Practice Of Geriatric Psychiatry Research Articles

A Case of Acute Demyelinating Encephalitis Presenting as Manic Symptoms

Back to table of contents Previous article Next article LettersFull AccessA Case of Acute Demyelinating Encephalitis Presenting as Manic SymptomsOmopariola Adegbola, M.D., and Nahla Mahgoub, M.D.Omopariola AdegbolaSearch for more papers by this author, M.D., and Nahla MahgoubSearch for more papers by this author, M.D.Published Online:1 Jan 2014https://doi.org/10.1176/appi.neuropsych.13010003AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Differentiating a manic episode of bipolar disorder from mania secondary to a medical condition in older adults is challenging. The diagnostic dilemma appears when the patient has an established diagnosis of bipolar disorder from a young age. The neuropsychiatric manifestations are similar, and there have been numerous conditions to which secondary mania can be attributed. A thorough differential diagnosis should be considered to help guide appropriate management. Evidence suggests that neurological conditions are the most common causes of secondary mania. In a retrospective study examining 50 manic patients older than age 65, neurological disorders were reported in 74% of the patients.1 We summarize a case of mania that emerged in the context of acute demyelinating encephalitis in an elderly patient with a diagnosis of bipolar disorder since adolescence.Case ReportA 60-year-old woman was first diagnosed with bipolar disorder at age 16 and was treated with divalproex sodium. She had neither medical nor family history of psychiatric illness. She was admitted for manic symptoms attributed to medication nonadherence. She was treated with lithium 900 mg daily (serum level on discharge was 0.83 mEq/L) and risperidone 4 mg daily. Two months later, she was readmitted because of mood lability and disorganized thoughts for 1 week. She was found to be lethargic and had delirium. Her lithium level was 0.41 mEq/L. Laboratory tests including urine toxicology were negative. Head CT was negative. Neuropsychological assessment revealed impairment in areas of visuospatial and visuomotor functioning, attention, and executive functioning. The neurology consultation found no focal deficits, and brain MRI suggested a demyelinating disease. Lithium and risperidone were stopped, and the patient was transferred to a neurological floor for further evaluation. Video-EEG showed diffuse slowing but no epileptiform activity. Lumbar puncture and paraneoplastic panel were negative. A serial of brain MRI suggested acute demyelinating encephalitis, most pronounced within the frontal and temporal lobes, right greater than left. She was treated with intravenous immunoglobulin and corticosteroid. Her delirium resolved, but she continued to have residual mood symptoms that took several weeks to subside.DiscussionThe frontotemporal involvement in our patient is thought to have contributed to the development of her manifestations. Studies suggest that brain pathology disrupting neural circuits in the right orbitofrontal and temporal cortices has been implicated in mania. Starkstein et al.2 reported predominance of right-sided hemispheric localization of heterogeneous brain lesions, including tumors, strokes, and head injuries in patients with mania.2The evaluation of manic symptoms in older patients requires a thorough history, laboratory tests, neurological assessment, and neuroimaging. Secondary mania may result from a neuropathological process associated with the underlying condition.3 Multiple sclerosis, Parkinson’s disease, epilepsy, dementia, brain aneurisms, brain tumors, traumatic brain injuries, and cerebrovascular events are the most common brain lesions associated with secondary mania.4 There is a temporal relationship between manic episode and primary medical condition in 20% of patients with a latent period of months-to-years.5In summary, there is a high rate of secondary mania in older adults that is more likely to be associated with an underlying neurological illness and warrant a comprehensive assessment. Clinicians should collaborate with a multidisciplinary medical and neurological team when manic symptoms develop in an older patient, even though a diagnosis of bipolar disorder was established at a younger age.Geriatric Psychiatry FellowAssistant Professor of PsychiatryWeill Medical College of Cornell University, Westchester DivisionWhite Plains, NYCorrespondence: Dr. Mahgoub; e-mail: [email protected]com and [email protected]cornell.eduThe authors have no direct financial interests in the subject materials discussed in the article.References1 Tohen M, Castillo J, Pope HG, et al.: Concomitant use of valproate and carbamazepine in bipolar and schizoaffective disorders. J Clin Psychopharmacol 1994; 14:67–70Crossref, Medline, Google Scholar2 Starkstein SE, Mayberg HS, Berthier ML, et al.: Mania after brain injury: neuroradiological and metabolic findings. Ann Neurol 1990; 27:652–659Crossref, Medline, Google Scholar3 Holtzheimer PE, Mayberg HS: Neuropsychiatric aspects of mood disorders, in Textbook of Neuropsychiatry and Behavioral Neurosciences, 5th Edition. Edited by Yudofsky SCHales RE. Washington, DC, American Psychiatric Publishing, Inc., 2008, pp 1003–1024Google Scholar4 Belli H, Akbudak M, Ural C, et al.: Solitary lesion in ponto-mesencephalic area related secondary mania: a case report. Psychiatr Danub 2012; 24:223–225Medline, Google Scholar5 Forster B, Antognini FC, Stoll A: Geriatric bipolar disorder, in Principles and Practice of Geriatric Psychiatry. Edited by Agronin MEMaletta GJ. Baltimore, MD, Lippincott Williams & Wilkins, 2006, pp 369–391Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 26Issue 1 Winter 2014Pages E17-E18 Metrics PDF download History Published online 1 January 2014 Published in print 1 January 2014

Principles and practice of geriatric psychiatry, second edition

Principles and practice of geriatric psychiatry, second edition

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry (3rd edition) Editors: Mohammed T. Abou-Saleh, Cornelius L.E. Katona and Anand Kumar Chichester: John Wiley & Sons, 2011, £150, hardback, 934 pp. ISBN-13: 978-0-470-74723-0

Principles and Practice of Geriatric Psychiatry (3rd edition) Editors: Mohammed T. Abou-Saleh, Cornelius L.E. Katona and Anand Kumar Chichester: John Wiley & Sons, 2011, £150, hardback, 934 pp. ISBN-13: 978-0-470-74723-0

Peculiarities of Geriatric Psychiatry: A Focus on Aging and Depression

There is a debate on whether Geriatric Psychiatry stands for itself as a discrete specialty or whether it is an extension of clinical Geriatrics, Neurology, and Psychiatry. This review aims to outline some recent data and possible approaches to define peculiarities of Geriatric Psychiatry, focusing on certain characteristics that define the aging brain. Geriatric depression is discussed taking into consideration some data from translational research. The brain aging process is not uniform. Frontal areas show marked impairment in inhibiting irrelevant information in working memory as they age, and the recruitment of these areas occur differently than in young subjects. Executive functions also change in normal elderly. Geriatric depression is a general definition of a multidimensional disorder with multiple risk factors. Dysexecutive syndrome is considered as a key to the neuropsychology of geriatric depression, correlated with functional impairment in late life. Late-onset depression has a higher load of comordibity, of cerebrovascular disease, and of some genetic factors that may be different from early onset depression. Also, there are at least four clusters of treatment outcomes that are common in geriatric depression, which mirror the neuropsychological and clinical profiles. Research and practice in Geriatric Psychiatry should focus on the interaction of various dimensions and risk factors rather than on attempting to find a single cause to the disorders. Some answers may be found in comorbidity issues, in white matter lesions, which are more common in the elderly, and in genetic factors that impact on the aging process.

Mental health economics, health service provision, and the practice of geriatric psychiatry

Economic evaluation is becoming more and more important as a means to assist policy makers in choosing the best intervention or treatment against a pervasive scarcity of resources relative to the demands. Health service provision and the practice of geriatric psychiatry are closely associated with costs and outcomes of health economics. Recently published literature raising unanswered questions in these areas is reviewed. Some studies on the costs, outcomes, and cost-effectiveness of certain interventions or treatments (e.g. respite care, home-visiting community service) compared with usual strategies show that these are not optimal in terms of health economics. The updated guidance by the National Institute for Health and Clinical Excellence that cholinesterase inhibitors should be used only for moderate severity dementia on the grounds of cost-effectiveness has been heavily criticized. Mental health provision for older people varies across 'developed' and 'developing' countries. Updated findings provide better understanding of recent progress and issues on mental health economics, health service provision, and the practice of geriatric psychiatry. The application of health economics to the field of mental health should make complicated issues simple and explicit. Constructive criticisms and scientific debates will hasten the development of better tools or methodologies to evaluate the cost-effectiveness of current and new interventions or treatments.

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry

Book Review Principles and Practice of Geriatric Psychiatry Edited by Marc E. Agronin and Gabe J. Maletta. 762 pp. Philadelphia, Lippincott Williams & Wilkins, 2006. $149. 978-0-7817-4810-0

Book Review Principles and Practice of Geriatric Psychiatry Edited by Marc E. Agronin and Gabe J. Maletta. 762 pp. Philadelphia, Lippincott Williams & Wilkins, 2006. $149. 978-0-7817-4810-0

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry

Surrogate decision making: special issues in geriatric psychiatry.

Surrogate decision-makers, usually family and friends, are often called on to assist seniors who are incapable of making certain decisions. The literature to date has focused primarily on decisions regarding medical treatment. Less has been written about issues faced by surrogates when making other types of decisions that often arise in the practice of geriatric psychiatry. This article outlines a case relating to personal care decision-making. The discussion focuses on areas that need to be addressed to understand and assist surrogates in making personal care decisions in the future.

Manual Of Nursing Home Practices for Psychiatrists

Article AbstractFrom our regular book review column.Geriatric psychiatry is a rapidly evolving field that plays an extremely significant role in the overall medical care of older adults. At the same time, the long-term care industry has been undergoing significant change dictated by evolving payment structures. Medicare provides extensive oversight and helps determine both the practice of geriatric psychiatry and the role of the geriatric psychiatrist within the long-term care facility.

Neuroimaging Applications in Elderly Patients

Although geriatric psychiatry has evolved into a specialty with increasingly sophisticated diagnostic and treatment tools, the incorporation of neuroimaging into the field has been challenging. A major reason for the difficulty is the rapid evolution and diversity of neuroimaging methodology, without there being a circumscribed set of procedures or measures with established clinical relevance. Nonetheless, neuroimaging methods are vital for obtaining in vivo information on brain structure and functioning, thus bridging molecular and systems understanding of brain and behavior. It is therefore difficult to imagine future research and even practice of geriatric psychiatry that does not exploit the ability to link behavior to the anatomic and functional integrity of its organ. We hope this special issue will help spark much-needed further research relevant to understanding the process of brain aging—interacting with age-related disorders—in a way that is helpful to geriatric psychiatry. At the same time, geriatric psychiatrists need to become familiar with the potential of neuroimaging, so that the field will be in a position to harness this methodology in the service of improved assessment and care. Our goal is to highlight the available methodologies and point to some opportunities and challenges for geriatric psychiatry.

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study.

To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Electroconvulsive therapy and falls in the elderly.

Electroconvulsive therapy (ECT) is commonly used in the practice of geriatric psychiatry. Although it has been found to be both safe and effective, one of the most common complications associated with ECT is falls. A logistic regression model was created to identify independent risk factors for falls in the elderly. Two risk factors were identified: the number of ECT treatments and the diagnosis of Parkinson disease. Further studies are needed to develop strategies aimed at reducing the number of falls. In the meantime, clinicians need to be aware that falls represent an important complication associated with ECT.

Psychiatry in the Elderly, 2nd ed.

Back to table of contents Previous article Next article Book Forum: GERIATRIC PSYCHIATRYFull AccessPsychiatry in the Elderly, 2nd ed.CARL SALZMAN, M.D., CARL SALZMANSearch for more papers by this author, M.D., Boston, Mass.Published Online:1 Feb 2000AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail It is gratifying to see the steady increase in psychiatry’s interest in the elderly. An increasing number of comprehensive and excellent textbooks on the topic of geriatric psychiatry and geriatric psychopharmacology are now available in the Untied States. This interest extends to Great Britain as well, where excellent volumes such as Principles and Practice of Geriatric Psychiatry, edited by Copeland and Abou-Saleh (1), have been published. Psychiatry in the Elderly is the second edition of another extraordinary British geriatric resource. With an occasional exception, the contributors to this outstanding volume are all psychiatrists in Britain or in Commonwealth nations. Although their names may not be well-known to American readers, their distinctly British perspective provides a nice counterpoint to American authors.Reflecting the British style, the contents of this book focus on manifest behavior, cognition, and emotion of the elderly, sociological and neurobiological phenomena, and treatment. What is not discussed are psychodynamic formulations or psychoanalytic concepts of the normal aging process. Readers who are interested in Eriksonian concepts of integration versus despair or discussions of the psychodynamics of identity change in retirement, late-life illness, etc., will have to look elsewhere. Even chapters titled “Neurotic Disorders in the Elderly” (a curious inclusion for a book that uses the ICD diagnostic scheme) and on “Personality” lack psychodynamic discussion.Psychiatry in the Elderly, however, offers perspectives that are not always as readily available in American texts. The chapter on sexuality in old age is superb, discussing the details of sexual life in old age without any hint of embarrassment. Another chapter discusses common ethical dilemmas that psychiatrists face when working with older people, such as quality of life, substituted judgment, and allocation of resources. Still another chapter is devoted to the abuse of elderly people. This chapter is buttressed by important data on the incidence and prevalence of abuse of elderly individuals as well as a discussion of crimes perpetrated against the elderly and even by the elderly. There is an extraordinary chapter (with photographs and building plans) on the need for better environments for people with dementia. Another wonderful chapter deals with the problems of caretakers of the elderly, especially those with Alzheimer’s disease, and there is a no-nonsense chapter on the economics and financial realities of the elderly and the need for long-term care services.The chapters on specific disorders and their diagnosis and treatment are equally straightforward but do not offer information that is not otherwise already available to American readers. Diagnostic issues are presented from the British perspective. For example, there is a wonderful discussion about the problems using the term “pseudodementia” and an equally wonderful discussion of the usefulness and problems of the diagnostic category known as “late paraphrenia.” Psychopharmacological treatment is presented in a relatively brief single-chapter overview but is also part of each treatment chapter. American readers are likely to find the psychopharmacology discussions adequate, but there are now available several American texts of geriatric psychopharmacology that provide considerably more detailed discussions of the use of medications than would be expected in a single large volume.Psychiatry in the Elderly would be a particularly welcome addition to the library of any psychiatrist with interest in the elderly or any geriatric psychiatrist practitioner. However, since similar American volumes are already available, the usefulness of this excellent book for American readers is probably as an augmenting rather than primary resource.edited by Robin Jacoby, Catherine Oppenheimer. New York, Oxford University Press, 1997, 776 pp., $189.50; $98.00 (paper).

Practice of geriatric psychiatry and mental health services for the elderly: results of an international survey.

The authors conducted a survey of members of the International Psychogeriatric Association (IPA) to determine the state of development of both the profession of geriatric psychiatry and services for mentally ill elderly. Ratings for both issues were based on a scale of 1 to 4, with 1 being little to no development and 4 being the highest. A rating of 2 was set as the desired minimum, and 12 countries met this goal in both categories, with 6 more countries reaching this goal in service development only. We conclude that although the field of geriatric psychiatry and services for mentally ill elderly are still underdeveloped in much of the world, in many countries they are developed sufficiently enough that the IPA is in an excellent position to provide both information and technical assistance to nations wishing to advance.

The practice of geriatric psychiatry in three countries: observations of an American in the British Isles

The author compares the practice of geriatric psychiatry among three countries: Ireland, the United Kingdom and the United States. The two main areas reviewed are how the practice of geriatric psychiatry is done, and the mental health services available in each country, including organizational characteristics. The US is the most entrepreneurial of the three, Britain's greatest strength is the uniformity and comprehensiveness of its services, and Ireland provides an excellent model for nations of comparable size. Considerable change is occurring in all three countries.

The practice of geriatric psychiatry in three countries: observations of an American in the British Isles

The author compares the practice of geriatric psychiatry among three countries: Ireland, the United Kingdom and the United States. The two main areas reviewed are how the practice of geriatric psychiatry is done, and the mental health services available in each country, including organizational characteristics. The US is the most entrepreneurial of the three, Britain's greatest strength is the uniformity and comprehensiveness of its services, and Ireland provides an excellent model for nations of comparable size. Considerable change is occurring in all three countries. © 1997 John Wiley & Sons, Ltd.

Principles and Practice of Geriatric Psychiatry

Principles and Practice of Geriatric Psychiatry