Pain Management

Educational Objectives
1. To appreciate the barriers to optional pain management at the end of life
2. To understand the importance of assessment and reassessment of pain for patients at the end of life
3. To be knowledgeable of the unique approaches to assessment and management of pain in the elderly
4. To be able to utilize the Three-Step Analgesic Ladder approach of the World Health Organization in the management of pain at the end of life

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Con...

Hallucination is defined as “false sensory perception not associated with real external stimuli.” Hallucinations in patients with PD are reported as visual hallucinations in 30%,1 auditory hallucinations in 10%,2 and, rarely, tactile hallucinations.3

Visual hallucinations experienced by patients with PD are complex. They occur when the patients are awake and alert,2,4 as opposed to hypnogogic hallucinations. Hallucinations can occur at any time of the day or night, but are more common at nighttime. Initially, patients may be aware of the nonreality of these experiences but gradua...

Psychiatric Complications of Stroke

Many of the studies addressing post-stroke depression (PSD) have arrived at different conclusions. Pseudodepressive mood disorders are often classified simply as depression.

These pseudodepressive manifestations, which occur shortly after a stroke, include emotionalism, catastrophic reaction, pathological crying, anxiety, apathy, and loss of psychic self-activation.4

Some of the studies lump together acute and chronic complications of stroke; for example, mania or mania-like states and catastrophic reactions are seen early in the cour...

This continuing medical education activity is sponsored by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

These examination questions are based on the article “Evaluation and Treatment of Depression in Patients with Cognitive Impairment,” which appears on pages 39-45 in this issue of Clinical Geriatrics.

Accreditation

The Johns Hopkins University School of Medicine is accredited by the Accreditation Cou...

Case Presentation

A 68-year-old widowed woman was referred to a psychologist for counseling by her primary care physician. The physician was concerned that Mrs. R was dieting and exercising excessively. Mrs. R is a nurse who retired two years ago. She moved to an assisted living facility one year ago following the death of her husband. Mrs. R has two daughters who live nearby. She was referred to both a psychiatrist and psychologist many times, but refused to see them. Her daughter convinced her to see a psychologist and came with her to the appointment.

Mrs. R arrived early f...

Case Presentation

A 71-year-old married man was seen regularly by his geriatric physician for hypertension, irritable bowel syndrome, depression, and anxiety. He requested frequent medical appointments and always came prepared with a list of questions about his health. His anxiety increased when he read about his conditions and medications in medical guides and on the Internet. He had been given several trials of antidepressants, but perceived intolerable side effects from each. His physician referred him to a cognitive behavioral therapy (CBT) group for treatment of depression and a...