Clinical Guidance: Therapeutic Approach to Geriatric Depression With Executive Dysfunction
Geriatric patients with comorbid major depression and executive dysfunction have psychomotor retardation, apathy, lack of insight into their illness, and behavioral disability disproportionate to the level of their depression, according to Areán et al. (CME , p. 1391). Patients received 12 sessions of psychotherapy that taught steps in problem solving: identifying a difficult problem, setting goals, discussing and then evaluating different strategies to reach goals, creating action plans, and evaluating their effectiveness. This treatment produced a 47% remission rate, compared to 29% with supportive therapy alone. Time to remission correlated with attainment in problem-solving proficiency, generally after 9 to 12 weeks of therapy. Wetherell's editorial (p. 1297) points out the increased effectiveness of psychotherapy that is targeted to the patient's identified problem.