Geriatric Psychiatry

Sleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.

Dementia is characterized as a progressive and chronic decline in cognitive function, not limited to memory impairment, which significantly interferes with baseline daily functioning and frequently involves behavioral disturbances. It is known that behavioral problems in dementia negatively affect patients and caregivers. These disturbances lead to institutionalization, increased costs and caregiver burden, and a poorer prognosis.

Guardianship laws--the provisions aimed at ensuring that elderly and incompetent individuals receive the necessities of life (including medical care and financial protection)--are drawing fire around the country amid charges of abuse, fraud and civil rights violations.

Despite high prevalence and negative consequences of anxiety disorders in later life, this area has received little research attention. A relatively small number of outcome investigations on late-life anxiety have focused on the impact of pharmacological and psychotherapeutic treatments.

Congress agreed in December to drop from its consideration of a budget reconciliation bill a provision that would have allowed family therapists and counselors to bill Medicare for mental health diagnoses. Many psychiatrists viewed the proposed legislation as a scope-of-practice attack by non-MDs.

As the new science content editor of Psychiatric Times, long-time contributor and editorial board member Ronald Pies, M.D., will collaborate with editors to expand the depth, breadth and credibility of the publication.

Although forensic psychiatry is a formal subspecialty, general clinicians are often called upon to perform the bulk of forensic assessment. As such, the need for some basic training in and knowledge of forensic psychiatry is clearer than ever.

Several significant factors have converged to impact and heighten concern about the potential for malpractice litigation related to psychopharmacology. Current influences as well as frequent sources of professional liability risk related to psychopharmacology are reviewed and suggestions for preventing and reducing risk are made.

The multitalented psychiatrist talks with Psychiatric Times about his research, his literary work and the future of psychiatry itself.

Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.

Affecting 70% of patients with Alzheimer's disease and common in patients suffering from other dementing illnesses, apathy is associated with functional impairment and caregiver distress at all levels of disease severity. Assessment and treatment for this under-recognized syndrome are discussed.

Advances in technology are providing assistive and supportive interventions for people with dementia across all aspects of their lives. These interventions are mainly addressed at meeting the safety, security and social needs of people with dementia. The psychological needs of people with dementia for conversation and other forms of positive social interactions are also being tackled through developments such as the CIRCA project.

The United States is facing accelerated growth in the number of older citizens due to the aging baby boomer generation. It is expected that this emerging cohort will have more licensed drivers who will drive longer distances more frequently and later into life than preceding generations. What are the risks from elderly drivers and how can we help them drive safely?

Elderly patients are a heterogeneous population with myriad issues facing them. The group of articles in this Special Report should stimulate thinking, discussion and future research in a variety of areas.

Published a decade ago, the original National Comorbidity Survey focused largely on anxiety and depression. In an exclusive interview, the survey's designer, Ronald C. Kessler, Ph.D., talks with Psychiatric Times about the just-published replication study, which found that the combined lifetime prevalence of impulse control disorders is higher than that for either mood or substance use disorders.

There is growing epidemiologic and clinical data that confirm progressive hypothalamic-pituitary-gonadal hypofunctioning in aging men. What role does the HPG axis play in the complex psychobiology of male sexual and affective disorders? The treatment rationale, clinical indications and risks in using exogenous testosterone for late-life depression are explored.

Health-related quality of life can provide a simultaneous and net assessment of the therapeutic and adverse affects of psychiatric treatments for depression. While the cognitive side effects of ECT might be thought of as a limiting factor in HRQOL gains, they have not been systematically studied until recently. Find out what quantitative assessment of HRQOL following ECT for major depressive disorder shows.

Selective serotonin reuptake inhibitors have been shown effective in the treatment of depression with psychosis. This efficacy appears to correlate with the SSRIs’ level of affinity at the sigma-1 receptors in the brain. What role does the sigma-1 receptor play in psychotic depression? Based on this role, are there implications for other treatments?

The incidence of polypharmacy is on the rise, and with the increase comes a greater risk of drug-drug reactions. One survey estimated that patients seeing a psychiatrist may be six times more likely to receive multiple psychotropic medicines compared to patients seen by a primary care physician. This article provides an overview of the extent of polypharmacy, the factors driving the phenomenon and issues clinicians should consider when treating patients who are already taking medicines for other illnesses.

Delirium,Dementia

Of concern is the safety of our roadways as the effects of aging take their toll upon drivers nationwide. Are there accurate ways to test the cognition and response ability of elderly drivers?

Is the HAM-D still viable? What are its flaws and is it possible to compensate for them?

Multiple studies show that diabetes approximately doubles the risk of comorbid depression. Furthermore, major depressive disorder is a risk factor for the subsequent development of type 2 diabetes mellitus. Treatments for depression in the setting of diabetes must be evaluated for their effects on blood glucose levels, propensity for weight gain, possible concomitant use for diabetic neuropathy and potential drug interactions.

Dr. Cummings, the originator of Psychiatric Times' "Brain and Behavior" column, looks back over his career in neurology. Looking forward, he predicts that psychiatry and neurology will become ever-more intertwined.

Telepsychiatry has been hailed as the future of psychiatry. Proponents have claimed that it can reduce costs and allow access to difficult-to-reach patients. What are the promises and pitfalls of this new technology?