Saturday, 22.02.2020

Thomas A. Ban
Neuropsychopharmacology in Historical Perspective
Education in the Field in the Post-Neuropsychopharmacology Era

 
Background to An Oral History of the First Fifty Years
Special Areas (Volume Seven): 2. Geriatric Psychiatry
(Bulletin 60)

 

 

            While individual life span has remained unchanged, average life expectancy has increased at least four-fold over the course of recorded history (Dublin, Lotka and Spiegelman 1969). There was an unprecedented rapid increase in life-expectancy during the first half of the 20th century; from 1900 to 1960 the percentage of old people tripled, reaching 13% of the total population of Europe and 10% of North America (Encyclopedia Britannica 1979).The increase in individuals aged 65 years or older has directed attention to gerontology, a term introduced in 1907 by the Russian medical scientist Eli Metschnikoff for the scientific study of the aging process, and to geriatrics, a term introduced in 1914 by the American pediatrician, Ignatz Nascher, for the medical specialty concerned with the study, prevention and treatment of pathologic conditions in the aged (Metchnikoff 1907; Nascher 1914). Gerontology deals with primary aging or senescence, which is a biologic process rooted in heredity; geriatrics deals with secondary aging or senility, i.e., defects and disabilities resulting from trauma, including disease (Butler 1975).

            Psychiatric morbidity is high in the aged. The three-fold increase in the number of people 65 or older in the United States was associated with a nine-fold increase in admissions to mental hospitals from this age group (Kramer, Taub and Starr 1968). A study in Baltimore from the 1960s showed that 12% of the non-institutionalized geriatric population suffered from mental illness (Pasamanick 1967). In San Francisco, the figure was 15% (Simon 1968). It was the high prevalence of psychiatric morbidity in old people that created the need for the geropsychiatry, or psychogeriatrics (Ban 1980).

            Developments which led to psychogeriatrics began in the 1870s with Krafft-Ebing’s introduction of the term “dementia senilis” and with his separation of senile dementia from the other organic dementias (Kraft-Ebing 1872). It continued in the 1880s with the description of what was to become known as the Wernicke-Korsakoff amnestic syndromeand the separation of the dysmnesias from the dementias (Korsakoff 1887; Wernicke 1881). In 1892 the disease that was to bear his name was described by Pickand separated from senile dementia (Pick 1892). In 1899 Binswanger coined the term “pre-senile dementia”that was to include Pick’s disease; Alzheimer’s disease, described in 1907; Jacob-Creutzfeld’s disease,described in 1920 and ’21; and several other conditions (Alzheimer 1907; Binswanger1898; Creutzfeld1920; Jacob 1921; Mayer-Gross, Slater and Roth 1980) 

            In the mid-1930s, a possible relationship between Alzheimer’s disease and senile conditions was raised by Rothschild and Kasanin; and in the mid-1940s Jervis suggested that atrophy of nerve cells and fibers with some glial reaction is the common basic process of the senile and presenile dementias (Jervis 1945; Rotschild and Kasanin 1936). Yet, it was also in the mid-1940s that Rothschild described the differential clinical features of senile and arteriosclerotic (today referred to as multi-infarct) “psychoses” (Hachinski, Lassen and Marshall 1974; Rotschild 1947). 

            By the 1950s it was recognized that psychiatric diseases in the aged are not restricted to the dementias and dysmnesias.A survey in the UK indicated that the in 30 to 50% of patients admitted to mental hospitals over 60 years of age, the clinical picture was dominated by depressive clinical features (Roth and Morissey 1957). Martin Roth and his associates found little overlap in symptomatology between these patients and patients with organic degenerative diseases. They also demonstrated that only about 3% of them developed dementia in two to three years (Roth 1952).

            In Kraepelin’s estimation about 6-7% of the first episode of manic-depressive psychosis occurs at age 60 or later (Kraepelin 1921).A similar figure was reported in 1952 by Stenstedt (Stenstedt 1952).

            “Late paraphrenia,” another distinct diagnosticpopulation in the aged, was identified in 1957 by Roth (Roth 1957).It differs from “late schizophrenia” by firmly systematized delusions. 

            Late schizophrenia was first recognized in 1911 by Eugen Bleuler (Bleuler 1911).In 1943, Manfred Bleuler found that in 15-17% of patients, schizophrenia, starts at age 40 or later. He referred to this population as “late onset schizophrenia.” In Bleuler’s estimation, for the 4% of patients with late schizophrenia the onset of the disease starts at age 60 or later (1943).Frank Fish, in the early 1960, found that in 1% of patients with schizophrenia the disease starts at age 69 or later (Fish 1962).

            In the late 1940s De Werdenerand Lennox found that Vitamin B1 insufficiency induced loss of memory for recent events, disorientation and confabulations, a clinical picture similar to that seen in the Wernicke-Korsakoff syndrome. They also demonstrated that thiamine administration reversed the memory disturbance (De Werdener and Lennox1947).

            In the 1950s, V. A. Kral separated “benign senescent forgetfulness” from “malignant senescent forgetfulness” (Kral 195, 19591, 1959b, 1962).He also reported on favorable effects with fluoxymesterone in “benign senescent forgetfulness” (Kral and Wigdor 1959, 1961).

            Stimulated by Holger Hyden’s discovery of the role of ribonucleic acid (RNA) in learning, Ewen Cameron administered yeast RNA to patients with senile and arteriosclerotic dementia in the late 1950s (Cameron 1958; Cameron and Solyom 1958; Hyden 1955).In spite of his initial favorable impression and of the supportive findings of Leonard Cook in animal pharmacological research,later studies by Cameron and his associates with labeled RNA revealed that RNA molecules don’t enter the cerebral neurons (Cook, Davidson, Davis, Green and Fellows 1963). They could only be found in the cells of the ependyma and plexus choroideus (Cameron, Sved, Solyom and Wainrib 1964). 

            During the 1950s a wide variety of drugs - including gonadal hormones, i.e., estrogen and testosterone alone and in various combinations;psychostimulants, such as pentylenetetrazol,pipradroland methylphenidate; vasodilators, e.g., isoxsuprine;and drugs with an effect on cerebral metabolism, e.g., Hydergine, a hydrogenated alkaloid of ergot,were employed in the treatment of psychiatric diseases in the aged  (Bachrach 1959; Begg and Reid1956; Benjamin 1949; Billiottet and Ferrand 1958; Birkmayer and Mentasti 1958; Caldwell and Watson 1957; Chesrow, Giacobe and Wosika 1951; Darwill 1959; Gould and Strosberg 1953; Foster, Schultz and Henderson 1955; Hollister 1955; Jacobson 1958; Kleemeier, Rich and Justin 1956; Levy 1953; Martin, Overly and Krone 1957; Pauker, Kheirn, Mensh and Koun 1958; Pomeranze and Ladek 1957; Popklin 1956; Zahn 1965).Prescription practices in elderly patients began to shift in the middle of the decade with the introduction of psychotropic drugs. The first reports on the effects of chlorpromazine in geropsychiatric patients were published in 1955 by Kurland,Seager and Terman; on reserpine alone and in combination with psychostimulants and/or vitamins in 1956and ’58;on prochlorperazine in 1957;on meprobamate in 1957and ’58; on imipramine in 1958and ’59; and on perphenazine,thioridazineand trifluoperazine in 1959 (Blackman, Glenn and Olinger 1958; Blanc 1958; Cameron 1959; Ferguson 1956; Jensen, Kristjansen and Paerregaard1957;  Judah, Murphree and Seager1959; Kropach1959;  Kurland1955; Lehmann, Cahn and deVerteuil 1958; Cruzand Sarro-Martin 1959;  Seager 1955; Settel 1957; Silverman, Parker and Busse  1959; Terman 1955; Tschudin 1958).

 

References:

 

Alzheimer A. Über eine eigenartige Erkrankung der Hirnrinde.  Allg Z Psychiat 1907; 74: 146-8.

Bachrach S. A new stimulant supplement for the geriatric patient. J Am Geriat Soc 1959; 7: 408-9.

Ban TA. Psychopharmacology for the Aged. Basel: Karger; 1980. p. 4-6.

Begg WA, Reid AA. Meratran a new stimulant drug.  BMJ 1956; 1: 946-9.

Benjamin H. Endocrine gerontotherapy. Use of sex hormone combinations in female patients. J Geront 1949; 4: 222-33.

Billiottet  J, Ferrand A. A new synthetic vasodilator and antispasmodic. Preliminary results in vascular therapy. Sem mèd 1958; 34: 635-7.

Binswanger O. (1898.) In: Mayer-Gross W, Slater E, Roth M.  Clinical Psychiatry. 2nd edition.  London: Cassell and Company; 1960. p. 486-7.

Birkmayer  W, Mentasti  M. Clinical experience  with a new vasodilator in neurological diseases. Wien med Wschr 1958; 108: 395-6.

Blackman LM, Glenn M, Olinger L. Combined use of a tranquilizer and vitamin in the treatment of elderly psychotic patients.  Am J Psychiat 1958; 114: 837-8.

Blanc B. The use of meprobamate in gerontology.  Lyon méd 1958; 200: 885-92.

Bleuler EP. Dementia Praecox oder Gruppe der Schizophrenien.  Liepzig: Deuticke; 1911.

Bleuler M. Die spätschizophrenen Krankheitsbilder. Fortschritt Neurol Psychiat 1943; 15: 259-90.

Butler RN. Why Survive? Being Old in America.  New York: Harper & Row; 1975.

Caldwell BM, Watson RJ.  Evaluation of psychotropic effects of sex hormone administration in aged women.  Results of therapy after six month.  J Geront 1952; 7: 228-44.

Cameron DE. The use of nucleic acid in aged patients suffering from memory impairment. Am J Psychiatry 1958; 114: 943-4.

Cameron DE. The use of Tofranil in the aged.  Canadian Psychiatric Association Journal 1959; 4 (supplement 1): 160-5.  

Cameron DE, Solyom L. Effects of ribonucleic acid on memory. Geriatrics 1961; 16: 74-81.

Cameron DE, Sved S, Solyom L, Wainrib B. Ribonucleic acid in psychiatric therapy. In: Masserman J, editor. Current Psychiatric Therapies. Volume 4. New York: Grune & Stratton; 1964. p.127-33.

Chesrow EJ, Giacobe  AJ, Wosika PH. Metrazol in arterisoclerosis associated with  senility. Geriatrics 1951; 6: 319-23.

Cook L, Davidson DJ, Davis H, Green H, Fellows EJ. Ribonucleic acid: Effect on conditioned behavior. Science 1963; 141: 268-9.

Creutzfeldt  HG. Über einige  eigenartige  herdformige Erkrankung  des Zentralnerven system. Z ges Neurol Psychiat  1920;  57: 1-18.

Cruz M, Sarro-Martin A. Eperencias on nuevo anidepressivo derivado del  iminidibencilo.  Med Clinic Barcelona 1959; 33: 122-5. 

Darwill FT. Double-blind evaluation of methylphenidate (Ritalin) hydrochloride; Its use in the management of hospitalized geriatric patients. JAMA 169: 1739-41. 1959. 

De Werdener HE, Lennox B. Cerebral beriberi (Wernicke’s encephalopathy). Lancet 1947; 1: 11-7.

Dublin LL, Lotka AJ, Spiegelman M. Length of Life. New York: Ronald Press: 1969.

Ferguson JT, Funderburk WH. Improving senile behavior with reserpine and Ritalin. JAMA 1956; 160: 279-83. 

Fish F. Schizophrenia. Bristol: Wright; 1962.

Foster W, Schultz S, Henderson A. Combined hydrogenated alkaloids of ergot in senile and arteriosclerotic psychoses.  Geriatrics  1955;  10: 26-30.

Gould WL, Strosberg L. Female senility. Report on series of 217 cases using Glutest, a new fortified androgen. NY State J Med 1953; 53: 661-6.

Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia; a cause of mental deterioration in the elderly. Lancet 1974; 2:  207-10.

Hollister LE. Combined hydrogenated alkaloids of ergot in nervous and mental disorders associated with old age.  Dis Nerv Syst 1955; 16: 1-4.

Hyden H. Nucleic acids and proteins. In Elliot RA, editor. Neurochemistry. Springfield: Charles C. Thomas; 1955.

Jacobson A. The use of Ritalin in psychotherapy of depression in the aged.  Psychiat Q 1958; 32: 474-83.

Jakob A. On peculiar disease of the central nervous system with pathological finding. Z ges Neurol Psychiat 1921; 64: 147-228. (In German.) 

Jensen K, Kristjansen P, Paerregaard G. Effect of meprobamate in neurotic & senile patients. Nord Med 1957; 58: 1614-7.

Jervis GA. The presenile dementias.  In: Kaplan DJ, editor. Mental Disorders in Later Life. Lonon: Oxford University Press; 1945.

Judah L, Murphree D, SeagerL. Psychiatric response of geriatric-psychiatric patients to Mellaril (TP 21 Sandoz). Am J Psychiat 1959; 115: 1118- 9. 

Kleemeier RW, Rich TA, Justin WA. Effect of α-(2-piperidyl)–benzhydrol hydrochloride (Meratran)  on psychomotor  performance in a group  of aged males. J Geront 1956; 1: 165-70. 

Korsakoff SS. Disturbances of psychic functions in alcoholic paralysis in relation to the disturbances of the psychic structure in multiple neuritis of non-alcoholic in origin.  Vestnik Klin Sudebnol Psichiat Nervopatol (St. Petersburg) 1887; 4: 1-102.

Kraepelin E. ManicDepressive Insanity and Paranoia. Edinburgh: E & S Livingstone; 1921.

Krafft-Ebing R. Lehrbuch der Psychiatrie. Stuttgart: Enke; 1872.

Kral VA Neuropsychiatric observations in an old people’s home; studies in memory dysfunction in senescenec. J Gerontol 1956; 13:169-76.

Kral VA. Types of memory dysfunction in senescence.  Psychiat Res Rep 1959a; 11: 33-40.

Kral VA. Amnesia and the amnestic syndrome. Can Psychiat Assoc J 1959b; 4: 61-8.

Kral VA. Senescent forgetfulness: benign and malignant. CMAJ 1962; 86: 257-60.

Kral VA, Wigdor BT. Androgen effect on senescent memory function. Geriatrics 1959; 14: 450-6.

Kral VA, Wigdor BT. Further studies on androgen effect on senescent memory function. Canadian Psychiatric Association Journal 1961; 6: 345-52.

Kropach K. The treatment of acutely agitated senile patients with trifluoperazine (Stelazine).  Br J clin Pract 1959; 13: 859-62. 

Kurland AA. Chlorpromazine in the management of the institutionalized aged psychiatric patients with chronic brain syndrome. Dis Nerv Syst 1955; 16: 336-9.

Lehmann HE, Cahn CH, deVerteuil R. Treatment of depressive conditions with imipramine (G-22355’). Canad Psychiat Assoc J 1958; 3: 155-54.

LevyS. Pharmacological treatment of aged patients in a state mental hospital. JAMA 1953; 153: 1260-5.

Mayer-Gross W, Slater E, Roth M.  Clinical Psychiatry. 2nd edition.  London: Cassell and Company; 1960.

Metschnikoff E. The Prolongation of Life. London: Heinemann; 1907.

Nascher IL. The Diseases of Old Age and Their Treatment. Philadelphia: P. Blackstone’s Sons & Co; 1914.

Pasamanick B. A survey of mental disease in an urban population. An approach to total prevalence by age.  Ment Hosp 1967; 46: 567-72.

Pauker JD, Kheirn J, Mensh N, Koun WB. Sex hormone replacement in the aged. I. Psychological and medical evaluation of administration of androgen-estrogen and of androgen–estrogen combined with reserpine.  J Geront  1958;  1: 389-97. 

Pick A. Über die Behandlung der senilen Hirnatrophie zur Aphasie. Prag Med Wochenschr 1892; 17: 165-7.

Pomeranze J, Ladek RJ. Clinical studies in geriatrics. III. The “tonic”.  J Am Geriat Soc 1957;  5: 997-1002.

Popklin RJ. The hydrogenated alkaloids of ergot (Hydergine) in geriatrics.  Follow-up study.  Am Pract Dig  Treat 1956; 7: 1594-7. 

Roth M. The natural histoty of mental disorders in old age. J ment Sci 1955; 101: 281-301.

Roth M. Interaction of genes and environmental factors in the causation of schizophrenia. In: Richter D, editor. Schizophrenia - Somatic Aspects. London: Pergamon Press; 1957.

Roth M, Morrissey JD. Problems in the diagnosis and classification of mental diseases in old age with a study of case material. J ment Sci 1952; 98: 66-80.

Rotschild D. The clinical differentiation of senile and arteriosclerotic psychoses. Geriatrics 1947; 2: 155-7.

Rotschild D, Kasanin J. A clinicopathologic study of Alzheimer’s disease: relationship to senile conditions. Arch Neurol Psychiat 1936; 36: 293-321.

Seager CP. Chlorpromazine in the treatment of elderly psychotic women. BMJ 1955; 1: 882-4.

Settel E.  Treatment of anxiety and agitation with prochlorperazine in geriatric patients.  J Am geriat Soc 1957; 5: 827-31. 

Silverman M, Parker JB, Busse EW. A review of drugs in the elderly psychiatric patient. NC Med J 1959; 20: 428-32.

Simon AS. Mental health of community resident hospitalized aged. In: Simon AS, Epstein LJ, editors. Aging in Modern Society. (Psychiatric Research Report No. 23.) New York: American Psychiatric Association; 1968. 

Stenstedt A. A study of manic-depressive psychosis. Clinical, social and genetic investigations. Acta Psychiatr et Neurol 1952; 79 (supplement):  1-111. 

Terman LA.  Treatment of senile agitation with chlorpromazine.  Geriatrics 1955; 10: 520-2.

Tschudin  A. Die behandlung  depressiver Zustände mit Tofranil. Praxis 1958; 47: 1100-4.

Wernicke C. Lehrbuch der Geisteskrankheiten. Berlin: Kassel; 1881.

Zahn L. Erfahrungen mit einem zentralen Stimulans (Ritalin) bei cerebralen Altersveränderungen Berl Gesundheitsblatt  1955; 6: 419-20.

 

March 7, 2019