CORE--GERIATRIC PSYCHOPHARMACOLOGY

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The proposed activities of the Laboratory of Geriatric Psychopharmacology are derived from both the CRC's ongoing studies in this area and from the longstanding interests of Penn's program m psychopharmacology. The Laboratory is designed to provide a structure that will facilitate research on both the drug treatment of the psychiatric disorders of late life and the psychiatric effects of drugs used to treat medical disorders; it provides infrastructure support to develop new research and to support the development of junior investigators. The research described in this application consists of two studies, "Nortriptyline Treatment of Depression in the Nursing Home Aged", and "Delirium Reconsidered: Monitoring for Acute Cognitive Change in the Elderly" that were developed through CRC initiatives and are now independently funded as well as two new projects, "A Pilot Study of the Safety and Efficacy of Sertraline in Depression after Myocardial Infarction ", and "Stimulant Responses in Geriatric Depression: Treatment and Probe". The Sertraline study is proposed because the profile of adverse events observed with this agent is such that it may now, for the first time, be possible to conduct larger scale controlled studies of the treatment of depression in post-mi patients to assess the functional outcome of treatment as well as the reduction in symptoms; however, before such research can be conducted it is necessary to confirm the safety of sertraline specifically in post-mi patients. The Stimulant study is a placebo-controlled study of methylphenidate treatment for depression in the inpatient rehabilitation setting, where rapidity of response can be important to overcome the effects of depression as a barrier to the process of rehabilitation; it is also designed to develop stimulant challenges as tests for heterogeneity in aminergic systems underlying the regulation of affect in older patients with chronic disease.