Psychotherapeutic agents in older adults:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Clinics in geriatric medicine
14,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | IX, 198 S. Ill. |
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Datensatz im Suchindex
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| adam_text | I PSYCI lOTHERAPELmC AGENTS IN OLDER ADULTS 7
CONTENTS
Preface ix
George T. Grossberg and Vinod Kumar
Epidemiology of Psychotherapeutic Drug Use
in Older Adults 1
George T. Grossberg and Jonathan A. Grossberg
Those over 65 years of age constitute nearly 13% of the United
States population. This age group, however, consumes three times
their number of prescribed and over the counter remedies. In fact,
nearly 30% of all prescriptions and 40% of over the counter rem¬
edies are consumed by older adults. This is also the population
most sensitive to the side effects of drugs and, in particular, to the
mood or mind altering properties of commonly prescribed and
over the counter remedies. This article discusses medication usage
among older adults with a special focus on various classes of psy¬
chotherapeutic agents—their uses, potential abuses, and special
hazards.
Compliance: Problems and Opportunities 7
Kari L. Franson and Sherry L. Smith
Many studies have demonstrated the problems patients have with
medications. In these studies, the elderly and patients utilizing psy¬
chiatric medications are often cited as having the greatest noncom
pliance. This article reviews the extent of noncompliance in this
population and the effect of noncompliance on disease manage¬
ment. Factors related to the health care provider, the patient, and
the type of therapy that lead to noncompliance are reviewed. Op¬
portunities and intervention techniques are provided to improve
patient outcomes.
Metabolism, Bioavailabiliry, and Drug Interactions 17
David C. Steffens and K. Ranga Rama Krishnan
This article presents clinically relevant drug interactions which
may confront the geriatric psychiatrist. Changes in drug metabo
VOLUME 14 • NUMBER 1 • FEBRUARY 1998 V
lism due to aging, higher medical comorbidity, and frequent po
lypharmacy all place the older patient at a greater risk of devel¬
oping a drug drug interaction. Clinicians must be aware of the
potential for such interactions, but they should also be able to de¬
termine which of those possible interactions is appropriate for a
particular patient. Drug interactions are included in this article
based on frequency of the interaction, clinical severity, and fre¬
quency of contact with the drugs prescribed by the practicing cli¬
nician.
Treatment of Depression in Late Life 33
Donald P. Hay, Mercedes M. Rodriguez, and Kari L. Franson
Depression is a common problem in older patients and a significant
contributor to morbidity and mortality in this population. The
identification and treatment of depression is more complex in older
patients because of difficulty in diagnosis, coexisting illnesses, and
concurrent drug therapy. In addition, a variety of medical condi¬
tions and drugs can cause depression. Treatment often has to be
modified in consideration of other illnesses, medications, and the
reduced ability of the elderly to metabolize drugs. Duration of
treatment may be longer than with young patients because older
adults may respond more slowly to antidepressants.
Effective Use of Anxiolytics in Older Adults 47
William J. Burke, David G. Folks, and Dennis P. McNeilly
This article reviews the current classification of anxiety disorders
and the frequency of these disorders in older adults. General treat¬
ment principles are discussed, and an overview of anxiolytic
medications is presented. Use of these anxiolytic agents in specific
disorders is then discussed, followed by a brief review of non
pharmacologic treatment approaches to anxiety disorders.
Sedative Hypnotics and Sleep 67
David G. Folks and William J. Burke
Complaints about sleep are prominent among geriatric patients.
Insomnia is a prominent feature of many psychiatric and general
medical conditions. The physiologic effects of aging and primary
sleep disorders also contribute to insomnia, sleep pattern changes,
daytime sleepiness, and dozing. The clinical approach to insomnia
requires a thorough diagnostic assessment as well as study of sleep
habits and hygiene. Hypnotic agents may be useful in providing
short term relief. Pharmacologic intervention is best combined
with nonpharmacologic approaches that improve the effeciency of
sleep.
Vi CONTENTS
I Antipsychotics: Old and New 87
i Sanford I. Finkel
As the number of older adults worldwide continues to increase
markedly, the absolute increase in their numbers means that there
also will be a substantial increase in the number of older people
with mental disorders. These disorders include several that mani¬
fest psychotic symptoms. Many credit the substantial reduction in
the number of older people in state mental hospitals over the past
40 years primarily to the advent of antipsychotic (neuroleptic)
medication. Although the traditional neuroleptic medications often
are effective, they also are associated with troublesome side effects.
Newer neuroleptic medications appear to be just as effective but
have fewer adverse side effects.
Commonly Prescribed and Over the Counter Remedies:
Causes of Confusion 101
Joseph H. Flaherty
Acute confusion is associated with significant morbidity and mor¬
tality among older persons. Among the common causes of confu¬
sion, medications are at the top of the list. Since virtually any drug
can cause confusion, it is helpful for the clinician to know which
patients are at risk and which medications are risky. At particular
risk are patients with dementia and patients whose pharmacoki
netics or pharmacodynamics have been impaired by the aging pro¬
cess or diseases. The list of medications that can cause confusion
is a long one, yet it can be remembered by the mnemonic ACUTE
CHANGE IN MS (mental status). In addition to recognizing the
offending agent, it is prudent for clinicians to prevent the chance
of drug induced confusion. One of the safest ways to do this is to
avoid too many medications since the risk of adverse drug events
rises exponentially with the number of medications prescribed.
Pharmacologic Management of Alzheimer s Disease 129
Vinod Kumar, U. Nalla B. Durai, and Thomas Jobe
Alzheimer s disease is a chronically progressive neurodegenerative
disorder. Examinations of brains of Alzheimer s disease patients
have shown various neuropathologic and neurochemical deficits,
especially decreases in acetylcholine, norepinephrine, serotonin,
and some neuropeptides. During the long course of the illness,
almost every patient experiences psychiatric symptoms and exhib¬
its behavioral disturbance, most of which can be treated effectively
with antidepressant, antipsychotic, and mood stabilizing drugs.
This article is divided into several sections to discuss specific symp¬
toms and relevant medications used to treat each of these symp
CONTENTS vii
toms: cholinergic drugs, anti inflammatory agents, antiamyloidi
genic strategy and antioxidant therapy, estrogen, management of
psychosis and agitation, and management of depression.
Treatment of Agitation in Patients with Dementia 147
Jacobo E. Mintzer, Kathleen S. Hoernig, and Dario F. Mirski
This article attempts to summarize some of the pertinent literature
in the context of the authors clinical experience and suggests that
a comprehensive psychiatric and medical evaluation, as well as a
combined behavioral/environmental approach together with ap¬
propriate pharmacotherapy, are important tools in the manage¬
ment of this complicated clinical challenge.
Estrogen as a Psychotherapeutic Agent 177
Mercedes M. Rodriguez and George T. Grossberg
This article provides information on the effects of estrogen as a
psychotherapeutic agent. Estrogen has a positive effect on several
neurotransmitter systems that are assumed to be involved in regu¬
lation of affect, behavior, and cognition. Clinical studies suggest
that an important cause of nonresponsiveness to antidepressants
in postmenopausal women may be inadequate hormone replace¬
ment. Potential uses of estrogen as a mood stabilizer or mood en¬
hancer also are described in this article. In the area of behavior,
estrogen regulates aggressivity, sexual drive, impulsivity, and hos¬
tility. In terms of cognition, evidence suggests the importance of
estrogen in the prevention and treatment of Alzheimer s type de¬
mentia. At the end of the article, future research directions are dis¬
cussed.
Index 191
Subscription Information Inside back cover
Viii CONTENTS
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| spelling | Psychotherapeutic agents in older adults George T. Grossberg ... guest ed. Philadelphia [u.a.] Saunders 1998 IX, 198 S. Ill. txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 14,1 Psychothérapie - Sujet âgé Trouble mental - Sujet agé Trouble mental - Thérapeutique Psychotherapie Aged Mental Disorders Mental Disorders therapy Psychotherapy Alter (DE-588)4001446-0 gnd rswk-swf Psychische Störung (DE-588)4047686-8 gnd rswk-swf Psychopharmakon (DE-588)4047729-0 gnd rswk-swf Pharmakotherapie (DE-588)4076066-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Alter (DE-588)4001446-0 s Psychische Störung (DE-588)4047686-8 s Pharmakotherapie (DE-588)4076066-2 s DE-604 Psychopharmakon (DE-588)4047729-0 s Grossberg, George T Sonstige oth Clinics in geriatric medicine 14,1 (DE-604)BV000019839 14,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008041709&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Psychotherapeutic agents in older adults Clinics in geriatric medicine Psychothérapie - Sujet âgé Trouble mental - Sujet agé Trouble mental - Thérapeutique Psychotherapie Aged Mental Disorders Mental Disorders therapy Psychotherapy Alter (DE-588)4001446-0 gnd Psychische Störung (DE-588)4047686-8 gnd Psychopharmakon (DE-588)4047729-0 gnd Pharmakotherapie (DE-588)4076066-2 gnd |
| subject_GND | (DE-588)4001446-0 (DE-588)4047686-8 (DE-588)4047729-0 (DE-588)4076066-2 (DE-588)4143413-4 |
| title | Psychotherapeutic agents in older adults |
| title_auth | Psychotherapeutic agents in older adults |
| title_exact_search | Psychotherapeutic agents in older adults |
| title_full | Psychotherapeutic agents in older adults George T. Grossberg ... guest ed. |
| title_fullStr | Psychotherapeutic agents in older adults George T. Grossberg ... guest ed. |
| title_full_unstemmed | Psychotherapeutic agents in older adults George T. Grossberg ... guest ed. |
| title_short | Psychotherapeutic agents in older adults |
| title_sort | psychotherapeutic agents in older adults |
| topic | Psychothérapie - Sujet âgé Trouble mental - Sujet agé Trouble mental - Thérapeutique Psychotherapie Aged Mental Disorders Mental Disorders therapy Psychotherapy Alter (DE-588)4001446-0 gnd Psychische Störung (DE-588)4047686-8 gnd Psychopharmakon (DE-588)4047729-0 gnd Pharmakotherapie (DE-588)4076066-2 gnd |
| topic_facet | Psychothérapie - Sujet âgé Trouble mental - Sujet agé Trouble mental - Thérapeutique Psychotherapie Aged Mental Disorders Mental Disorders therapy Psychotherapy Alter Psychische Störung Psychopharmakon Pharmakotherapie Aufsatzsammlung |
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