Geriatric Mental Health Care Book

1.	Introduction to the Geriatric Imperative	1
	Core Concepts from Sociology and Clinical Sciences	2
	The New Psychopharmacology: Burdens and Benefits	10
	Attributes of Successful Geriatric Practice	15
	References	16
2.	Depression and Anxiety	19
	Assessment	19
	Symptom Identification, Screening for the Disorders	20
	Geriatric Syndromes, Depression, and Anxiety	21
	Comorbidity of Mental and Physical Disorders	22
	Anxiety Disorders	23
	Suicide	25
	Comprehensive Treatment of Depression and Anxiety Disorders	25
	References	38
3.	The Dementias	44
	Dementia Defined	44
	Epidemiology	45
	Genetic and Other Risk Factors	45
	Diagnostic Criteria and Procedures	46
	Differential Diagnosis	47
	Cognitive Assessment	52
	Assessment of Functional Impairment	55
	General Treatment Considerations	56
	Medications to Palliate Cognitive Impairment	57
	Environmental Modifications	62
	Management of Behavioral and Psychological Signs and Symptoms	63
	Specific Problem Behaviors and Symptoms	64
	Medications to Lessen Behavioral and Psychological Disturbances	71
	Caregiver Burden and Dysfunctional Family Dynamics	73
	Practitioner as De Facto Guardian and Other Medical--Legal Issues	74
	Management of Financial Resources	75
	Preparations for End-of-Life Care	76
	Summary	76
	References	77
4.	Psychosis and Mania	84
	Achieving and Sustaining the Alliance	84
	The Schizophrenias	89
	Delusional Disorder	91
	Mania	91
	Antipsychotics and the Avoidance of Movement Disorders	94
	Electroconvulsive Therapy for Mania or Psychosis	99
	Summary	99
	References	100
5.	Sleep Disturbances	103
	Assessment	103
	Treatment	107
	Summary	112
	References	112
6.	Personality, Somatoform, and Pain Disorders	114
	Personality Disorders	114
	Somatoform and Pain Disorders	121
	References	125
7.	Individual Psychotherapies for Older Adults	127
	Arguments for Psychotherapy in Late Life	127
	Assessment for Psychotherapy	130
	Brief Psychodynamic versus Supportive Therapy	131
	General Principles of Cognitive-Behavioral Therapy	133
	Interpersonal Therapy for Late-Life Depression	141
	Life Review or Reminiscence Therapy	143
	Problem-Solving Therapy	144
	Treatment of Caregiver Burden and Depression	144
	Bereavement Therapy	148
	Summary	151
	References	151
8.	Adapting Principles of Marital, Group, and Family Therapy to the Needs of Older Patients	155
	Marriage or Couple Therapy with Older Adults	155
	Models	157
	Group Therapy with Older Adults: General Considerations	160
	Family Work	165
	Work with Ethnic Elders, Emigres, and Religious Minorities	168
	Preparing for Genetic Counseling	169
	Summary	170
	References	170
9.	Sexuality	175
	Myths about Sex and Aging	175
	Realities	176
	The Genesis of Late-Life Sexual Dysfunction	179
	Evaluation	181
	Management of Sexual Dysfunction	182
	Sex in the Nursing Home	188
	Summary	188
	Suggested Reading for Patients	189
	References	189
10.	Elder Abuse, Neglect, and Self-Injurious Behaviors	192
	Definitions	192
	Problem with Reports of Elder Mistreatment	193
	Detection	197
	Intervention	200
	Summary	201
	Appendix	202
	References	205
11.	Alcohol and Substance Abuse	208
	Prevalence of Alcohol Problems among Older Adults	208
	Prevalence of Nonalcohol Substance Abuse in Late Life	209
	Pharmacodynamics of Alcohol in the Aged	210
	Uncertain Diagnostic Criteria	211
	Symptom Presentation of Alcohol Abuse in Old Age	212
	Detection and Screening	213
	Assessment	217
	Treatment	218
	Presentation of a Case	222
	Summary	225
	Books for Patients and Families	225
	References	225
12.	Recognition and Reduction of Suicide Risk	229
	Trends in the Prevalence of Late-Life Suicide	230
	Gender, Race, and Social Factors	231
	Historical and Generational Effects	232
	Methods of Death	232
	Physical Illness	233
	Excesses of Modern Medicine	234
	Attitudes of Older Adults Regarding Suicide	234
	The Neurobiology of Suicidality	235
	Mental Disorders and Suicide	235
	Personality and Neuropsychology	236
	The Clinical Assessment of Suicidal Thought and Behavior	236
	Management of Acute Suicidal Risk	238
	Management of Chronic Suicidal Risk	240
	When Prevention Fails	240
	Public Policy and Prevention	241
	Summary	243
	References	243
13.	Mental Health Consultation in the General Hospital, Home, or Nursing Facility	248
	Patterns of Mental Health Consultation	248
	Models and Methods	249
	Mental Health Care in Nursing Homes	262
	Consultation to Certified Home Health Agencies: How to Make a House Call	267
	Summary	276
	References	277
14.	Legal and Ethical Issues	282
	Modern History of the Doctor--Patient Relationship	282
	Autonomy, Abandonment, and the Sanctity of Life	283
	Assessment of Decision Making: Competence or Capacity?	286
	Other Bioethical Issues of Concern	299
	Medical Futility: Who Decides, Who Defines?	302
	Physician-Assisted Suicide	304
	How to Conduct a Bioethics Consultation	307
	Summary	310
	Appendix	310
	References	315
15.	Advice on Exercise and Nutrition	318
	Nutrition and Exercise as Primary and Secondary Prevention	318
	Dietary Intervention	319
	Gaining Weight	322
	Treatment of Overweight and Obesity	323
	Constipation	324
	Healthy Exercise for Seniors	324
	Summary	328
	Books on Exercise and Nutrition for the General Reader	329
	References	329
	Index	333