd...........
Points to remember before prescribing medication in elderly Magnitude of effect (clinical response) = Pharmacodynamics x Pharmacokinetics x biological variance
In elderly medical complication of pharmacotherapy alone constitute a highly significant treatable health problem.
Adverse reaction to drugs of all types is seven times higher in those aged 70 to 79 years, than in those 20 to 29 years old.
Non compliance with therapy is a major problem for psychiatric patients, and this dilemma is exacerbated with age.
Age related health problems combines with physiological changes to increase the probability of adverse effect from medication which in turn increase the likelihood of non compliance.
Complexities of medication regimens are further complicated by communication difficulties arising from impaired hearing, cognitive impairment, language & cultural difficulties.
Psychopharmacological Treatment of Geriatric Disorders The psychiatrist of an 87 year old patient suffering from heart disease, arthritis and depression must ask a number of questions to himself. Q. What is the best treatment - Pharmacotherapy? Psychotherapy? E.C.T.? Q. If pharmacotherapy, what is the most appropriate drug? Q. Balancing the adverse effect and efficacy. What is the best dosage? Q. How soon will the patient’s symptom decrease? Q. If the drug is effective. How long will the treatment last? Q. If the drug is ineffective how long should the wait before changing the treatment?
GERIATRIC MANIA Risk of Mania decline in late life, nonetheless mania and hypomania affect 5-10% of psychiatric patients.
Cumulative incidence of depression in people aged upto 70 years is 26.95% for men & 42.5% for women, still most of the drug trials exclude elderly subjects.
In addition, most of the drug trials also exclude subjects with medical comorbidity, which is a rule rather than exception. Hence the results of drug trials done in young adults can't be generalized to elderly.
… Antidepressants in old age depression contd.
Prior to 1995, there were occasional studies which evaluated the use of antidepressants in elderly. But fortunately in the last 10 years many studies have evaluated the use of antidepressants in the elderly.
These studies can be broadly classified as:
comparative studies using either placebo or another antidepressant or both and
meta-analyses of the above studies.
Antidepressant Drugs and Dosages Preferred for Use in the Elderly