Clinical Geriatric Psychopharmacology 4e

Author: Carl Salzman
Published: October 2004
Publisher: Lippincott Williams & Wilkins
ISBN: 078174380X
Hardcover Book
Number of Pages: 700

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Table of Contents
Preface vii
Contributors ix
Part 1 Overview
1 Older Americans and Mental Illness 3
Characteristics of U.S. Elderly 3
Benefits of Treatment 6
Rates of Mental Disorders 6
Problems in the Use of Psychotropic Drugs 11
Treatment Settings 13
Clinician Misperceptions in Use of Psychotropic Medications 15
2 Drug Prescribing, Adverse Reactions, and Compliance in Elderly Patients 23
Prescription-Drug Use Concerns 23
Over-the-Counter Medication Concerns 25
Prevalence of Psychotropic Drug Use 26
Psychotropic Prescribing Practices in Selected Settings 26
Approaches to Improving Prescription Practices 28
Common Side Effects of Psychotropic Drug Use 32
Ageism, Polypharmacy, and Adverse Drug Reactions 35
Nutritional Status and Drug Effects 37
Compliance 37
Conclusion 42
3 The Cost of Psychotropic Drug Use for the Elderly 49
2003 Medicare Prescription Drug Legislation 51
Rise in Prescription Drug Costs 52
Psychotropic Drug Utilization 55
Psychotropic Drug Costs and Compromised Patients 56
Conclusions 58
Part 2 The Aging Process and Response to Psychotropic Drugs
4 Neurotransmission in the Aging Central Nervous System 63
The Neurotransmission Process 64
Effect of Age on Neurotransmitters 66
Effect of Psychotropic Drugs on Neurotransmission 76
Age-Related Central Nervous System Alterations in Receptor Sensitivity and Psychotropic Drug Effects 77
5 Kinetics and Dynamics of Psychotropic Drugs in the Elderly 87
Basic Pharmacokinetic Principles and the Aging Process 88
Pharmacokinetics of Specific Drug Groups 96
Using Pharmacokinetic Information in Prescribing Psychotropic Drugs 105
Comment 106
Part 3 Geriatric Agitation and Behavior Disorders
6 Diagnosis of Late-Life Disordered Behavior, Agitation, and Psychosis 117
Characteristics of Disordered Behavior 117
Causes of Behavioral Symptoms 117
Conclusion 124
7 Treatment of Late-Life Disordered Behavior, Agitation, and Psychosis 129
General Principles for Antipsychotic Treatment 129
Side Effects of Antipsychotics 133
Choice of Antipsychotics 143
Treatment of Agitation with Non-Antipsychotic Drugs 160
Use of Antipsychotics in Difficult Clinical Situations 170
Part 4 Affective Disorders
8 Diagnosis of Late-Life Depression 199
Epidemiology 199
Diagnosis as Process 200
Onset of Depression 206
Major Depressive Episode 206
Nonmajor Depressive Disorders 210
Neuropsychiatry of Late-Life Depression 212
Consequences of Depression 217
9 Treatment of Depression with Tricyclic Antidepressants, MAOIs, and Psychostimulants 233
Tricyclic Antidepressants 233
Monoamine Oxidase Inhibitors 267
Psychostimulants 275
Treatment of Psychotic Depression 277
Augmenting Strategies 278
10 Treatment of Depression with New and Atypical Antidepressants 305
Selective Serotonin Reuptake Inhibitors 305
Other Atypical Antidepressants 316
Treatment Duration 321
11 Treatment of Late-Life Depression Associated with Medical Illness 335
Comorbidity of Depression with Medical Illness 335
Cardiovascular Disease 336
Hypertension 339
Stroke 339
Parkinson's Disease and Depression 340
Cancer 342
Treatment of Depression in Dementia 344
12 Diagnosis and Treatment of Late-Life Bipolar Disorder 353
Epidemiology 353
Clinical Presentation and Diagnosis 353
Course of Illness 354
Etiology 355
General Treatment Principles 356
Acute Treatment of Mania 356
Treatment with Lithium 358
Treatment with Anticonvulsants 364
Treatment of Mania with Antipsychotics 367
Treatment with other Agents 369
Electroconvulsive Therapy 369
13 Electroconvulsive Therapy in Late-Life Depression 385
Indications for ECT 386
Efficacy 387
Medical Complications and Relative Contraindications 397
Cognitive Side Effects 397
ECT for Depressed Patients with Neurologic Disorders 403
14 Response Prediction, Maintenance Treatment, and Late-Life Depression 423
Clinical Correlates of Treatment Response and Prediction 423
Neurobiologic Correlates of Outcome and Prediction 425
Prediction of Relapse, Recurrence, and Remission 427
Maintenance Treatment 428
Conclusions 429
Part 5 Anxiety and Related Disorders (Panic, Obsessive Compulsive, Phobias)
15 Diagnosis of Anxiety and Anxiety-Related Disorders 437
Epidemiology 437
Characteristics of Late-Life Anxiety 438
Differential Diagnosis 438
Diagnostic Evaluation 442
Neurobiologic Mechanisms of Anxiety 443
Panic Anxiety, Obsessive-Compulsive Disorders, Phobias 444
Conclusions 446
16 Treatment of Anxiety and Anxiety-Related Disorders 449
Acute Anxiety and Generalized Anxiety Disorder 449
Anxiety Spectrum Disorders 465
Part 6 Sleep Disorders
17 The Impact of Age on Sleep and Sleep Disorders 483
Neurobiologic and Chronobiologic of Normal Sleep 483
Normal Age-Related Changes in Sleep and Wakefulness 488
Napping Behaviors and Excessive Daytime Sleepiness 489
Formal Evaluation of Sleep Disorders 490
Types of Sleep-Wake Disorders 493
Special Issues and Sleep-Wake Patterns in The Elderly 499
Dementia and Sleep 501
Conclusion 501
18 Treatment of Insomnia in the Elderly 513
Insomnia Complaints and Use of Medications 515
Treating Insomnia in Later Life 515
Pharmacologic Treatment of Late-Life Insomnia 520
Principles/Recommendations for Treatment 521
Behavioral Treatments of Chronic Primary Insomnia 529
Conclusion 529
Part 7 Dementia and Memory Disorders
19 Neurobiology of Alzheimer's Disease 543
Neuropathology 543
Constituents of Senile Plaques and Neurofibrillary Tangles 547
Biology of Amyloid 548
Neurotransmitters and Their Receptors 550
Energy Metabolism 556
Cell Membranes 557
Inflammation and Immune Mechanisms 560
Infectious Agents and Toxins 561
Mechanisms of Cell Death 563
Genetics of Alzheimer's Disease 563
Etiologic Model 568
Conclusions and Future Directions 572
20 Treatment of Dementia 595
Treatment Implications of Alzheimer's Disease Pathology 595
Cholinergic Restitutive Therapies 596
Other Neurotransmitter-Based Approaches 603
Nonneurotransmitter Treatment Strategies 605
Nootropics 608
Combination Treatments 608
Current Clinical Considerations 608
Appendix A Prescribing Information 625
Appendix B Enzyme Metabolism and Drug Interaction 631
Appendix C Drug Interactions with Psychotropic Medications 643
Index 677

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