Update 2000. Guidelines for prescribing psychoactive drugs

As patients age, a pattern develops in the primary care setting of underdiagnosis and undertreatment of psychiatric disorders, including dementing illnesses and depression. Choosing an appropriate psychoactive drug and dosage for an older patient is a complex task, due to the wide array of medications available and the need for careful titration. To address these problems, this article provides prescribing recommendations for antidepressants, antipsychotic medications, benzodiazepines (antianxiety/hypnotics), and other psychoactive medications.

Guidelines for prescribing psychoactive drugs in the elderly: Part 1

Primary care physicians are usually the first to see elderly patients with emotional problems secondary to dementia and other psychiatric disorders. Because these problems often can be treated effectively, physicians should have a working knowledge of the guidelines for optimal use of psychoactive medications. Part 1 of this two-part article discusses general prescribing guidelines based on the pharmacokinetics of aging and provides specific information about benzodiazepines and antidepressants. Antipsychotics and other psychoactive agents used to treat the elderly are discussed in part 2 (page 52).

Guidelines for prescribing psychoactive drugs in the elderly: Part 2

Antipsychotic drugs are frequently used (and sometimes overused) to manage behavioral problems, especially in demented patients. All antipsychotics theoretically work through the same mechanism, so drug selection is based primarily on side effect profiles. In this article, we provide prescribing guidelines for antipsychotics and other psychoactive drugs used in the treatment of elderly patients with emotional dysfunction. Included are stimulants, lithium, carbamazepine, propranolol HCl, and buspirone HCl. Guidelines for benzodiazepines and antidepressants were discussed in part 1 of this two-part article (page 40).

Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose

PURPOSE

The purpose of this study was to evaluate the use of sorbitol as an inexpensive alternative to lactulose for treating constipation in the elderly.

PATIENTS AND METHODS

Thirty men aged 65 to 86 with chronic constipation were studied in a randomized, double-blind, cross-over trial in which lactulose and 70% sorbitol (0 to 60 mL daily) were each given for 4 weeks preceded by a 2-week washout period.

RESULTS

The average number of bowel movements per week was 6.71 with sorbitol and 7.02 with lactulose (95% confidence interval of the difference: -0.43 to 1.06), and the average number of days per week with bowel movements was 5.23 with sorbitol and 5.31 with lactulose (95% confidence interval of the difference: -0.32 to 0.48). Eleven patients stated a preference for sorbitol, 12 for lactulose, and seven had no preference. On a visual analogue scale measuring severity of constipation (0 to 100 mm), the average score for sorbitol was 35.6 mm versus 37.1 mm for lactulose (95% confidence interval of the difference: -6.4 to 9.3). The sorbitol and lactulose treatment periods were also similar in percent of bowel movements recorded as "normal," frequency and severity of symptoms such as bloating, cramping, and excessive flatulence, and overall health status as assessed by a previously validated five-category questionnaire. There were no significant differences between sorbitol and lactulose in any outcome measured except nausea, which was increased with lactulose (p less than 0.05).

CONCLUSION

These results support the hypothesis that sorbitol and lactulose have no clinically significant differences in laxative effect. Sorbitol can be recommended as a cost-effective alternative to lactulose for the treatment of constipation in the elderly.