Geriatric Psychiatry

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.

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.