Principles and Practice of Geriatric Psychiatry

September 1, 2006
Shilpa Srinivasan, MD

Volume 23, Issue 9

A review of the book, "Principles and Practice of Geriatric Psychiatry."

by Marc E. Agronin, MD and Gabe J. Maletta, PhD, MD Philadelphia: Lippincott Williams & Wilkins, 2005 762 pages • $149 (hardcover)

This is the latest clinical textbook in the field of geriatric psychiatry. There are 102 contributing authors, many of whom are experts in their field, who join the esteemed lead authors, Marc E. Agronin and Gabe J. Maletta. This book spans 43 chapters and is divided into 5 sections.

Section I introduces key elements in clinical practice: patient, clinician, caregiver, and setting. Gene Cohen sets the tone in the first chapter by presenting 4 distinct "second-half- of-life developmental phases" using examples of renowned authors, politicians, and musicians to illustrate these phases. Theories on aging are also briefly covered.

Section II addresses principles of clinical evaluation. Chapter 8, titled "Neuroimaging in the Geriatric Patient," provides an excellent, well-referenced review of neuroimaging findings in mild cognitive impairment, mood disorders, psychosis, and in the various dementias.

Section III covers general principles of psychiatric treatment, including detailed chapters on psychotherapy, pharmacotherapy, and electro- convulsive therapy. Len Sperry's chapter on spirituality and its role in geriatric psychiatry is an outstanding addition, highlighting an often underaddressed facet of clinical care. Chapter 18, "Ethical Issues in Geriatric Psychiatry," provides a thorough overview of capacity, informed consent, and advance directives that the practicing psychiatrist will find extremely useful.

Section IV, on psychiatric disorders, is the largest part of this book and perhaps the most important for the clinician. It exhaustively covers dementias; delirium; affective disorders; psychosis; and anxiety, personality, and sleep disorders in the elderly. Noted sex therapist, Dr Ruth Westheimer, collaborates with Agronin in chapter 35 to outline the very relevant issues of sexuality and sexual disorders in late life.

The challenges in addressing psychosis and agitation in dementia and the existing literature on medication trials are extensively reviewed in Section V, along with Parkinson disease and other associated psychiatric issues. Three unique appendices are included: a guide to psychotropic pharmacotherapy in the elderly, a good review of human neuroanatomy, and a comprehensive list of resources for the practicing clinician.

This book's strength lies in its logical organization. Many chapters are concise and easy to read. Clinical vignettes, tables of clinical information, and algorithms for diagnosis and treatment are well presented. In addition to thoroughly addressing the clinical tenets of geriatric psychiatry, the chapters that cover cultural issues in late life, forensic evaluation, and the aging patient with intellectual disabilities make this book stand out in its breadth and balance.

The authors describe this book as "a clinical, patient-based, practical resource written to assist practicing clinicians of geriatric psychiatry in evaluating and managing their patients." This book ably achieves its goal and is a wonderful contribution to the literature.

Dr Srinivasan is assistant professor of clinical psychiatry in neuropsychiatry and behavioral science at the University of South Carolina School of Medicine, Columbia.