Supplements & Special Projects
Psychiatry
Screening for Depression in Older Adults: Recommended Instruments and Considerations for Community-Based Practice
Introduction
Depression is a treatable medical condition and one of the most frequent causes of emotional distress in older adults. Depressive symptoms are not a normal part of aging, and a recent population-based survey documents the prevalence of current depressive symptoms (defined as an 8-item Patient Health Questionnaire [PHQ-8] score of 10 or higher) as 4.9% among community-dwelling older adults 65 years of age and older.1 Depression in older adults complicates chronic conditions (eg, cardiac disease, diabetes) and reduces quality of life and functional abilities.2 Older adu
Addressing Attention-Deficit/Hyperactivity Disorder in Later Adulthood
Introduction
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral condition characterized by symptoms of impulsitivity, distractibility, and impaired concentration stamina. ADHD is present throughout the lifecycle and is associated with significant functional and emotional impairment.1,2 When studied in all other age groups, ADHD demonstrates a consistency of epidemiology and prognosis that would predict similar findings in older adults.3 However, while very little is known regarding prevalence rates, morbidity, and prognosis of ADHD in adults over age 45 yea
Violence in Older Persons
Part II-Occurrence in Hospitals and Pharmacological/Behavioral Treatment of Agitation, Agression, and Violence
Dr. Ryan Hall is an Affiliate Instructor at the Department of Psychiatry and Behavioral Medicine, University of South Florida, Tampa, FL, and is a 2006 Rappeport Fellow of the American Academy of Psychiatry and the Law; Dr. Richard Hall is Courtesy Clinical Professor of Psychiatry, University
Distinguishing Dementia with Lewy Bodies From Parkinson's Disease Dementia and Alzheimer's Disease: A Geriatric Case Study
Case Presentation
Mr. P* is a 71-year-old widowed male resident of an assisted living facility who was recently diagnosed with Parkinson’s disease (PD), depression, and generalized anxiety. Mr. P had no prior history of mental illness. He acknowledged some regular alcohol use as a young man, consisting of drinking three to four alcoholic beverages per day over many years, but denied any alcohol-related blackouts, seizures, or treatment. Recent symptoms of anxiety and depression were attributed to a prolonged grief reaction from the loss of his wife ju
Central Serotonin Syndrome: Part II—Pathophysiology, Drug Interactions, and Treatment
This is the second part of a two-part series on central serotonin syndrome in the elderly that reviews the incidence, how central serotonin syndrome presents in the elderly, which psychiatric and nonpsychiatric medications interact to exacerbate or cause the syndrome, the pathophysiology of the disorder, and its treatment. Part I discussed the history and prevalence of the disorder, causative agents, presentations and diagnostic criteria, and ways to distinguish the condition from
Central Serotonin Syndrome: Part I—Causative Agents, Presentation, and Differential Diagnosis
This is the first part of a two-part series that examines central serotonin syndrome in the elderly. Part I reviews the history and prevalence of the disorder, causative agents, presentation and diagnostic criteria, and ways to distinguish the condition from other similar states, such as neuroleptic malignant syndrome. Part II will focus on the pathophysiology, opiate and psychiatric drug interactions, and treatment approaches for central serotonin syndrome in the elderly.
INTRODUCTION
The term serotonin syndrome was first used in a case report in 1982, but study of th
Suicidality and Antidepressants in the Elderly
Introduction
Suicidality is a serious clinical concern that influences mental health treatment in the elderly. It manifests across a continuum that spans from suicidal ideation to completed suicide and is an urgent public health problem; both the rate and lethality of suicide attempts in geriatric age groups are increased relative to younger persons. Recent concern about a relationship between antidepressant use and suicidality raises questions about the risks associated with this treatment modality for depression and other mood disorders. This review delineates the known risk correlat
Cognitive Enhancers for Treatment of Noncognitive Symptoms of Dementia
Behavioral and psychological symptoms of dementia (BPSD) is a term used to describe a heterogeneous group of noncognitive symptoms and behaviors that occurs in people with dementia.1 The term BPSD was defined by the International Psychogeriatric Association at the Update Consensus Conference, entitled “Behavioral and Psychological Symptoms of Dementia (BPSD): A Clinical and Research Update,” held in May 1999, as “Symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia.”2 The various behavioral symptoms described include physic
Link Between Anxiety and Insomnia in the Older Person
Sleep disturbances are very common in the context of psychological distress.1,2 Studies of individuals with insomnia have found rates of comorbid psychiatric disorders as high as 62%.3 A substantial amount of research has been conducted investigating insomnia in the context of depression in later life, but relatively little research has been conducted investigating sleep disturbances in the context of anxiety symptoms experienced by the elderly. This is surprising, given that complaints about anxiety and sleep disturbances are among the most common that the elderly express to their physicians.
CME Article: Use of Psychotropic Drugs in Cerebrovascular Disease
ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit th
Clinical Geriatrics Blogs
Coming in Future Issues of Clinical Geriatrics
CME Resource Center
THE BURDEN OF PARKINSON’S DISEASE AND THE NEED FOR EARLY DIAGNOSIS AND EARLY TREATMENT
CME Resource Center is currently being updated. Check back soon.
