Psychopharmacologic Investigations in Elderly Volunteers: Effect of Diazepam in Males†

Salzman, Carl; Shader, Richard I.; Harmatz, Jerold S.; Robertson, Linda K.

doi:10.1111/j.1532-5415.1975.tb00929.x

Cited by 21 publications

(9 citation statements)

References 18 publications

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“…Chesrow et al (30), in the first published clinical study of Valium in geriatric patients, concluded that 95 percent of patients exhibiting behavioral disorders who received a daily dosage of 6 mg, showed moderate to marked reduction of symptoms; many who manifested depression and confusion also showed moderate to excellent improvement. However, in their more recent studies, Salzman et al (31) found that older subjects reported more consistent reductions in anxiety from placebo. Not only was the placebo useful as an antianxiety agent for the geriatric population, but it also reduced fatigue and improved memory and motor function.…”

Section: Discussionmentioning

confidence: 93%

“…Failure to recognise the age-related changes that affect absorption, plasma binding, metabolism, excretion and end-organ response can lead to the development of toxic accumulation of drugs, increased susceptibility to drug interactions and potentially dangerous side effects. In prescribing for the elderly, it is wise to 31 4 1 remember Napoleon's words, "I do not want two diseases -one nature made, one doctor made" (11).…”

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confidence: 99%

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Incidence of Polypharmacy in a Long‐Term Care Facility

Kalchthaler

Coccaro

Lichtiger

1977

J American Geriatrics Society

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The incidence of polypharmacy was investigated in a 200-bed long-term care facility. One hundred residents were drawn at random for the study. The average number of drugs prescribed per patient was 3.33, and the average number of pills was 6.34 daily. The most frequently prescribed drugs were the analgesics, followed in order by antihypertensive agents, cardiotonic preparations and antimicrobials. The literature is reviewed with respect to the incidence, causes and end-results of polypharmacy. It is recommended that long-term care facilities develop enlightened and aggressive pharmacy committees to monitor and evaluate drug use routinely in an institutional setting.

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

Incidence of Polypharmacy in a Long‐Term Care Facility

Kalchthaler

Coccaro

Lichtiger

1977

J American Geriatrics Society

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“…The recall of information learned prior to medication may be facilitated by diazepam (Hinrichs et al 1984). On the other hand, many patients take BZ medications several times daily, and the memory-impairing effect of BZs may have greater impact for certain kinds of patients, such as cardiac patients (Frazure-Smith and Rolicz-Woloszyk 1982) or the elderly (Salzman et al 1975). The implications of laboratory tests of recall ability with BZs for the overall clinical status of patients' memory function should be evaluated with further clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Chronic use of benzodiazepines and psychomotor and cognitive test performance

1986

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The performance of 43 long-term users (average = 5 years) of benzodiazepine (BZ) medications was examined on a battery of behavioral tasks, cognitive tests, and subjective mood rating scales. The performance of the chronic BZ users did not differ significantly from age- and sex-matched anxious subjects, except that critical flicker fusion (CFF) thresholds were lower and subjective ratings of tranquilization were higher in the BZ users. Twenty-two subjects were reexamined in order to determine the acute effects of BZ medications in long-term users. The acute administration of BZ medications significantly increased CFF thresholds, improved digit-symbol substitution test performance, impaired the delayed recall of verbal material, increased subjective ratings of tranquilization, and reduced physical sedation. Motor performance tests were not impaired and subjective feelings of sedation were not increased after the acute administration of BZs by chronic users. During withdrawal from long-term BZ use (17 subjects), CFF thresholds were elevated, subjective ratings of physical sedation and anxiety were increased, but performance on other psychomotor and cognitive tests was not altered. The results suggest that tolerance develops selectively to different behavioral and subjective effects of BZ medications with their continued use. Tolerance failed to develop to the antianxiety effects, the reduction of CFF threshold, and to the impairment of short-term memory caused by BZs. However, chronic users of BZ medications failed to demonstrate psychomotor-impairing or sedating effects to BZ medications. The results have implications for evaluating the safety of the long-term use of BZ medications.

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“…Studies comparing neuroleptics and benzodiazepines suggest that neuroleptics are more likely to be effective. Sedation, confusion, memory impairment, and ataxia are commonly reported side effects in older patients taking benzodiazepines, 70–78 and these side effects are likely to be more common in the older demented patient. Although not reported specifically in the elderly, paradoxical rage reactions and disinhibition have been reported with diazepam and chlordiazepoxide 79 .…”

Section: Benzodiazepinesmentioning

confidence: 99%

Pharmacologic Treatment of Agitation Associated With Dementia

Risse

Barnes

1986

J American Geriatrics Society

120

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Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.

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Psychopharmacologic Investigations in Elderly Volunteers: Effect of Diazepam in Males†

Cited by 21 publications

References 18 publications

Incidence of Polypharmacy in a Long‐Term Care Facility

Incidence of Polypharmacy in a Long‐Term Care Facility

Chronic use of benzodiazepines and psychomotor and cognitive test performance

Pharmacologic Treatment of Agitation Associated With Dementia

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