Kando J C, Tohen M, Castillo J, Zarate C A
ValueRx/HPI, Boston, MA, USA.
J Clin Psychiatry. 1996 Jun;57(6):238-40.
Little is known about the efficacy and tolerability of valproate in the elderly population with affective disorders. This pharmacoepidemiologic study was undertaken to determine the side effect profile and efficacy of valproate in an elderly population with psychiatric symptomatology.
This was a retrospective chart review of all elderly inpatients at McLean Hospital who received valproate between May 8, 1989, and May 8, 1992. Charts were reviewed to determine gender, discharge diagnosis, indication for the agent, and length of time on each medication. Charts were also reviewed for abnormalities in liver function tests, blood cell dyscrasias, sedation, nausea and vomiting, weight gain, impairment of cognition, tremor, and hair loss. The efficacy of the medication was also determined.
Thirty-five elderly subjects who suffered from an affective disorder and who had received valproate were identified. The mean age was 71.3 years. The mean length of time the patient received valproate was 32.7 days. The mean dose was 743 mg/day, and the mean blood drug level was 52.9 mg/L. The valproate was rated as efficacious in 18 (62%) of the 29 patients who had had an adequate drug trial at discharge. Overall the medication was well tolerated. There were no reports of liver function test abnormalities. One patient experienced transient leukopenia. Other adverse events included two reports of nausea, two reports of sedation, and one complaint of confusion. None of the variables examined were found to be statistically significant in regard to efficacy.
Valproate was well tolerated and efficacious in this elderly population with affective disorders. Further controlled studies are needed to confirm our results.
丙戊酸盐对患有情感障碍的老年人群的疗效和耐受性了解甚少。本药物流行病学研究旨在确定丙戊酸盐在有精神症状的老年人群中的副作用情况和疗效。
这是一项对1989年5月8日至1992年5月8日期间在麦克莱恩医院接受丙戊酸盐治疗的所有老年住院患者的回顾性病历审查。审查病历以确定性别、出院诊断、用药指征以及每种药物的使用时长。还审查病历以查看肝功能测试异常、血细胞异常、镇静、恶心和呕吐、体重增加、认知障碍、震颤和脱发情况。同时也确定了药物的疗效。
确定了35名患有情感障碍且接受过丙戊酸盐治疗的老年受试者。平均年龄为71.3岁。患者接受丙戊酸盐的平均时长为32.7天。平均剂量为743毫克/天，平均血药浓度为52.9毫克/升。在出院时接受了充分药物试验的29名患者中，有18名（62%）患者的丙戊酸盐被评定为有效。总体而言，该药物耐受性良好。没有肝功能测试异常的报告。1名患者出现短暂性白细胞减少。其他不良事件包括2例恶心报告、2例镇静报告和1例意识模糊主诉。在所检查的变量中，没有发现与疗效有统计学显著差异的情况。
丙戊酸盐在患有情感障碍的老年人群中耐受性良好且有效。需要进一步的对照研究来证实我们的结果。
