IMPACT OF ACUTE PSYCHIATRIC INPATIENT TREATMENT ON MAJOR DEPRESSION IN LATE-LIFE AND PREDICTION OF RESPONSE

Objective: The authors conducted a prospective study to examine the so ciodemographic and clinical characteristics of elderly inpatients with major depression and their response to acute psychiatric hospitalizat ion. The relation between the descriptive variables and clinical respo nse was also investigated. Method: The subjects were 205 consecutively admitted in-patients, whose mean age was 71 years, who met the DSM-II I-R criteria for major depression. Each subject received detailed phys ical, psychiatric, and mental status examinations, along with quantita tive assessments of psychiatric symptoms and cognitive performance at admission and at discharge. Management of physical problems was optimi zed, and patients were treated with a combination of somatic and psych otherapeutic interventions. The average duration of hospitalization wa s approximately 1 month. Results: Despite considerable medical and psy chiatric comorbidity, the patients responded well to treatment, as ref lected by a 50% reduction in the average score on the Hamilton Depress ion 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 relate d to the other sociodemographic variables examined or to any of the in dexes of severity of depressive episode. Conclusions: Short-term psych iatric hospitalization offers art effective and efficient vehicle for the treatment of severe or complicated cases of major depression in th e elderly, even when considerable medical and psychiatric comorbidity is present.