Despite the increasing number of elderly nursing home patients with dementia or Alzheimer's disease, there are problems providing appropriate care. Two of the major difficulties are lack of Medicare reimbursement and poor staff training. How can we better care for these elderly patients?
It has been well established that there is a high incidence of depression in conjunction with Alzheimer's disease and other forms of dementia. What are the best assessment and diagnostic methods, and which treatments will produce the best results?
Allegations of complicity by Chinese psychiatrists in abuse and persecution of members of the Falun Gong continues to trouble the World Psychiatric Association. Are the steps being taken to learn the truth enough? Dr. Stone provides a look at the events that have unfolded to date.
Over the past quarter-century, new treatments for depression have emerged that are as effective as original pharmacotherapies but have fewer side effects. Yet, full remission and access to care remain out of reach for so many people. In this introduction to our Depressive Disorders Special Report, Dr. Golden encourages readers to see the glass as half-full.
Underdiagnosis of sexual dysfunction occurs frequently, even though more than two out of five adult women and one out of five adult men experience it in their lifetime. To increase recognition and care of sexual dysfunction, multidisciplinary teams of medical experts recently published diagnostic algorithms and treatment guidelines that include comprehensive psychosocial assessments, sexual histories, and discussions of selected psychotherapies and pharmacotherapies.
Geriatric psychotherapy has begun to receive consistent and supportive attention in the psychiatric literature. Despite this growing interest in psychotherapy for older adults, studies of efficacy of either psychotherapy alone or of combined treatments for older patients are still limited in number, and more attention to the issue is needed.
A cross-cultural comparison of suicide in old age, including a discussion of recent epidemiological trends in suicide rates. The authors also discuss the impact of social and cultural variables on the detection of depression and the formulation of suicide prevention strategies.
The field of neuropsychiatry has undergone tremendous growth over the past few decades.
Three studies over the past three years show that individuals over age 65 who are suffering from depression may still not be receiving the treatment they need. Is integrating treatment into primary care the answer?
Monitoring patients for possible QTC prolongation with psychotropic use can be difficult--even more so in children or adolescents. What screening and treatment techniques should be used for maximum therapeutic benefit with minimum cardiac risk?
Psychopharmacologic management has become increasingly complex, and physicians run the risk of precipitating drug-drug interactions when certain drugs interact via the cytochrome P450 system. In addition, the P-glycoprotein transporter may play a role in certain drug-drug interactions. While physicians currently rely on Web sites and textbooks to avoid potentially morbid and lethal interactions, electronic medical records may play a crucial role in the future.
In modern practice, psychiatrists will invariably have patients who come from different ethnic or cultural backgrounds. Practitioners will need to consider socioeconomic status, diet, use of herbal medications and immigration status, as well as patients' own self-perception of ethnicity, in assessing patients and planning treatment.
With proposed cuts in state budgets nationwide, social services--including mental health care--are taking a financial blow. As a result, mental health care facilities are closing and services are disappearing. What will the effect be on patient care?
Depression and dementia or Alzheimer's disease often go together. The presence of dementia may also increase the odds of depression. What can clinicians do to treat these two often comorbid conditions?
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.
