Am J Psychiatry 1994; 151:987-994
Copyright © 1994 by American Psychiatric Association
Impact of acute psychiatric inpatient treatment on major depression in late life and prediction of response
GS Zubenko, BH Mulsant, AH Rifai, RA Sweet, RE Pasternak, LJ Marino Jr and XM Tu
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
OBJECTIVE: The authors conducted a prospective study to examine the
sociodemographic and clinical characteristics of elderly inpatients with
major depression and their response to acute psychiatric hospitalization.
The relation between the descriptive variables and clinical response was
also investigated. METHOD: The subjects were 205 consecutively admitted
inpatients, whose mean age was 71 years, who met the DSM-III-R criteria for
major depression. Each subject received detailed physical, psychiatric, and
mental status examinations, along with quantitative assessments of
psychiatric symptoms and cognitive performance at admission and at
discharge. Management of physical problems was optimized, and patients were
treated with a combination of somatic and psychotherapeutic interventions.
The average duration of hospitalization was approximately 1 month. RESULTS:
Despite considerable medical and psychiatric comorbidity, the patients
responded well to treatment, as reflected by a 50% reduction in the average
score on the Hamilton Depression Rating Scale. Nearly one-half of the
patients had experienced the resolution of their depressive symptoms by the
time of discharge. Race, cognitive performance at admission, number of
medical problems, use of ECT, and length of hospitalization independently
contributed to the prediction of clinical response. Response to treatment
was not related to the other sociodemographic variables examined or to any
of the indexes of severity of depressive episode. CONCLUSIONS: Short-term
psychiatric hospitalization offers an effective and efficient vehicle for
the treatment of severe or complicated cases of major depression in the
elderly, even when considerable medical and psychiatric comorbidity is
present.
