A Case Study on Polypharmacy and Depression in a 75-Year-Old Woman with Visual Deficits and Charles Bonnet Syndrome
Abstract
:1. Introduction
2. Case
2.1. Personal History
2.2. Ethical Standards
2.3. Medical History
2.4. History of the Disease
2.5. Supplementary Tests
2.6. Follow-Up during 2021
3. Case Management from Family Medicine
4. Discussion
4.1. Multifactorial Etiology of the Disease
4.2. Diagnosis of Depression
4.3. Efficacy of the Psychopharmacological Treatment
4.4. Role of the Family in the Patient’s Care
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Mañana Rendal, P.M. Depresión y ansiedad. In Gerontología y Geriatría: Valoración e intervención; Calentí, M., Ed.; Médica Panamericana: Madrid, Spain, 2010; pp. 285–301. [Google Scholar]
- Blazer, D.G. Depression in Late Life: Review and Commentary. J. Gerontol. A Biol. Sci. Med. Sci 2003, 58, 249–265. [Google Scholar] [CrossRef] [Green Version]
- Diego Calderón, M. Epidemiología de la depresión en el adulto mayor. Rev. Med. Hered. 2018, 29, 182–191. [Google Scholar] [CrossRef]
- Sotelo-Alonso, I.; Rojas-Soto, J.E.; Sánchez-Arenas, C.; Irigoyen-Coria, A. Depresión en el adulto mayor: Una perspectiva clínica y epidemiológica desde el primer nivel de atención. Arch. Med. Fam. 2012, 14, 5–13. [Google Scholar]
- Pando Moreno, M.; Aranda Beltrán, C.; Alfaro Alfaro, N.; Mendoza Roaf, P. Prevalencia de depresión en adultos mayores en población urbana. Rev. Esp. Geriatr. Gerontol. 2001, 36, 140–144. [Google Scholar] [CrossRef]
- Anton Jiménez, M.; Gálvez Sánchez, N.; Esteban Saiz, R. Tratado de Geriatría para Residentes. Depresión y Ansiedad; Sociedad Española de Geriatría y Gerontología: Madrid, Spain, 2006. [Google Scholar]
- Zarebski, G. Factores de riesgo psíquico de envejecimiento patológico y factores protectores. In Cuestionario Mi Envejecer. Un Instrumento Psicogerontológico para Evaluar la Actitud Frente al Propio Envejecimiento; En Zarebski, G., Ed.; Paidós: Buenos Aires, Argentina, 2014; pp. 37–50. [Google Scholar]
- Biermann, T.; Sperling, W.; Bleich, S.; Kornhuber, J.; Reulbach, H. Particularities of suicide in the elderly. A population-based study. Aging Clin. Exp. Res. 2009, 21, 470–474. [Google Scholar] [CrossRef]
- Ferraris, L.; Lopez, G. Depresión y envejecimiento: Complejidades del diagnóstico y abordaje (Caso clínico). Neurama Revista Electrónica de Psicogeriatría 2017, 4, 45–49. [Google Scholar]
- World Health Organization. ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines; World Health Organization: Geneva, Switzerland, 1992. [Google Scholar]
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5); American Psychiatric Association: Philadelphia, PA, USA, 2013. [Google Scholar]
- Gil Gregorio, P.; Martín Carrasco, M. Guía de Buena Práctica Clínica en Geriatría. Depresión y Ansiedad; Sociedad Española de Geriatría y Gerontología: Madrid, Spain, 2004. [Google Scholar]
- Frank, C. Pharmacologic treatment of depression in the elderly. Can. Fam. Physician 2014, 60, 121–126. [Google Scholar]
- Alexopoulos, G.S. Pharmacotherapy for late-life depression. J. Clin. Psychiatry 2011, 72, e04. [Google Scholar] [CrossRef] [Green Version]
- Balo García, A.; González-Abraldes, I. Intervención no Farmacológica y con Cuidadores. In Gerontología y Geriatría: Valoración e intervención; Calentí, M., Ed.; Médica Panamericana: Madrid, Spain, 2010; pp. 303–319. [Google Scholar]
- Jan, T.; del Castillo, J. Visual hallucinations: Charles BonnetsSyndrome. West. J. EmergMed. 2012, 13, 544–547. [Google Scholar] [CrossRef]
- García Fraga, J.A.; López Rego, L.; Mayán Cones, P.; Serrano Vázquez, M. Síndrome de Charles Bonnet. Rev. Esp. Geriatr. Gerontol. 2007, 42, 60–61. [Google Scholar] [CrossRef]
- Beekman, A.T.; de Beurs, E.; van Balkom, A.J.; Deeg, D.J.; van Dyck, R.; van Tilburg, W. Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am. J. Psychiatry 2000, 157, 89–95. [Google Scholar] [CrossRef] [PubMed]
- Vilalta-Franch, J.; Planas-Pujol, X.; Lopez-Pousa, S.; Llinas-Regla, J.; Merino-Aguado, J.; Garre-Olmo, J. Depression subtypes and 5-years risk of mortality in aged 70 years: A population-based cohort study. Int. J. Geriatr. Psychiatry 2011, 27, 67–75. [Google Scholar] [CrossRef] [PubMed]
- Sözeri-Varma, G. Depression in the elderly: Clinical features and risk factors. Aging Dis. 2012, 3, 465–471. [Google Scholar] [PubMed]
- Hayward, R.D.; Taylor, W.D.; Smoski, M.J.; Steffens, D.C.; Payne, M.E. Association of NEO personality domains and facets with presence, onset, and treatment outcomes of major depression in older adults. Am. J. Geriatr. Psychiatry 2013, 21, 88–96. [Google Scholar] [CrossRef] [Green Version]
- Pintor, L. Insuficiencia cardiaca y enfermedad depresiva, una frecuente combinación tantas veces olvidada. Rev. Esp. Cardiol. 2006, 59, 761–765. [Google Scholar] [CrossRef]
- Lett, H.S.; Blumenthal, J.A.; Babyak, M.A.; Sherwood, A.; Strauman, T.; Robins, C.; Newman, M.F. Depression as a risk factor for coronary artery disease: Evidence, mechanisms, and treatment. Psychosom. Med. 2004, 66, 305–315. [Google Scholar]
- Turvey, C.L.; Klein, D.M.; Pies, C.J. Depression, physical impairment, and treatment of depression in chronic heart failure. J. Cardiovasc. Nurs. 2006, 21, 175–178. [Google Scholar] [CrossRef]
- López, S.; Gasull, V.; Alcalá, J.A. Depresión mayor: Recomendaciones SEMERGEN; Editorial Medical & Marketing Comunications: Madrid, Spain, 2016; pp. 8–38. [Google Scholar]
- Alcalde, P.; Dapena, M.D.; Nieto, M.D.; Fontecha, B.J. Ingreso hospitalario atribuible a efectos adversos a medicamentos. Rev. Esp. Geriatr. Gerontol. 2001, 36, 340–344. [Google Scholar] [CrossRef]
- Schatzberg, A.F.; Cole, J.O.; DeBattista, C. Manual of Clinical Psychopharmacology; American Psychiatric Association: Washington, DC, USA, 2003. [Google Scholar]
- Schatzberg, A.F.; Nemeroff, C.B. Textbook of Psychopharmacology, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2017. [Google Scholar]
- Cole, M.G.; Elie, L.M.; McCusker, J.; Bellavance, F.; Mansour, A. Feasibility and effectiveness of treatments for depression in elderly medical inpatients: A systematic review. Int. Psychogeriatr. 2000, 12, 453–461. [Google Scholar] [CrossRef]
- Magni, L.R.; Purgato, M.; Gastaldon, C.; Papola, D.; Furukawa, T.A.; Cipriani, A.; Barbui, C. Fluoxetine versus other types of pharmacotherapy for depression. Cochrane Database Syst. Rev. 2013, 17, CD004185. [Google Scholar] [CrossRef] [Green Version]
- Purgato, M.; Papola, D.; Gastaldon, C.; Trespidi, C.; Magni, L.R.; Rizzo, C.; Furukawa, T.A.; Watanabe, N.; Cipriani, A.; Barbui, C. Paroxetine versus other anti-depressive agents for depression. Cochrane Database Syst. Rev. 2014, 3, CD006531. [Google Scholar] [CrossRef] [Green Version]
- Muñiz-Schwochert, R.; Olazarán-Rodríguez, J.; López-Álvarez, J.; Agüera-Ortiz, L.F.; López-Arrieta, J.M.; Beltrán-Aguirre, J.L.; García-García, P.; Rigueira-García, A.; Martín-Carrasco, M.; Qintana-Hernández, D.J. Criterios CHROME para la acreditación de centros libres de sujeciones químicas y para una prescripción de psicofármacos de calidad. Psicogeriatría 2016, 6, 91–98. [Google Scholar]
- Norris, S.; Blier, P. Duloxetine, milnacipram and levomilnacipram. In Textbook of Psychopharmacology, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2017; pp. 529–548. [Google Scholar]
- Wise, T.N.; Wiltse, C.G.; Iosifescu, D.V.; Sheridan, M.; Xu, J.I.; Raskin, J. The safety and tolerability of duloxetine in depressed elderly patients with and without medical comorbidity. Int. J. Clin. Pract. 2007, 61, 1283–1293. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Raskin, J.; Xu, J.Y.; Kajdasz, D.K. Time to response for duloxetine 60 mg once daily versus placebo in elderly patients with major depressive disorder. Int. Psychogeriatr. 2008, 20, 309–327. [Google Scholar] [CrossRef] [PubMed]
- Thase, M.E. Venlafaxine and desvenlafaxine. In Textbook of Psychopharmacology, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2017. [Google Scholar]
- Kirby, D.; Harrigan, S.; Ames, D. Hyponatraemia in elderly psychiatric patients treated with Selective Serotonin Reuptake Inhibitors and venlafaxine: A retrospective controlled study in an inpatient unit. Int. J. Geriatr. Psychiatry 2002, 17, 231–237. [Google Scholar] [CrossRef] [PubMed]
- Dyer, A.H.; Murphy, C.; Briggs, R.; Lawlor, B.; Kennelly, S.P.; NILVAD Study Group. Antidepressant use and orthost atic hypotension in older adults living with mild-to-moderate Alzheimer disease. Int. J. Geriatr. Psychiatry 2020, 35, 1367–1375. [Google Scholar] [CrossRef] [PubMed]
- Schatzberg, A.F. Mirtazapine. In Textbook of Psychopharmacology, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2017. [Google Scholar]
- Schatzberg, A.F.; Kremer, C.; Rodrigues, H.E.; Murphy, G.M., Jr. Double-blind, randomized comparison of mirtazapine and paroxetine in elderly depressed patients. Am. J. Geriatr. Psychiatry 2002, 10, 541–550. [Google Scholar] [CrossRef] [PubMed]
- Behlke, L.M.; Lenze, E.J.; Carney, R.M. The cardiovascular effects of newer antidepressants in older adults and those with or at high risk for cardiovascular diseases. CNS Drugs 2020, 34, 1133–1147. [Google Scholar] [CrossRef]
- Hannan, N.; Hamzah, Z.; Akinpeloye, H.O.; Meagher, D. Venlafaxine-mirtazapine combination in the treatment of persistent depressive illness. J. Psychopharmacol. 2007, 21, 161–164. [Google Scholar] [CrossRef] [PubMed]
- Picaza Gorrochategi, M.; Eiguren Munitis, A.E.; Dosil Santamaria, M.; Ozamiz Etxebarria, N. Stress, anxiety, and depression in people aged over 60 in the COVID-19 outbreak in a sample collected in northern Spain. Am. J. Geriatr. Psychiatry 2020, 28, 993–998. [Google Scholar] [CrossRef]
- Aranda Rubio, Y.; Aranda Rubio, L.; Alcaraz-L, C.; Isach Comallonga, M. Repercusiones en la salud mental del paciente anciano tras padecer COVID-19: Trastorno de estrés postraumático. A propósito de un caso. Rev. Esp. Geriatr. Gerontol. 2021, 56, 115–116. [Google Scholar] [CrossRef]
- Márquez-González, M. Nuevas herramientas para la intervención psicológica con personas mayores: La tercera generación de terapias conductuales. Rev. Esp. Geriatr. Gerontol. 2021, 45, 247–249. [Google Scholar] [CrossRef] [PubMed]
- Pérez-Salanova, M.; Yanguas-Lezaun, J.J. Dependencia, personas mayores y familias. De los enunciados a las intervenciones. An. Psicol. 1998, 14, 95–104. [Google Scholar]
- Acker, G.M.; Lawrence, D. Social work and managed care: Measuring competence, burnout, and role stress of workers providing mental health services in a managed care era. J. Soc. Work 2009, 9, 269–283. [Google Scholar] [CrossRef]
Drugs/Year | 2014 | 2018 | 2019 | 2020 | 2021-1 | 2021-2 |
---|---|---|---|---|---|---|
Levotiroxina | 100 | 100 | 100 | 100 | 100 | 100 |
Metformina | - | - | 850 | 850 | 1275 | 1275 |
Espironolactona | 25 | 25 | 25 | - | - | - |
Digoxina | - | - | 125 | 125 | 125 | 125 |
Diltiazem R | - | - | 120 | 120 | 120 | 120 |
Azetazolamida | - | - | 250 | 250 | 250 | 250 |
Boi-K | - | - | 1 c | 1 c | 1 c | 1 c |
Edobaxan | - | - | 60 | 60 | 60 | 60 |
Armolipid/Lipok | ’1 c | 1 c | 1 c | 1 c | 1 c | 1 c |
Ezetimiba | - | 10 | 10 | 10 | 10 | 10 |
Atorvastatina | - | 10 | - | - | - | - |
Duloxetina | 60 | 60 | - | - | - | - |
Citalopram | - | - | 10 | - | - | - |
Venlafaxin R | - | - | - | 150 | 150 | 150 |
Venlafaxin | - | - | - | 75 | 75 | 75 |
Mirtazapine | - | - | - | - | 15 | 15 |
Lorazepam | 1 | 1 | 1 | 1 | 1 | 1 |
Clonazepam | 0.6 | 0.6 | 0.6 | - | - | 0.6 |
Parameter/Year | 2014 | 2018 | 2019 | 2020 | 2021-1 | 2021-2 |
---|---|---|---|---|---|---|
TSH | 4.22 | niop | 4.50 | 4.96 | 2.30 | 2.95 |
T3 | 8.2 | niop | 8.7 | niop | 7.5 | 6.5 |
T4 | 0.9 | niop | 0.9 | niop | 0.8 | 0.8 |
Vit D | niop | niop | niop | 34.6 | 42.77 | 39.1 |
Glu | 112 | 115 | 125 | 136 | 156 | 151 |
Hgb A1c | 6.2 | 6.1 | niop | niop | 6,6 | 6.1 |
Cholesterol | 288 | 224 | 240 | 155 | 164 | 171 |
HDL | 58 | 47 | 41 | 43 | 49 | 52 |
LDL | 214 | 162 | 150 | 90 | 82 | 100 |
Triglicéridos | 80 | 77 | 81 | 110 | 165 | 93 |
Digoxinemia | niop | niop | niop | niop | niop | 0.8 |
Parameter/Year | 2014 | 2018 | 2019 | 2020 | 2021-1 | 2021-2 |
---|---|---|---|---|---|---|
SBP | 120 | 135 | 116 | 125 | 150 | 135 |
DBP | 65 | 66 | 67 | 70 | 75 | 70 |
Heart rate | 80 | 80 | 120 | 80 | 70 | 72 |
SO% | niop | 99 | niop | niop | 96 | 96 |
ECG | niop | niop | AF | AF | AF | AF |
Test | ||||||
GADS | - | - | - | - | 8/5 | 7/0 |
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Caamaño-Ponte, J.; Gómez Digón, M.; Pereira Pía, M.; de la Iglesia Cabezudo, A.; Echevarría Canoura, M.; Facal, D. A Case Study on Polypharmacy and Depression in a 75-Year-Old Woman with Visual Deficits and Charles Bonnet Syndrome. Geriatrics 2022, 7, 5. https://doi.org/10.3390/geriatrics7010005
Caamaño-Ponte J, Gómez Digón M, Pereira Pía M, de la Iglesia Cabezudo A, Echevarría Canoura M, Facal D. A Case Study on Polypharmacy and Depression in a 75-Year-Old Woman with Visual Deficits and Charles Bonnet Syndrome. Geriatrics. 2022; 7(1):5. https://doi.org/10.3390/geriatrics7010005
Chicago/Turabian StyleCaamaño-Ponte, José, Martina Gómez Digón, Mercedes Pereira Pía, Antonio de la Iglesia Cabezudo, Margarita Echevarría Canoura, and David Facal. 2022. "A Case Study on Polypharmacy and Depression in a 75-Year-Old Woman with Visual Deficits and Charles Bonnet Syndrome" Geriatrics 7, no. 1: 5. https://doi.org/10.3390/geriatrics7010005