Problem solving therapy for the depression-executive dysfunction syndrome of late life.
BACKGROUND
The 'depression executive dysfunction syndrome' afflicts a considerable number of depressed elderly patients and may be resistant to conventional pharmacotherapy. Non-pharmacological approaches addressing their behavioral deficits may reduce disability and experienced stress and improve depression.


METHODS
This paper focuses on problem solving therapy (PST) because it targets concrete problems that can be understood by patients with executive dysfunction and trains patients to address them using an easy to comprehend structured approach.


RESULTS
We suggest that PST is a suitable treatment for patients with the depression-executive dysfunction syndrome because it has been found effective in uncomplicated geriatric major depression and in other psychiatric disorders accompanied by severe executive dysfunction. Furthermore, PST can address specific clinical features of depressed patients with executive dysfunction, especially when modified to address difficulties with affect regulation, initiation and perseveration.


CONCLUSIONS
A preliminary study suggests that appropriately modified PST improves problem solving skills, depression and disability in elderly patients with the depression-executive dysfunction syndrome of late life. If these findings are confirmed, PST may become a therapeutic option for a large group of depressed elderly patients likely to be drug resistant.
Alexopoulos
George S
GS
Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA. gsalexop@med.cornell.edu
Raue
Patrick J
PJ
Kanellopoulos
Dora
D
Mackin
Scott
S
Arean
Patricia A
PA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000150:complications; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011340:Problem Solving / Q000502:physiology; D011596:Psychomotor Disorders / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D012944:Social Support; D013577:Syndrome; D016896:Treatment Outcome