This month's theme of the Mental Health Clinician is geropsychiatry. The number of people in the U.S. over the age of 65 years is expected to double and those over the age of 85 years is expected to increase five-fold.12 The majority of older adults suffer from at least one chronic disease and 90% take at least one chronic medication daily.3 The average community older adult takes at least 3 medications on average. Residents in long-term care settings have even higher medication use rates. It is also reported that adherence with medication regimens is poor,
The use of antipsychotics in the treatment of neuropsychiatric symptoms (NPS) in the geropsychiatric population is a controversial topic. Clinicians must be aware of current guidelines and best practices regarding antipsychotic use in long term care populations due to an associated risk of mortality. This article discusses and compares the guidelines regarding treatment of NPS published by the American College of Neuropsychopharmacology and the World Federation of Societies of Biological Psychiatry, and reviews the guidelines regarding gradual dose reduction in this population.
The acetylcholinesterase inhibitor donepezil has been in clinical use for the treatment of Alzheimer's disease since 1996. The patent on the medication expired in November 2010, and at approximately the same time, a new dosage form of donepezil was FDA approved for moderate to severe Alzheimer's disease. This article discusses the benefits and risks of the new 23 mg sustained-release dosage form compared with donepezil 10 mg, based on the clinical trial data.
It is estimated that more than half of elderly patients with dementia will develop some degree of behavioral and psychological symptoms of dementia (BPSD). BPSD is associated with significant morbidity, rapid functional decline, and psychiatric hospitalization, and there are currently no medications approved by the Food and Drug Administration (FDA) for its treatment. One treatment option that has been evaluated is the antiepileptic drug valproate. This retrospective medical record review evaluated the tolerability of valproate in elderly patients with dementia. A total of 62 patients met inclusion criteria for this review, which sought to determine whether there was an association either between the initial valproate dose and discontinuation or dose reduction (DCDR) or the maximum valproate dose achieved and DCDR. Both the total daily dose and total daily dose in mg/kg were assessed. For both the maximum daily dose (OR 1.0; 95% CI 0.99, 1.01) and maximum daily mg/kg dose (OR =1.15; 95% CI 0.92, 1.49) there was also no association with DCDR. There was no associated risk of DCDR when evaluating initial daily doses (OR: 1.0; 95% CI: 0.99 – 1.01). However, an association between DCDR and initial daily mg/kg dose was found (OR: 1.92; 95% CI: 1.11–4.02). For both the initial dose and initial mg/kg dose model, African Americans were associated with the need for DCDR (OR 20.75; 95% CI: 1.77–660). Results from this study suggest that higher initial starting doses based on weight may lead to higher rates of side effects necessitating a discontinuation or dose reduction; however, large trials are needed to confirm these results.
We consult approximately 1000 charts per month in a variety of long term care settings (e.g., Skilled Nursing, Assisted Living, MRDD Intermediate Care Facilities) which equates to 1 x FTE or 40 hours per week. A typical day consists of meeting with the Director of Nursing and Licensed Nursing Home Administrator upon arrival to a facility in order to ascertain specific health needs/complications of the community residents. Depending on the situation, this may require directly meeting with the patient and/orDescribe your geriatric clinic/long-term care setting and your day-to-day activities. What is your time commitment to the practice or clinic?
I am an Assistant Professor of Pharmacy Practice at North Dakota State University College of Pharmacy, Nursing, and Allied Sciences. My practice site is based out of Fergus Falls, MN. There, I am part of a team of consultant pharmacists that provide consultant services to over 60 facilities, including Long Term Care facilities, assisted livings, Community Behavioral Health Hospitals, hospice, and community hospitals. My day-to-day activities vary greatly due to the variety of facilities we provide services for. In aDescribe your geriatric clinic/long-term care setting and your day-to-day activities. What is your time commitment to the practice or clinic?
The Iowa Geriatric Education Center is pleased to announce a new training program and toolkit to improve antipsychotic appropriateness in dementia patients, available here. The site includes clinical decision aids, available free for downloading, to help providers evaluate and manage problem behaviors and psychosis as well as a free continuing education program and resources for patient families. Antipsychotics are commonly used off-label in people with dementia to manage problem behaviors or psychotic symptoms. They have modest efficacy in reducing some behaviors and symptoms, but also have serious adverse effects including an increased risk of stroke and mortality.1
Alzheimer's disease affects an estimated 35 million people worldwide, with over 5 million affected in the United States. Few medications are currently approved by the Food and Drug Administration (FDA) for the treatment of Alzheimer's disease; subsequently, patients and caregivers often look for additional treatment options. This article reviews studies evaluating the use of Ginkgo biloba and vitamin E for the treatment of Alzheimer's disease.
The geriatric population is continually growing in the United States, and the number of individuals over the age of 65 is expected to double by the year 2050. Changes in the pharmacokinetic profiles of elderly patients make appropriate medication dosing more challenging for health care providers. The Beers Criteria is a validated, consensus-based screening tool to help identify potentially inappropriate medications in geriatric patients. This article reviews recent updates to the Beers Criteria, as well as other screening tools which have been developed for this purpose.
CPNP members maintain a suggested reading list to provide information on peer recommended resources and convenient access to the highest quality neuropsychopharmacology publications. A reminder that if you shop with CPNP, by following the links below to Amazon, a small commission will be paid to CPNP which helps to financially support our mission to improve the minds and lives of individuals with psychiatric and/or neurologic disorders. You can help grow this list of resources by suggesting a book. Book: Clinical Handbook of Psychotropic Drugs, 19th revised edition Fully updated and expanded,PRODUCT DESCRIPTION:
Student Perspective: Take Shelter takes place in a small town in Ohio, where Curtis LaForche (Michael Shannon) lives with his beautiful wife Samantha and daughter Hannah, who is deaf. He has a great job as a construction crew chief but money is still tight. As the movie progresses, he begins to have visions and nightmares of horrific storms, tornadoes, and of being attacked. Due to these visions Curtis becomes consumed with building an adequate storm shelter for him and his family. His delusions and hallucinations stem from paranoid schizophrenia, a diagnosis he shares with his mother, and
What a fabulous 15th annual meeting we had in Tampa! The CPNP Annual Meeting is the one clinical meeting that I most look forward to each year and this year exceeded even my expectations. The clinical information, the educational programming, and the professional and personal networking opportunities were unmatched. The driving force of our organization is the volunteer spirit that we share, the desire to help others, the desire to educate, and the desire to be educated. This energy both sustains and drives CPNP. I always leave the annual meeting re-energized and with renewed professional enthusiasm. We are
The July, 2011 issue of Current Psychiatry features an article co-authored by CPNP member Jolene Bostwick. In the article “How to Prevent Adverse Drug Events: Enhanced Awareness, Vigilant Monitoring Can Reduce Morbidity and Mortality” the authors highlight potential ADEs and major medication safety concerns that may contribute to morbidity and mortality among patients taking psychotropics. A reminder that a special subscription price is available to Current Psychiatry, a monthly peer-reviewed publication, and the leading source of practical,HOW TO PREVENT ADVERSE DRUG EVENTS: ENHANCED AWARENESS, VIGILANT MONITORING CAN REDUCE MORBIDITY AND MORTALITY