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Book Details
Abstract
Apart from Alzheimer's dementia, depressive disorders are emerging to account for the next greatest share of disability among older adults. Depressive illnesses complicate the recovery of many important medical illnesses and are associated with suicide death in the elderly at rates exceeding those seen in young adults. This issue of Psychiatric Clinics provides information for general adult psychiatrists, internal medicine geriatricians, and primary care physicians and care extenders to enable them to meet the most basic needs of depressed older adults. Topics in this issue address the questions: What is late life depression? What are the unique cognitive deficits seen in late life depression? What is the nature of the two-way relationship between medical illness and depression in late life depression? What complications arise from late life depression? What is the relationship between late life depression and dementing illnesses? What assessments should be done of the person with suspected late life depression? What are the psychological treatments for late life depression? What is the role of medications in late life depression? What is the role of alternative treatments in late life depression? Is there a role for ECT/TMS/VNS in late life depression? Vaughn McCall of Georgia Health Sciences University provides his expertise to lead this issue.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Late Life Depression\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Psychiatric Clinics Of\rNorth America\r | x | ||
| Preface | xi | ||
| Erratum | xiii | ||
| Late Life Depression | 475 | ||
| Key points | 475 | ||
| An aging population | 475 | ||
| The burden of mental health disorders | 476 | ||
| General Mental Health | 476 | ||
| Depression | 477 | ||
| Impact of aging on health care resources | 479 | ||
| General Health Care Resources | 479 | ||
| Mental Health Resources | 480 | ||
| References | 481 | ||
| What Characterizes Late-Life Depression? | 483 | ||
| Key points | 483 | ||
| Who are the elderly? | 483 | ||
| How common is the problem? | 484 | ||
| Complications and differences in symptoms between young and old patients with depression | 485 | ||
| Subsyndromal depression | 487 | ||
| Bipolar depression in the elderly | 487 | ||
| Sleep, quality of life, and suicide | 488 | ||
| Relationship between grief and depression | 490 | ||
| Summary | 490 | ||
| References | 491 | ||
| What Are the Causes of Late-Life Depression? | 497 | ||
| Key points | 497 | ||
| Overview | 497 | ||
| Description of depression in older adults | 499 | ||
| Epidemiology | 500 | ||
| Mortality | 501 | ||
| Contributors to elder depression | 502 | ||
| Biologic Factors | 503 | ||
| Vascular depression | 503 | ||
| Relationship of late-life depression and cognitive impairment | 505 | ||
| Risk factor for dementia | 505 | ||
| Cause of dementia | 506 | ||
| Vascular depression | 506 | ||
| Medical comorbidity | 506 | ||
| Neurologic disorders | 507 | ||
| Psychosocial Factors | 507 | ||
| Personality attributes | 507 | ||
| Behavior | 508 | ||
| Cognition | 509 | ||
| Psychodynamic theory | 509 | ||
| Social support | 510 | ||
| Life stressors | 510 | ||
| Summary | 511 | ||
| References | 511 | ||
| Cognitive Deficits in Geriatric Depression | 517 | ||
| Key points | 517 | ||
| Introduction | 517 | ||
| Cognitive deficits in geriatric depression | 518 | ||
| Neurobiological underpinnings of cognitive deficits | 519 | ||
| Neurocognitive deficits influencing treatment response of geriatric depression | 519 | ||
| Neurobiological abnormalities influencing treatment response of geriatric depression | 520 | ||
| The prognosis of depression with cognitive impairment | 521 | ||
| Depression as a risk factor and/or prodrome of dementing disorders | 521 | ||
| Can the cognitive deficits of late life depression be mitigated with drug treatment? | 523 | ||
| Can cognitive deficits in late-life depression be mitigated with cognitive remediation? | 523 | ||
| Summary | 524 | ||
| References | 525 | ||
| The Two-Way Relationship Between Medical Illness and Late-Life Depression | 533 | ||
| Key points | 533 | ||
| Introduction | 533 | ||
| Late-life depression and cardiovascular disease | 534 | ||
| Late-life depression and endocrine disorders | 537 | ||
| Late-life depression and chronic obstructive pulmonary disease | 538 | ||
| Late-life depression and chronic renal disease | 539 | ||
| Late-life depression and gastrointestinal disease | 539 | ||
| Summary | 541 | ||
| References | 541 | ||
| Assessment of the Person with Late-life Depression | 545 | ||
| Key points | 545 | ||
| Introduction | 545 | ||
| Clinical presentation of LLD | 548 | ||
| Identification of risk and protective factors in depression | 548 | ||
| Clinical assessment of LLD: the psychiatric interview | 550 | ||
| History of Present Illness | 550 | ||
| Past Psychiatric History | 550 | ||
| Medical History, Current Medications, and Family History | 550 | ||
| Social History | 550 | ||
| Functional Status Assessment | 551 | ||
| Differential diagnosis of LLD | 551 | ||
| Clinical Assessment of LLD: Mental Status Examination | 551 | ||
| Screening and Assessment for Suicide | 551 | ||
| Physical examination and laboratory studies | 553 | ||
| Depression rating scales | 553 | ||
| GDS | 553 | ||
| PHQ-9 | 554 | ||
| BDI | 554 | ||
| HAM-D | 555 | ||
| Cognition and LLD | 555 | ||
| Folstein MMSE | 555 | ||
| SLUMS Examination | 556 | ||
| Mini-Cog | 556 | ||
| Vascular depression and the role of neuroimaging | 556 | ||
| Summary | 557 | ||
| References | 557 | ||
| Psychological Treatment of Late-Life Depression | 561 | ||
| Key points | 561 | ||
| Introduction | 561 | ||
| Methods | 561 | ||
| Interventions | 563 | ||
| Cognitive and Behavioral Therapies | 563 | ||
| Interpersonal Therapy | 568 | ||
| Problem-Solving Therapy | 568 | ||
| Reminiscence and Life Review | 569 | ||
| Brief Psychodynamic Therapy | 569 | ||
| Discussion | 570 | ||
| References | 572 | ||
| What is the Role of Alternative Treatments in Late-life Depression? | 577 | ||
| Key points | 577 | ||
| Introduction | 577 | ||
| Natural remedies | 578 | ||
| St. John’s Wort (Hypericum perforatum L.) | 578 | ||
| Fish Oil | 579 | ||
| S-Adenosyl Methionine | 580 | ||
| Folic Acid | 580 | ||
| Summary: Natural Supplements | 580 | ||
| Exercise | 581 | ||
| Yoga | 582 | ||
| Yoga and Health | 582 | ||
| Yoga and Depression | 582 | ||
| Summary: Yoga | 583 | ||
| Tai chi | 583 | ||
| Tai Chi and Health | 584 | ||
| Tai Chi and Depression | 584 | ||
| Summary: Tai Chi | 585 | ||
| Massage therapy | 585 | ||
| Music therapy | 586 | ||
| Religion and spirituality | 587 | ||
| Summary | 588 | ||
| References | 589 | ||
| What Is the Role of Medications in Late Life Depression? | 597 | ||
| Key points | 597 | ||
| Introduction | 597 | ||
| Antidepressants | 598 | ||
| Efficacy of antidepressants | 599 | ||
| Side effects of antidepressants | 600 | ||
| Treatment resistance | 601 | ||
| Maintenance | 601 | ||
| Mood stabilizers | 601 | ||
| Psychostimulants | 602 | ||
| Naturopathics | 602 | ||
| Summary | 602 | ||
| References | 603 | ||
| The Role of Electroconvulsive and Neuromodulation Therapies in the Treatment of Geriatric Depression | 607 | ||
| Key points | 607 | ||
| Introduction | 607 | ||
| ECT | 609 | ||
| ECT in Neuropsychiatric Disorders | 609 | ||
| Parkinson disease | 609 | ||
| Alzheimer disease and other dementias | 610 | ||
| Cerebrovascular disease and stroke | 611 | ||
| The Pre-ECT Workup in Geriatric Patients | 612 | ||
| Anesthesia in Geriatric Patients | 613 | ||
| Administering ECT in the Elderly | 613 | ||
| Ultrabrief ECT technology | 614 | ||
| Seizure titration | 614 | ||
| Study comparing ECT dose titration with other dosing strategies | 614 | ||
| Delirium monitoring | 615 | ||
| Maintenance ECT | 615 | ||
| Summary of ECT | 616 | ||
| Novel neuromodulatory approaches | 616 | ||
| VNS | 616 | ||
| Transcranial Magnetic Stimulation | 617 | ||
| Deep Brain Stimulation | 618 | ||
| Transcranial Direct Current Stimulation | 618 | ||
| Magnetic Seizure Therapy | 619 | ||
| Focal Electrically Administered Seizure Therapy | 619 | ||
| Summary | 619 | ||
| References | 619 | ||
| The Economic, Public Health, and Caregiver Burden of Late-life Depression | 631 | ||
| Key points | 631 | ||
| Overview | 631 | ||
| Prevalence and patterns of LLD | 632 | ||
| Economic burden of LLD | 632 | ||
| Direct Costs | 632 | ||
| Indirect Costs | 633 | ||
| Example: bidirectional relationship between depression and retirement | 634 | ||
| Background and Introduction | 634 | ||
| Disciplinary and Theoretic Perspectives | 634 | ||
| Methods | 635 | ||
| Study sample | 635 | ||
| Study measures | 636 | ||
| Depression | 636 | ||
| Retirement | 636 | ||
| Covariates | 636 | ||
| Statistical analyses | 636 | ||
| Results | 638 | ||
| Implications of Example for Research and Practice | 638 | ||
| Public health burden of LLD | 638 | ||
| Caregiver burden of LLD | 640 | ||
| Future directions | 641 | ||
| Treatment | 641 | ||
| Genetics | 642 | ||
| Summary | 642 | ||
| Acknowledgments | 642 | ||
| References | 642 | ||
| A Team-based Approach to the Care of Depression in Later Life | 651 | ||
| Key points | 651 | ||
| Introduction | 651 | ||
| The aging population | 652 | ||
| Mental health and depression | 652 | ||
| Health care workforce | 652 | ||
| Historical perspective of the chronic care model | 653 | ||
| Recent research on collaborative care models treating depression alone | 653 | ||
| Recent research on collaborative care of depression with comorbid illnesses | 655 | ||
| Studies related to patient and provider satisfaction | 656 | ||
| Moving toward a new model | 656 | ||
| Implications for Practice | 656 | ||
| Implications for Research | 657 | ||
| Implications for Education | 657 | ||
| Summary | 658 | ||
| References | 658 | ||
| Index | 661 |