Seminars in Old Age Psychiatry-2판

Half-title
Series information
Title page
Copyright information
Contents
Contributors
Preface
Note

Chapter 1 Healthy Ageing
Background
Healthy Ageing Is Complex
More People Are Living Longer
More Time in Poor Health
Causes of Morbidity
Risk Factors for Disability
Risk Factors for Morbidity
Theories of Ageing
Genetics
Longevity Genes
Telomeres
DNA Damage and Repair
The Disposable Soma Theory of Ageing
Calorie Restriction
Sugar
Gender
Assessment of Healthy Ageing
People with Severe Mental Illness
The Mortality Gap and Physical Health
What Can Clinicians Do for Older People with Severe Mental Illness?
Seven Healthy Lifestyle Choices
Be Social
Be Loving
Exercise
Eat Healthily and Stay Trim
Keep Stimulated
Sleep Well
Don't Smoke or Drink Too Much Alcohol
Change
References

Chapter 2 Clinical Assessment
Location of Assessment
Interviewing Relatives and Carers
Cultural Competence
History
Setting
History of Presenting Complaint
Family History
Personal History
Past Psychiatric History
Medical History
Medications
Alcohol History
Activities of Daily Living
Social History
Premorbid Personality
Mental State
Appearance and Behaviour
Speech
Mood
Abnormal Beliefs
Abnormal Perceptions
Cognition
Insight
Risk Assessment
Physical Examination
Investigations
Formulation
Diagnosis
Rating Instruments
Cognitive Scales
Other Cognitive Scales
Depression Scales
Other Depression Scales
Comprehensive Assessments
Outcome Scales
Patient-Rated Outcome Measures
Conclusion
References

Chapter 3 Cognitive Assessment
Introduction
Attention, Concentration and Information Processing
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Visuospatial and Visuoconstructional and Perceptual Skills
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Language
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Memory
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Executive Function
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Social Cognition
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Praxis
Definitions and Psychological Models
Neural Basis and Pathologies
Assessment
Delirium, Depression, Dementia and MCI
History Taking and Examination
Comprehensive Neuropsychological Evaluation
References

Chapter 4 Imaging
Introduction
Imaging Modalities
Imaging in Dementia
Dementia of Alzheimer Type
Mild Cognitive Impairment and Prognosis towards Dementia
Vascular Dementia
Lewy Body Dementia
Frontotemporal Dementias
Rare Dementias (Neurological Dementias)
Imaging in Other Psychiatric Conditions
Depression (Late Onset vs. Early Onset)
Future Developments
References

Chapter 5 Delirium
Historical Context
Definition and Classification
Epidemiology
Aetiology
Clinical Features
Assessment and Diagnosis
Management
Antipsychotic Agents
Benzodiazepines
Prevention
Prognosis
Future Directions
References

Chapter 6 Alzheimer's Disease
Epidemiology
Incidence and Prevalence
Gender
History
Mild Cognitive Impairment
Clinical Features of Alzheimer's Dementia
Amnesia
Aphasia
Apraxia
Agnosia
Behavioural and Psychological Symptoms of Dementia
Assessment
History
Mental State Examination
Cognitive Testing
Physical Examination
Investigations
EEG
Brain Imaging
Diagnostic Classification and Criteria
Differential Diagnosis
Aetiology and Risk Factors
Cholinergic Hypothesis
Amyloid Hypothesis
Tau Hypothesis
Other Hypotheses
Principles of Management
Lifestyle
Biological
Psychological
Memory
Social
Caregivers
Prognosis
Research and the Future
References

Chapter 7 Vascular Dementia
Background
Vascular Changes
Pathology
Diagnostic Criteria
Hachinski
SIVD
NINDS-AIREN
VCI
VICCCS
Risk Factors and Clinical Features
Risk Factors
Genetics
Differentiation from AD
Brain Imaging
Type and Location of Lesion
CT
MRI
Molecular Imaging
Prevention and Treatment
Lifestyle Changes
Medication
Summary
References

Chapter 8 Dementia with Lewy Bodies
Introduction
Pathology
Genetics
Clinical Features
Core Symptoms
Visual Hallucinations
Parkinsonism
Fluctuation of Cognition
REM Sleep Behaviour Disorder
Supportive Clinical Features
Autonomic Dysfunction
Neuroleptic Sensitivity
Delusions
Apathy
Hyposmia
Imaging
Structural Imaging
Functional Imaging
Tracers
CSF Biomarkers
Prodromal DLB
Management of DLB
Cholinesterase Inhibitors
Psychostimulents and Antidepressants
Managing Hallucinations
Antipsychotics
Levodopa
Managing REM Sleep Disorder
Managing Autonomic Dysfunction
Managing Constipation
Prognosis
Quality of Life
Admission to Care Home
Mortality
References

Chapter 9 Frontotemporal Dementia
Historical Context
Demographics
Classification
Clinical Features
Behavioural Variant FTD
Primary Progressive Aphasia
Semantic Variant
NfvPPA
Logopenic Variant PPA
FTD-MND
Parkinsonism
Overlap
Aetiology
MAPT
GRN
C9orf72
Other Genetic Mutations
Diagnosis
General Principles of Management
Non-Pharmaceutical Interventions
Pharmaceutical Management
Prognosis
References

Chapter 10 Depression
Classification
Epidemiology
Clinical Features
Association between Depression and Cognitive Impairment/Dementia
Aetiology
Assessment
Differential Diagnoses
Prevention
Treatment
Psychological Therapies
Pharmacotherapy
Electroconvulsive Therapy
Depression in Dementia
Suicide
Prognosis
References

Chapter 11 Bipolar Disorder
Introduction
Epidemiology and Clinical Features
Diagnosis
Prevalence
Neuropathology and Biomarkers
Physical Health
Weight Gain and Metabolic Syndrome
Thyroid and Parathyroid Dysfunction
Renal Failure
Cognition
Care Approaches
Guidelines
Treating Depression
Maintenance
Conclusion
References

Chapter 12 Psychosis
Introduction
Common Causes of Psychosis in Later Life
Dementia
Mood Disorders
Delirium
Late-Onset Schizophrenia and Delusional Disorder
Parkinson's Disease
Drug and Alcohol Use
The Consequences of Psychosis in Later Life
Management of Psychotic Symptoms
Dementia and Parkinson's Disease
Mood Disorders
Delirium
Late Onset Schizophrenia and Delusional Disorders
Conclusion
References

Chapter 13 Anxiety Disorders
Introduction
Epidemiology
Classification
Differential Diagnosis
Phenomenology
Older Adults
Specific (Isolated) Phobias
Fear of Falling
Agoraphobia
Social Anxiety Disorder
Panic Disorder
Subthreshold Anxiety
Assessment
Anxiety Measures
Treatment and Management of Late Life Anxiety
Pharmacological Treatment Methods
Selective-Serotonin Reuptake Inhibitors
Benzodiazepines
Other Medications
Non-Pharmacological Treatment Methods
Conclusion
References

Chapter 14 Drug and Alcohol Misuse
Definitions
Epidemiology
Risk and Alcohol Consumption
Drugs for Anxiety, Insomnia and Pain
Drug Interactions
Assessment
Barriers to Identifying Drug and Alcohol Misuse
General Assessment
Taking a Drug and Alcohol History
Screening
Psychiatric Disorders
Alcohol Dependence
Delirium Tremens
Benzodiazepine Withdrawal Syndrome
Alcohol-Related Brain Damage
Amnestic Syndromes
Alcohol-Related Dementia
Medical Disorders
Alcohol
Smoking
Intravenous Drug Misuse
Treatment
Alcohol Withdrawal
Psychological Treatment
Developing and Delivering Services
Treatment Outcomes
Conclusion
References

Chapter 15 Attention Deficit Hyperactivity Disorder
Introduction
Diagnosis and Assessment
Prevalence and Validity
Impairment of Function over the Lifespan and Living with ADHD
Differential Diagnosis of ADHD in New Presentations in Older Adults
Co-Morbid Psychiatric Conditions in Older Adults
Treatment of ADHD in Older Adults
Guidelines
Assessment
Length of Treatment
Medication Effects on Cognition
Adverse Effects
Baseline Tests
Initiation of Treatment
Choice of Medication
Monitoring
Managing Adverse Effects
Older Age
Co-Prescribing in Older Patients with ADHD
Prison Populations
Service Provision for Older Adults with ADHD
Models
Conclusions
References

Chapter 16 Medications
Pharmacokinetics
Pharmacodynamics
The Dementias
Alzheimer's Dementia
Physiology
Treatment Strategies
Augmenting the Cholinergic Pathway: Acetylcholinesterase Inhibitors
Donepezil
Pharmacokinetics
Tolerability
Rivastigmine
Pharmacokinetics
Tolerability
Galantamine
Pharmacokinetics
Tolerability
N-Methyl-D-Aspartate Receptor Antagonist: Memantine
Pharmacokinetics
Tolerability
Indications
Pharmacological Management of Behavioural and Psychological Symptoms of Dementia
Other Dementias
Vascular Dementia
Dementia with Lewy Bodies
Dementia in Parkinson's Disease
Other Psychiatric Conditions
Delirium
Depression
Bipolar Disorder
Lithium
Psychosis
Medicines Optimisation
Polypharmacy
Adherence
Medication Review
Team Working
Carers
Primary Care
Pharmacy
References

Chapter 17 Electroconvulsive Therapy and Neurostimulation
Introduction
ECT in Older Adults
The Efficacy of ECT in Older Adults
Speed of Response to ECT
Older Adults vs. Younger Age Groups
ECT for Late Onset Depression
ECT in the Context of Brain Changes and Cognitive Impairment
ECT for Bipolar Depression
ECT Treatment: Electrode Placement
ECT Treatment: Pulse Width
Continuation and Maintenance ECT in Older Adults
ECT for Mania in Older Adults
ECT for Primary Psychoses in Older Adults
ECT for Catatonia
ECT for Agitation or Aggression in Older Adults with Dementia
Side Effects from ECT
General
Cognition
Cardiac
Mortality
ECT Administration
Pre-ECT Workup
Seizure Threshold
Electrode Placement
Pulse Width
Dose Titration
Dose
Medication
Transcranial Magnetic Stimulation in Older Adults
Introduction
Efficacy of rTMS in Older Adults
Continuation and Maintenance rTMS Treatment
Safety of rTMS in Older Adults
Conclusion
References

Chapter 18 Psychological Therapies
Introduction
The Psychological Therapies with Older People
Psychoanalytical Psychotherapy with Older People
Interpersonal Psychotherapy with Older People
Problem Solving Therapy with Older People
Reminiscence and Life Review Therapy with Older People
CBT with Older People
Application of CBT with Older People
Early Phase of CBT Treatment
Middle Phase of CBT Treatment
Final Phase of CBT Treatment
The Efficacy of CBT with Older People
CBT for People with Dementia and Their Caregivers
CBT with People with Depression and Anxiety in Dementia
Summary
References

Chapter 19 Role of an Old Age Psychiatrist
The CanMEDS Framework: Core Competencies and Roles
Medical Expert
Communicator
Collaborator
Leader
Health Advocate
Scholar
Professionals
Conclusion
References

Chapter 20 Consultation-Liaison
Introduction
History
Scope
Models
Telemedicine
Referrals
Principles
Research
Training
Conclusion
References

Chapter 21 Palliative Care
Defining Palliative and End-of-Life Care
Multidisciplinary Care and the Role of the Psychiatrist
Prognostication and Uncertainty at the End of Life
Advance Care Planning
Decision Making at the End of Life
Symptom Control
Identifying Pain and Using Pain Scales
Managing Pain
Nutrition and Hydration
Infections
Breathing Difficulties
Dealing with Loss and Grief
Persistent Complex Bereavement Disorder
Grief before Death While Caring for a Dying Family Member
Conclusion
References

Chapter 22 Care Homes
Introduction
Human Rights and Dignity
Decision-Making Capacity and Autonomy
Common Psychiatric Problems in Long-Term Care
Behavioural and Psychological Symptoms of Dementia
A Models of Care: Person Centred/ Relationship Centred Care, Culture Change
Designing Environments for People with Dementia
Prescribing and De-Prescribing
End of Life for Those with Dementia
Conclusion
References

Chapter 23 Carers
Family Carers as Decision Makers
The Capacity to Make Decisions
Making Decisions for a Family Member
Caring for Family Carers
What Helps Carers Continue to Cope with Caring at Home?
Which Family Carers Find Caring Particularly Difficult?
Sleep Disturbance and Agitation as Symptoms of Dementia
Interventions for Family Carers
Conclusions
References

Chapter 24 Law, Capacity and Ethics
Principles and Ethics
The Mental Health Act (England and Wales)
The Mental Capacity Act (England and Wales)
Assessing Capacity and Proxy Decision Making
Capacity to Take Part in Research
Independent Mental Capacity Advocates
Lasting Power of Attorney
Advance Decisions
Deprivation of Liberty Safeguards
Court of Protection
Testamentary Capacity
Mental Capacity Act (Northern Ireland) 2016
Driving
Elder Abuse
Conclusion
References

Chapter 25 Migrants, Refugees and Asylum Seekers
Introduction
Definitions
The Scale of the Problem
How Valid Are Standard Age Cut-Offs for This Population?
Challenges to the Integration of Older Refugees and Asylum Seekers
Health Inequalities
Meeting the Needs of Older Refugees and Asylum Seekers
Recommendations
References

Chapter 26 Clinical Scenarios
Cognitive Impairment 1
What Is the Differential Diagnosis?
What Other Features Would You Look for in the History?
What Further Investigations Would You Consider?
Exam Tips
Cognitive Impairment 2
What Is the Most Likely Diagnosis?
Exam Tips
Cognitive Impairment 3
What Is the Likely Diagnosis?
Differential Diagnosis
Alzheimer's Disease
Frontal Tumour
Psychotic Episode
Neurosyphilis
Exam Tips
Cognitive Impairment 4
What Is the Most Likely Diagnosis?
What Is the Differential Diagnosis?
What Do You Need To Do?
Exam Tips
Cognitive Impairment 5
Likely Diagnosis
Differential Diagnosis
Exam Tips
Psychosis
What Is the Differential Diagnosis?
What Investigations Would You Undertake?
What Are the Management Options? What Are the Likely Challenges?
Exam Tips
Generalised Anxiety
What Is the Differential Diagnosis and What Other Features Might You Look For?
What Are the Possible Treatment Options?
What Should You Cover in the Risk Assessment?
Exam Tips
Therapeutics
What Is the Likely Adverse Drug Reaction?
Her Sodium Comes Back at 115 mEq/l. What Should You Do Next?
Exam Tips
Self-Harm
What Features in the Story Are Salient to Risk Assessment?
What Is the Differential Diagnosis?
What Will Be the Key Features of Your Management Plan?
Exam Tips
References
Index