116 CHAPTER 4
and Older Populations Targeting Neurological Factors in Younger
and Older Populations
Patients at two ends of the developmental continuum—children (including ado-
lescents) and the elderly—may respond somewhat differently than do young and
middle-aged adults to the same biomedical treatments. Let’s explore how biomedi-
cal treatments may be modifi ed for these special populations.and Older Populations Targeting Psychological Factors in Younger
The Food and Drug Administration is the federal agency in the United States
charged with determining whether a medication is safe for use and, if so, for
what disorders and at what dosages. However, most medications are tested on
and approved for use with adults. (One exception is the skin patch containing a
daily dose of methylphenidate for the treatment of attention-defi cit/ hyperactivity
disorder.) However, some medications that are effective for adults may not
alleviate symptoms in children; for example, tricyclic antidepressants are not an
effective treatment for depression in children (Stein, Weizman, & Bloch, 2006).
Other medications are prescribed for patients off-label, meaning that the
medication has not been approved for treating the given disorder or for treat-
ing children and/or adolescents. For younger patients, the dosage and frequency
of medications that are prescribed off-label may need to be adjusted, and these
patients may need to be monitored for adverse side effects more frequently than
are adults.
Electroconvulsive therapy has rarely been used to treat children and ado-
lescents, and so there isn’t much research to guide clinicians about what kind of
disorders and symptoms are appropriate to treat with ECT in younger patients and
what level of electric current is best (Sporn & Lisanby, 2006). Interest in using brain
stimulation techniques to treat children and adolescents is increasing because side
effects of various antidepressant medications, such as increased risk for suicide,
have been noted in young patients (Stein et al., 2006).Targeting Neurological Factors in Older Patients
As adults become older, their bodies, and certain cognitive functions, change—
although in most cases these changes do not signifi cantly interfere with normal
functioning. For instance, older adults tend to process information more slowly
(Salthouse, 2005) and may have difficulty remembering names of objects or
people (Nicholas et al., 1985). In addition to these cognitive changes among
the elderly, their symptoms of some disorders may be different; for example,
depressed elders tend to have more agitation and more memory problems than
do depressed younger adults (Segal, Pearson, & Thase, 2003).
Mental health clinicians who treat older adults should be prepared to modify
biomedical treatments for this population. Consider that older adults are typically
more sensitive to medications and so need lower dosages than do younger adults
(Fick et al., 2003). In fact, if older adults are given a dose that is standard for younger
adults, they may experience symptoms that mimic psychological disorders—such as
being sedated (which can cause them to be slower, both physically and cognitively)
and confused.
In addition, many elderly people take medications to treat physical problems,
and these medications can adversely affect their mood, cognitive functioning, or
behavior. Indeed, one study found that elders who do not live in institutional care
(such as nursing homes) take an average of five prescription medications each
day (Rajska-Neumann & Wieczorowska-Tobis, 2007). Such medications, or their
interactions, can cause symptoms that appear to be related to depression, such
as diffi culty concentrating, sedation, and confusion. Thus, an elderly patient may
appear to be depressed, but not actually be.