Focus on Pharmacotherapy Studies in Elderly

The NIMH-sponsored New Clinical Drugs Evaluation Unit (NCDEU) meeting is a favored venue for reports and reviews of NIH-funded psychopharmacological studies, and this was true of the recent annual meeting in Hollywood, Fla. The meeting included a workshop on new investigations of antidepressant use in Alzheimer disease and a panel session on the safety of pharmacotherapy in older adults.

Two studies were developed, in part, in response to growing concern about both safety and lack of efficacy of antipsychotics for behavior symptoms in patients with dementia. These were the Depression in Alzheimer’s Disease Study–2 (DIADS-2) sertraline (Zoloft) trial, the citalopram (Celexa) versus antipsychotics nested study in the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD), and the recently initiated Citalopram for Agitation in Alzheimer’s Disease (CITAD).

In describing the rationale and design of the CITAD study, Bruce Pollock, MD, Center for Addiction and Mental Health, questioned the premise for using antipsychotics in this population. “The neuropharmacologic rationale for using dopamine antagonists in elders with dopaminergic deficits is questionable,” Pollock indicated. “Agitation in Alzheimer disease is commonly derived from anxious, impulsive, and compulsive symptoms, which may be responsive to serotonergic agents.”

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The Doctor-Patient Relationship in Pharmacotherapy

The Doctor-Patient Relationship in Pharmacotherapy
Improving Treatment Effectiveness
By Allan Tasman, Michelle B. Riba, and Kenneth R. Silk
182 Pages - May 2000

"It's the relationship that matters! That message encapsulates this volume's critically important lesson for psychiatrists. Even when medications are the primary modality of treatment and sessions are brief, the psychiatrist patient relationship is the hinge on which the efficacy of treatment depends. Attention paid to our patients as unique individuals rewards them as well as ourselves."

-Paul S. Appelbaum, MD, University of Massachusetts Medical School

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