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The lifetime course of illness in older outpatient men who remained symptomatic despite adequate pharmacologic treat ment for depression was examined. A bimodal distribution of age of onset of first major depression was found, with 75% having onset before age 35 years and 25% having onset after age 50 years. At all ages, episodes of chronic depression developed after episodes of major depression and appeared to be partially resolved major depression. In 88% of patients, anxiety disorders developed before age 35 years, preceded onset of other disorders, and continued throughout the patient's lifetime. Seventy percent developed alcoholism and 25% had a medical illness that impaired function to a signifi cant degree. The importance of obtaining a lifetime course of illness in older patients is discussed. ( J Geriatr Psychiatry Neurol 1989;2:89-95). [ABSTRACT FROM PUBLISHER]

Weight loss and malnutrition despite adequate dietary intake has been reported to be part of the clinical course in advanced dementia of the Alzheimer type. We present a case of reversible weight loss associated with neuroleptic use in a patient with Alzheimer's disease and discuss a possible pathophysiological basis for the weight loss. (J Geriatr Psychiatry Neurol 1989-2:45-47). [ABSTRACT FROM PUBLISHER]

Background: This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders., Methods: A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive primary medical care through an integrated care initiative located in the mental health clinic (n = 59) or through the VA general medicine clinic (n = 61). Veterans who obtained care in the integrated care clinic received on-site primary care and case management that emphasized preventive medical care, patient education, and close collaboration with mental health providers to improve access to and continuity of care. Analyses compared health process (use of medical services, quality of care, and satisfaction) and outcomes (health and mental health status and costs) between the groups in the year after randomization., Results: Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care visits than those in the usual care group. They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines. Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic (4.7 points vs -0.3 points, P<.001). There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs., Conclusion: On-site, integrated primary care was associated with improved quality and outcomes of medical care.

Objective: The authors assessed the association between depressive symptoms and health costs for a national Veterans Administration (VA) sample., Method: The Rand Depression Index was administered to 1,316 medical or surgical inpatients over the age of 60 at nine VA hospitals. Scores were merged with utilization, demographic, and hospital data from national VA inpatient and outpatient files., Results: Medical costs for respondents with the highest quartile of symptoms were approximately $3,200-or 50%-greater than medical costs for those in the least symptomatic quartile. Depressive symptoms were not associated with any statistically significant mental health expenditures., Conclusions: The study extends previous reports of the high medical costs associated with depressive disorders to an older, public sector population. The mechanisms underlying increased medical costs associated with depressive symptoms, while the subject of much speculation in the literature, still remain largely unknown.

A case of a man with Tourette's disorder associated with obsessive-compulsive disorder, multiple sexual paraphilias, and aggressive behavior is described. Treatment with haloperidol led to improvement in the characteristic tics of Tourette's disorder as well as to improvement in these three complex-associated behaviors. After haloperidol was discontinued, an exacerbation of tics and the associated behaviors occurred.