Geriatric Psychiatry

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.

The ranks of the elderly are swelling, yet fewer and fewer physicians are choosing to practice geriatric psychiatry. What will be the impact on older patients who receive their mental health care from primary care physicians?

Is there a difference between bifrontal, bitemporal and right unilateral? In addition to talking about other research into optimal strength and electrode placement, Max Fink, M.D., outlines some of his own ongoing research.

Evidence is accumulating that untreated depression can impede comorbid medical treatment and increase mortality. The author reports on the latest research and treatment recommendations for depression that accompanies cardiovascular disease, stroke and Parkinson's disease.

It was supposed to only take 100 days, but that was eight years ago. When President Bill Clinton took office in January 1993, an air of expectancy permeated Washington, D.C.'s stuffy corridors, and for a moment it seemed as if the world's most developed nation would finally have a national health care policy.

The SSRIs have become the most widely prescribed antidepressants in the United States. With this increased use has come more information on adverse events associated with their use, such as sexual dysfunction. However, movement disturbances associated with SSRI use can adversely impact treatment. This article explains the pathology of movement disorders and describes confounding variables such as other medications, pre-existing neurological insults and the nature of case reviews. Those at risk include the elderly, patients taking neuroleptics and those exposed to high levels of SSRIs.

In examining the demographics of a state Medicaid population, we found that members of ethnic minorities, rural residents, women, and patients aged 45 years and older were more likely to receive first-generation antipsychotic medications than the newer, second-generation agents, which have a more favorable side-effect profile.

Samantha Meltzer-Brody, M.D., et al. provided data suggesting that fluoxetine (Prozac) exerts a broad-spectrum effect in reducing all symptom clusters in a sample of 53 patients with posttraumatic stress disorder (PTSD). Their results indicated that fluoxetine was most effective in treating the individual symptoms of intrusive recollections and having a sense of failure.

The 89-year-old woman had undergone hip replacement surgery two days before, had tubes in her arms and couldn't walk. But she blithely announced to her daughter that she was leaving the hospital immediately and started to get out of bed. Astounded, the daughter sought out her mother's physician and asked, "What's going on?"

With more and more Americans engaging in gambling activities, odds are high that psychiatrists may see patients who have some sort of gambling problem. What can be done about this problem, and how can these patients best be treated?

More patients are reaching the old-old demographic-those age 75 and above-with psychiatric conditions such as treatment-resistant depression. Research has shown that with some careful screening and precautions, ECT is a safe, effective treatment option for these patients.

Dementia produces significant dependency and contributes to costly long-term care; depression contributes to high rates of suicide; and both contribute to lower quality of life and higher disability among older patients. Therefore, researchers are eager to find new ways of preventing and treating these conditions. Studies currently underway include evaluating the role of health specialists in treating depressed patients, looking at bereavement and its effects on patients, and the role of estrogen, vitamin E, NSAIDs and COX-2 inhibitors in preventing and treating Alzheimer's disease.

As the population ages, psychiatrists will need to take a more proactive role in preventing, diagnosing and treating elder abuse. This article looks at the definition of elder abuse and the history of reporting it, research findings on the effects of abuse on mortality, and needs for the future.

In addition to reports on psychotherapeutic agents now available and anticipated in the United States, the presentations at the 22nd annual Collegium Internationale Neuropsychopharmacologicum (CINP) Congress, held from July 8 to 13, in Brussels, provided a unique view of varied investigational compounds and approaches outside our country.

New studies show that the elderly may be more resilient in the face of natural disasters than younger victims. Preparing older patients is key to improving their coping skills.

Sexuality is a very important life issue for the elderly, but is often overlooked, according to Cynthia L. Ardito, Psy.D. Ardito frequently speaks on this subject to various health care provider groups in the United States and Canada.

The methodology of clinical trials was as much of interest as the trial results for investigators gathered at the 39th annual NCDEU (New Clinical Drug Evaluation Unit) Program meeting. This meeting was conducted in June by the National Institute of Mental Health in Boca Raton, Fla.

The methodology of clinical trials was as much of interest as the trial results for investigators gathered at the 39th annual NCDEU (New Clinical Drug Evaluation Unit) Program meeting. This meeting was conducted in June by the National Institute of Mental Health in Boca Raton, Fla.

As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.

The most common psychiatric sequelae following trauma include major depressive disorder, somatoform pain disorder, adjustment disorder and posttraumatic stress disorder (PTSD). In law, trauma that precipitates PTSD is viewed as a tort, which stems from the root word "torquere" (to twist), as does the word torture. In a sense, plaintiffs do allege torture in personal injury cases. A tort constitutes a civil or private wrong, as opposed to a criminal wrong, and rests on the general principle that every act of a person causing damage to a legally protected interest of another obliges that person, if at fault, to repair the damage (Slovenko, 1973).

Only one month after the American Medical Association unveiled a major reorganization of its science and technology departments-one that included the dismantling of its department of mental health-the former director, psychiatrist Larry Goldman, M.D., was fired after he criticized the changes.

Recent advances in the treatment of mental and addictive disorders, along with research findings in basic neuroscience, molecular genetics and molecular biology that contribute to the understanding of such disorders, were discussed at the American College of Neuropsychopharmacology's 37th annual meeting in Puerto Rico. The following are brief reports from selected presentations.

More than 80 medications are in development to treat mental illnesses, including 18 for depression, 15 for schizophrenia and 16 for anxiety disorders, according to the Pharmaceutical Researchers and Manufacturers of America (1998). Which ones will most likely come to market in the United States?

Daniel F. Kripke, M.D. has studied the relationship between biological rhythms and depression since the early 1970s. He states that seasonal responses in many mammals are controlled by the photoperiod. Therefore, it seemed that depression might be analogous to winter responses and that light might be an effective treatment.

Faced with the trend toward shorter length of stay in inpatient psychiatric units, practitioners and patients in need of care face dramatic changes in treatment.

Although evidence shows that selective serotonin reuptake inhibitor (SSRI) antidepressants cause less orthostasis and interfere less with psychomotor function than do tricyclic antidepressants (TCAs), a recent pharmacoepidemiologic study found them comparable in increasing elderly patients' risk for falling.

When treating agitation in the elderly, the optimization of certain behavioral techniques may enhance medication therapies or sometimes eliminate the need for them. Clinicians should look more closely at the behavioral causes behind a demented older person's problem behavior.

In Western psychiatry, depression is considered a major cause of suicide. But research from China calls that assumption into question. More than 300,000 suicides occur annually in China, nearly 10 times the number of suicides in the United States.

Consider the following scenario: You are contacted by the major health plan with which you contract and are told that your average length of inpatient stay is longer than their standard. You believe this is because your patients are more severely ill than average. How do you respond?

This is the second of two articles regarding herbal medicines as discussed at the American Psychiatric Association's annual meeting in Toronto. Potential benefits and risks of kava, St. John's wort and hoasca were considered at the recent American Psychiatric Association's symposium on herbal medicine.