Geriatric Psychiatry

Recent studies have shown that patients with schizophrenia experience a greater decline in cognitive abilities with age. Given the large baby boomer population, how will this influence treatment for aging patients with schizophrenia?

Cognitive impairment is a common symptom in many psychiatric and neurologic conditions. The articles selected for this Psychiatric Times special report provide a sampling of some important and topical issues regarding the influence of various factors on cognition in individuals with neuropsychiatric conditions.

What role might cognitive functioning play in suicidal ideation in elderly patients? How can psychiatrists determine the cognitive functioning skills of older patients who express suicidal thoughts?

Euthanasia is a word coined from Greek in the 17th century to refer to an easy, painless, happy death. In modern times, however, it has come to mean a physician's causing a patient's death by injection of a lethal dose of medication. In physician-assisted suicide, the physician prescribes the lethal dose, knowing the patient intends to end their life.

According to a survey done in 1999, 54% of Oregon's psychiatrists and 75% of the state's psychologists supported physician-assisted suicide, whereas between 20% and 33% of all health care professionals opposed it. The debate continues, as the federal government is trying to take away prescribing privileges for physicians who prescribe life-ending medications.

Women with schizophrenia may benefit from hormone replacement therapy. A new study measured the efficacy of estrogen, progesterone, Prolactin, luteinizing hormone, follicle stimulating hormone and testosterone on women with the disorder.

In what ways does culture impact treatments of depression? This case study follows the progress of "Mrs. H," a 77-year-old African-American female.

The current climate of managed care has dramatically changed how psychiatrists deal with the issue of suicide. What should clinicians know, both about the safety and welfare of their patients and to protect themselves legally, when dealing with managed care companies in cases of potential suicidality?

Assessing and treating suicidal behavior in the elderly can be difficult. What are the risk factors and how can this population best be treated?

The American Psychiatric Association has developed a sweeping vision for reforming mental health care in the midst of a fiscal crisis that it says threatens a wholesale collapse of the system. The plan calls for an investment in mental health services equal to the level of disability that mental disorders cause, an end to behavioral health carveouts and better integration between psychiatry and primary care.

Although the prospect of online mental health care raises obvious questions, it also offers an opportunity to make cost effective services available to many who may not otherwise have access. By understanding issues such as confidentiality, emergencies and lack of face-to-face contact, psychiatrists can determine if this area of treatment is right for them.

Inpatient care for the wealthy has arrived--fluffy bath robes, in-room Jacuzzis, a concierge at your beck and call. Do the luxuries of these "resorts" negate the care that is being provided, or can patients have the best of both worlds?

The World Trade Center attack changed the face of the United States and of psychiatry. Men and women of the cloth and of the clinic came together to care for the stricken masses. Yet, members of the clergy do not always refer congregants who exhibit duress to the psychiatrist, nor do psychiatrists refer patients to the clergy. What keeps these two fields apart? What is best for your patient?

Although late-onset psychosis is not as common as the early-onset variety, it can still pose difficulties in diagnosing and treating patients. How are patients with late-onset psychosis different from those who have early-onset, and what sorts of issues should clinicians be aware of?

Groups are important throughout the course of a patient's therapy, especially for patients who have substance use disorders. Group therapy's clinical and cost benefit is evaluated for its efficacy in preventing and treating substance abuse.

New developments in neuroimaging and effective diagnostic tools can help obtain early diagnosis of and timely treatment for Alzheimer's disease.

The promise of natural products as possible sources of new treatments for Alzheimer's disease and other dementing illnesses is on the rise. Scientific evidence for the 13 dietary supplements most commonly used for memory impairment is analyzed and evaluated.

Alzheimer's disease (AD) is a devastating and debilitating neurodegenerative condition, and the most common cause of dementia among the elderly. Despite considerable advances in the cellular and molecular biology of AD, however, little progress has been made in identifying the causes of the disease.

Patients with Alzheimer's disease and psychosis often have a more severe course of illness, with higher incidence of caregiver burden and hospitalization. Differentiating this disorder from Alzheimer's disease uncomplicated by psychosis is key to maximizing more positive outcomes.

More women than men are diagnosed with depression. Yet, men who are troubled by depression are also more likely to die, even when suicide is removed from the factors of consideration. Vascular depression, hyperintensities within the brain, physiological changes and late-life onset provide both insight and more questions into the nature of depression and this enigmatic paradox.

The patient, a young gay man who once lived for a time in Salt Lake City, describes his pursuers: Mormons who know where he is and are trying to kill him. As the clinic visit goes on, I see the doubt in his eyes when I explain my medication increase, and ask about it. He admits he can't be sure; his voices are saying that I'm a Mormon too. Only, with much persuasion and oversight will he comply with my prescription, because he trusts his case manager more than anyone else in the world.

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

For various reasons, up to half of patients stop taking their prescribed antidepressant within three months. Side effects are often the biggest obstacle in maintaining treatment adherence. How can clinicians help patients deal with the sexual dysfunction and weight gain that often accompany psychotropic treatment?

Jose R. Maldonado, M.D., assistant professor of psychiatry and behavioral sciences at Stanford University, was named the 2001 recipient of the Psychiatric Times Teacher of the Year award. The award was presented to Maldonado at the 14th Annual U.S. Psychiatric & Mental Health Congress in honor of his outstanding achievements in and steadfast dedication to psychiatry. For his work with geriatric psychiatry, Dilip V. Jeste, M.D., has been appointed to the endowed Estelle and Edgar Levi Memorial Chair in Aging at University of California, San Diego (UCSD). Jeste is founder and chief of UCSD's division of geriatric psychiatry and Founding President of the International College of Geriatric Psychoneuropharmacology. He focuses his research on schizophrenia and other psychotic disorders in late life and their successful treatment with the use of safer and more effective drug and psychosocial treatments.Helping people of all ages with schizophrenia to reintegrate into society is the focus of the Eli Lilly and Company-sponsored Reintegration Awards. Recognizing both patient advocates and mental health care professionals, these awards provide grants for their recipients' respective reintegration programs. In the Honorary category, the 2001 "Public Eye Recipient" is Elizabeth Baxter, M.D., a Tennessee-based psychiatrist who, while suffering from psychosis herself, is a mental health advocate on the national level. The 2001 Reintegration Awards were also given in the categories of Advocacy (New Jersey Association for Mental Health Agencies Inc. in Manasquan, N.J.), Clinical Medicine (The Whole Person Family Medicine Clinic in Torrance, Calif.), Education (The Guidance Center Supported Education Program in New Rochelle, N.Y.), Housing (Fred Geilfuss, Scott Reithel, Jack Rosenberg in Milwaukee), Occupational (Restoration Project in Acton, Mass.) and Social Support/Rehabilitation (Fountain House in New York City).

Women are more vulnerable to anxiety and depression, which are linked with the development and progression of heart disease. What has been discovered about the specific psychological outcomes for women with heart disease?

In this second article of a series, innovative research and technologies presented at the 41st Annual New Clinical Drug Evaluation Unit meeting are highlighted.

In the first of this series of articles, some of the innovative research and technologies presented at the 41st annual New Clinical Drug Evaluation Unit meeting in Phoenix in May are discussed.

Although many of the physiological functions of neurosteroids are currently unknown, evidence suggests that these endogenous molecules may play a role in the pathophysiology of psychiatric disorders and treatment strategies. Neurosteroids have been linked to SSRI action and may be relevant to antipsychotic drug effects. Do neurosteroids have neuroprotective properties or HPA axis effects?

In Illinois, the Department of Public Health and a nursing home facility came under fire after two mentally ill residents were charged with murder. Two recent federal government reports look into the nature of nursing homes and their role as long-term care mental health facilities. Are nursing homes providing appropriate care for mentally ill patients or are these facilities merely being used as warehouses for mentally ill patients?

Were you unable to attend the annual meeting of the American Psychiatric Association in May? Read the first part in a series of summaries of important new research presented there.