[Ambulatory psychopharmacotherapy of older subjects].
The author points out to the fact that bio-psycho-social situation of the elderly changes as compared with younger adults. One should notice e.g. that liver-functions (which is in elderly normally reduced) influences the pharmacokinetics and pharmacodynamics; to share of fat-tissue increases and that of muscles decreases - this can cause undesirable depot-formation, resulting with toxic effects. Due to comparatively frequent polymorbidity, different drugs are being prescribed and this can lead to undesirable interactions. According to the author's opinion the following principles are recommended as guidelines: some psychotropic drugs are more suitable for the psychogeriatrics than the other ones; drugs without marked side-effects should be preferred; one should get familiar with a certain amount of preparations and administer preferably them; use as few drugs as possible (including somatic ones); psychiatric treatment is syndrome-specific; depot-forms should be avoided; the treatment should be started in low-dosage (1/5 till 1/4 of average adult-dosage) and slowly increased; the maintenance-dose is about 1/3-1/2 of average adult-dose, but individual requirement is very different; psychotropic drugs cannot compensate the lack of human contacts, devotion and intensive relationship but complement them. The author describes further different groups of psychotropic drugs, their action, indications and side-effects. He mentions a number of different drugs and qualifies them as "own preferences" (giving them between one and four crosses), giving their average daily doses, properties and indications. He concludes that there is no such a thing as "ideal-drug" and points out to the destiny of physicians that one has to accept the so-called non-optimal solutions.(ABSTRACT TRUNCATED AT 250 WORDS)
Jovic
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Sozialpsychiatrischer Dienst der Psychiatrischen Universitätsklinik Zürich.
D000368:Aged; D000553:Ambulatory Care; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D010347:Patient Care Planning; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs
Ambulante Psychopharmakotherapie bei älteren Menschen.