The treatment of bipolar disorder in the elderly

2017 ◽  
Author(s):  
Gilberto Sousa Alves ◽  
Felipe Kenji Sudo ◽  
Johannes Pantel
Keyword(s):  
Bipolar Disorder ◽  
Gold Standard ◽  
Atypical Antipsychotics ◽  
Extended Release ◽  
Ethical Issues ◽  
The Elderly ◽  
Evidence Based ◽  
Pharmacological Interventions ◽  
First Line ◽  
Evidence Based Guidelines

Bipolar disorder (BD) is an extremely disabling condition characterized by mood switches, and cognitive and functional impairment. The current chapter discusses the updated review on pharmacological and non-pharmacological interventions targeting BD in the elderly. The risk of concurrent medical diseases (eg, metabolic syndrome) and relatively lower tolerability than young BD make the patient safety a major concern in most cases. Evidence-based guidelines, although useful for promoting rational and effective therapy, are generally lacking in elderly BD. Current recommendations for acute mania include atypical antipsychotics, careful use of lithium, and election of valproate as the gold-standard therapy. In acute BD depression, first-line agents in monotherapy may include lithium, lamotrigine, quetiapine, and quetiapine extended release (XR). Electroconvulsive therapy may be an option for severe/refractory cases. Family members or caregivers should be encouraged to support the patient, since potential ethical issues involving patrimony or profession may arise during the treatment.

The Role of Novel Bone Forming Agents in the Treatment of Osteoporosis

2020 ◽  
pp. 089719002096122
Author(s):  
Hansita B. Patel ◽  
Lynsie J. Lyerly ◽  
Cheryl K. Horlen
Keyword(s):  
Elderly Population ◽  
Cost Effective ◽  
The Elderly ◽  
Bisphosphonate Therapy ◽  
Evidence Based ◽  
First Line ◽  
Treatment Of Osteoporosis ◽  
Cost Effective Treatment

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.

Large pipeline and new safety issues likely to change 1st line recommendations for multiple sclerosis

2012 ◽  
Vol 2 (2) ◽  
pp. 32-36
Author(s):  
Gayle Kamm
Keyword(s):  
Multiple Sclerosis ◽  
Neurodegenerative Disorder ◽  
Review Article ◽  
Evidence Based ◽  
First Line ◽  
Safety Issues ◽  
Disease Modifying Therapies ◽  
Relapsing Remitting ◽  
Evidence Based Guidelines ◽  
Relapsing Remitting Multiple Sclerosis

ABSTRACT Multiple Sclerosis (MS) is chronic neurodegenerative disorder which can result in significant morbidity. Currently, there are not evidence-based guidelines for the choice of which first-line agent to start with, when to switch, or what to switch to, when treating MS. This review article discusses recent changes related to the treatment of MS and reviews disease modifying therapies in the pipeline for treatment of relapsing-remitting multiple sclerosis.

Venlafaxine and duloxetine: A comparison of efficacy and tolerability for the treatment of depression in elderly patients

2013 ◽  
Vol 3 (5) ◽  
pp. 258-265
Author(s):  
Hugh Franck ◽  
Jonathan Potter ◽  
Joshua Caballero
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Extended Release ◽  
The Elderly ◽  
Late Life Depression ◽  
First Line ◽  
Geriatric Population ◽  
Online Databases ◽  
Treatment Of Depression ◽  
Extended Release Formulations ◽  
Norepinephrine Reuptake

The geriatric population has a disproportionally higher rate of depression and related suicide compared to the general population. While selective serotonin reuptake inhibitors are considered first line, serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used. Online databases including MEDLINE, EMBASE, International Pharmaceutical Abstracts, and CINAHL were searched (up to June 2013) to identify trials using SNRIs in the elderly. Results revealed 15 studies involving venlafaxine (n=10) and duloxetine (n=5) use in the elderly. Overall, venlafaxine and duloxetine appear to be similar in efficacy and tolerability in treating late life depression. However, venlafaxine has been more extensively studied in this particular population, appears to carry fewer drug interactions, and is available in generic forms for regular and extended-release formulations. Doses greater than 225 mg/day for venlafaxine or 60 mg/day for duloxetine appear to lead to greater discontinuation rates.

scholarly journals Evidence-based clinical practice guidelines on the management of pain in older people – a summary report

2020 ◽  
pp. 204946372097615
Author(s):  
Margaret Dunham ◽  
Patricia Schofield ◽  
Roger Knaggs
Keyword(s):  
Health Care ◽  
Older People ◽  
Severity Of Illness ◽  
Evidence Based ◽  
Therapeutic Approaches ◽  
Pharmacological Interventions ◽  
Care Plans ◽  
Individualised Care ◽  
Evidence Based Guidelines ◽  
Routine Assessment

Objective: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people. Design: Review of evidence since 2010 using a systematic and consensus approach is performed. Results: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines. Conclusion: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.

scholarly journals Implementing evidence-based guidelines for managing depression in elderly patients: a Norwegian perspective

2012 ◽  
Vol 21 (3) ◽  
pp. 237-240 ◽  
Author(s):  
E. Aakhus ◽  
S. A. Flottorp ◽  
A. D. Oxman
Keyword(s):  
Primary Care ◽  
Implementation Strategies ◽  
The Elderly ◽  
Evidence Based ◽  
Social Changes ◽  
Scientific Publications ◽  
Effective Implementation ◽  
Tailored Implementation ◽  
Evidence Based Guidelines ◽  
Selection Of

Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called ‘Tailored Implementation for Chronic Diseases’ (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.

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