Issue

Diabetes mellitus is a growing concern for the older person. All too often undiagnosed and inappropriately treated, diabetes affects approximately 8% of persons over the age of 65 years and more than 20% of those over age 80. We have come a long way in our understanding of the pathogenesis of this life-threatening and potentially debilitating illness, and new methods of treatment continually become available. Preventing complications of diabetes depends largely on controlling the level of blood sugar, although even with good control certain end-organ effects may be inevitable. Clearly, the bes

To the Editor:

I was delighted to see your Psychiatry Rounds article, “Anxiety, Headaches, Insomnia, Restless Legs, and Hypertension: Multiple Disorders or One Problem?”1 I have long recognized a TRIAD: anxiety, restless legs syndrome (RLS), and labile hypertension. As a psychiatrist, I use small doses of clonazepam in these persons to treat three disorders with one drug. I have never before seen “my TRIAD” in print.

I suspect that a deficiency of cytochrome P4501A2, known to be a factor in anxiety, is the cause. Deficient individuals metabolize methylxanthines* at 2 perce

Delirium, bipolar disorder, multiple myeloma, history of colon cancer, constipation, hemoccult-positive stools…the litany of medical conditions continued as I attentively listened on rounds while a resident presented the case of an elderly woman who was brought to the hospital three days earlier after her family noted a change in her mental status. “She appears to be sleepy most of the time” was their description, and clearly they were concerned. While the patient was unable to give a thorough and accurate history and records were limited, the family provided key information. It was note

The “B” in the Medicare Part B program may come to be known as “BIG,” as in big changes; both the physician reimbursement component of Medicare Part B, as well as the coverage of outpatient medications, are undergoing major changes. Medicare Part B, also known as medical insurance, covers physician services. Physician and other providers, such as nurse practitioners, are paid for by Medicare under a fee schedule dictated by Medicare. In addition to physician services, Medicare Part B also covers supplies such as durable medical services and medications provided within a physician offic

Case Presentation
Mr. L is an 83-year-old widowed male who was referred for psychiatric evaluation by his primary care physician and dermatologist. Both physicians only started seeing Mr. L following the death of his wife, but suspect that he has some type of somatization disorder or is suffering from bereavement-related symptoms that are causing him to scratch himself. He has been complaining of generalized itching over most of his body. It worsens at night, and Mr. L often awakens frequently due to his discomfort. He has scratched the skin on his arms, chest, and legs, creating open

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

Desmoplastic melanoma (DM) is a rare form of malignant melanoma representing less than 4% of all melanomas. Classically, it shows high rates of local recurrence, rare lymph node metastases, and a tendency to metastasize to the lungs. Here, we present the case of a patient with multiple local recurrences of DM, followed by a review of the literature and treatment recommendations.

Case Presentation
We report a case of an 82-year-old white female, Ms. D, who presented to the Surgical Oncology service with a chief complaint of recurrent tumor of the right arm. The patient’s pa

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 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 1AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participat

June 2007

This continuing medical education activity is presented 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 “Risk Factors for Frailty in the Older Adult,” which appears on pages 37-44 in this issue of Clinical Geriatrics.

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