Geriatric psychiatry
Medical speciality
Medical specialty
Geriatric psychiatry
SystemNervous system, mental health
Significant diseasesAlzheimer's disease, vascular dementia, dementia with Lewy bodies, Parkinson's disease, depression, bipolar disorder, schizophrenia, delirium, behavioral and psychological symptoms of dementia, substance use disorder
Significant testsMental status examination, cognitive testing, neuroimaging
SpecialistGeriatric psychiatrist

Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment, and mental disorders in people of old age[1][2]. Geriatric psychiatry as a subspecialty has significant overlap with the specialties of geriatric medicine, behavioral neurology, neuropsychiatry, neurology, and general psychiatry[3]. Geriatric psychiatry has become an official subspecialty of psychiatry with a defined curriculum of study and core competencies[4].

Scope

Geriatric psychiatrist
Occupation
NamesDoctor, Psychiatry Specialist
Occupation type
Specialty
Activity sectors
Medicine, Psychiatry
Description
Education required
Fields of
employment
Hospitals, Clinics, Nursing Homes

A geriatric psychiatrist is a physician who specializes in the field of medical sub-specialty called geriatric psychiatry[5]. A geriatric psychiatrist holds a board certification after specialized training after attaining a medical degree, residency, and an additional geriatric psychiatry fellowship training program[5]. The requirements may vary by countries[6][7]. Some geriatric psychiatrists also conduct research to determine the cause and better treatments for neurodegenerative disorders and late-life mental health disorders.[8]

Geriatric psychiatrists may perform neurological examinations, mental status examination, laboratory investigations, neuroimaging, cognitive assessments to investigate the causes of psychiatric or neurologic symptoms in old age[9].

Diseases

Diseases and disorders diagnosed or managed by geriatric psychiatrists include, but are not limited to:[10]


History

Origins

Alois Alzheimer (1915), a German psychiatrist who identified the pathology involved in Alzheimer's disease

The origins of geriatric psychiatry began with Alois Alzheimer, a German psychiatrist and neuropathologist who first identified amyloid plaques and neurofibrillary tangles in a fifty-year-old woman he called Auguste D[16]. These plaques and tangles were later identified as being responsible for her behavioural symptoms, short-term memory loss, and psychiatric symptoms.[16] These brain anomalies would become identifiers of what later became known as Alzheimer's disease[17].

Subspecialty

The subspecialty of geriatric psychiatry originated in the United Kingdom in the 1950s[18]. In 1958, the first mental health service was designed specifically for the elderly under the guidance of Dr. Ronald Robinson in Scotland[19]. At this time, much of the knowledge related to this field was based of notable psychiatrists in the United Kingdom including: Sir Martin Roth (psychiatrist), Dr. Felix Post, Dr. Aubrey Lewis, and Dr. David Henderson[20].

In the United States, the American Association for Geriatric Psychiatry was founded in 1978 under the direction of its first president, Dr. Sanford Finkel[21]. It was not until 1991 when the American Board of Psychiatry and Neurology began to conduct examinations for this subspecialty[22].

Investigations

Diagnostic Assessment Tools

Caption Clock Drawing Test to Differentiate between Normal vs. MCI vs. AD
  • The Clock Drawing Test (CDT) can be used to quickly assess cognitive function through visuospatial skills and executive function[23].

The CDT can be interpreted as normal, Mild Cognitive Impairment (MCI), possible Alzheimer's Disease (AD), or other diagnoses[23].

Role of Interdisciplinary Assessments

Treatments

The two major options for treatment in the elderly with psychiatric conditions includes pharmacologic intervention vs. non-pharmacologic intervention.[24]

Pharmacologic Interventions

In the geriatric population, careful pharmacologic consideration is required due to possibility of drug-drug interactions, co-morbid conditions, and risk of adverse effects[25]. Adverse effects, particularly concerning in this age group include drowsiness, increased risk of falls, postural hypotension, and sleep disturbances[25]

Non-Pharmacologic Interventions

When pharmacologic intervention has failed, electroconvulsive therapy is an option for treatment resistant depression, agitation secondary to delirium, catatonia, psychosis, and other psychiatric conditions in the elderly[26].

Training

International

The International Psychogeriatric Association is an international community of scientists and healthcare geriatric professionals working for mental health in aging.[27] International Psychogeriatrics is the official journal of the International Psychogeriatric Association.[28]

Canada

The Royal College of Physicians and Surgeons of Canada is responsible for training and certifying geriatric psychiatrists in Canada. Geriatric psychiatry requires an additional year of subspecialty fellowship training in addition to general psychiatry training.[6]

United Kingdom

The Royal College of Psychiatrists is responsible for training and certifying psychiatrists in the United Kingdom. Within the Royal College of Psychiatrists, the Faculty of Old Age Psychiatry is responsible for training in Old Age Psychiatry. Doctors who have membership of the Royal College of Psychiatrists can undertake a three or four-year training programme to become a specialist in Old Age Psychiatry. There is currently a shortage of old age psychiatrists in the United Kingdom.[7]

United States

The American Association for Geriatric Psychiatry (AAGP) is the national organization representing health care providers specializing in late life mental disorders. The American Journal of Geriatric Psychiatry[29] is the official journal of the AAGP.[30] The American Board of Psychiatry and Neurology and the American Osteopathic Board of Neurology and Psychiatry both issue a board certification in geriatric psychiatry.[31][32]

After a 4-year residency in psychiatry, a psychiatrist can complete a one-year fellowship in geriatric psychiatry. Many fellowships in geriatric psychiatry exist.[33]

See also

References

  1. ^ Barraclough, J.; Gill, D. (2007). Hughes' outline of modern psychiatry. (5th ed.) New York: John Wiley & Sons. ISBN 978-0-470-51657-7
  2. ^ Marino, Zubenko, Louis, George (2022-12-01). "Geriatric Psychiatry". Psychiatric Clinics of North America. 45 (4): Pages xiii-xvi. doi:10.1016/j.psc.2022.08.001. PMID 36396279.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Blazer, Schultz, Dan, Susan (2018-03-01). "Geriatric Psychiatry". Psychiatric Clinics of North America. 41 (1): Pages xiii-xv. doi:10.1016/j.psc.2017.10.014. PMID 29412857.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Fischer, Corinne E.; Ismail, Zahinoor; Rapoport, Mark J. (January 17, 2013). "Geriatric Psychiatry or Psychogeriatrics? Partnership at the CAGP/CCSMH 2012 Scientific Meeting". Canadian Geriatrics Journal. 16 (1): 3–5. doi:10.5770/cgj.16.66. PMC 3578771. PMID 23441142 – via cgjonline.ca.
  5. ^ a b "About Geriatric Psychiatry". American Association for Geriatric Psychiatry.
  6. ^ a b c "Canadian Academy of Geriatric Psychiatry - Definition of Geriatric Psychiatry". www.cagp.ca.
  7. ^ a b Blewett, Charlotte; Milward, Kate; Bailey, Alex; McAlpine, Lynsey (June 2019). "Recruitment into old age psychiatry". BJPsych Bulletin. 43 (3): 131–135. doi:10.1192/bjb.2018.112. ISSN 2056-4694.
  8. ^ "Federally Funded Programs–Geriatric Mental Health Research And Services Fact Sheet". www.aagponline.org.
  9. ^ "Careers in Geriatric Psychiatry". www.aagponline.org.
  10. ^ "Alzheimer's or depression: Could it be both? - Mayo Clinic". www.mayoclinic.org. Retrieved 2019-11-20.
  11. ^ "Depression in older adults: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-11-20.
  12. ^ Jiang, Wei (2020-05-01). "Depression and Cardiovascular Disorders in the Elderly". Clinics in Geriatric Medicine. 36 (2): Pages 211-219.
  13. ^ Wetherell, Petkus, McChesney, Stein, Judd, Rockwell, Sewell, Patterson, Julie, Andrew, Kathleen, Murray, Patricia, Enid, Daniel, Thomas (August 2009). "Older Adults Are Less Accurate Than Younger Adults at Identifying Symptoms of Anxiety and Depression". The Journal of Nervous and Mental Disease. 197 (8). doi:10.1097/NMD.0b013e3181b0c081. PMID 19684501.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Dols, Beekman, Annemiek, Aartjan (2020-05-01). "Older Age Bipolar Disorder". Clinics in Geriatric Medicine. 36 (2): Pages 281-296.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Folsom, Lebowitz, Lindamer, Palmer, Patterson, Jeste, David, Barry, Laurie, Barton, Thomas, Dilip (1 April 2022). "Schizophrenia in late life: emerging issues". Dialogues in Clinical Neuroscience. 8 (1): Pages 45-52. doi:10.31887/DCNS.2006.8.1/dfolsom. PMID 16640113.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ a b Berrios, G. E. (1990). "Alzheimer's disease: A conceptual history". International Journal of Geriatric Psychiatry. 5 (6): 355–365. doi:10.1002/gps.930050603. S2CID 145155424.
  17. ^ "Alois Alzheimer". Biography.com. 2 April 2014. Archived from the original on 23 March 2018. Retrieved 19 February 2019.
  18. ^ Clare Hilton; Tom Arle (December 2010). The Development of Old Age Psychiatry in the UK. pp. 7–11. doi:10.1002/9780470669600.ch2. ISBN 9780470747230 – via www.researchgate.net.
  19. ^ Hilton, Claire (April 2016). "Psychogeriatrics in England: Its Route to Recognition by the Government as a Distinct Medical Specialty, c.1970-89". Medical History. 60 (2): 206-228. doi:10.1017/mdh.2016.4. PMID 26971597.
  20. ^ Hilton, Claire (2005). "The origins of old age psychiatry in Britain in the 1940s". History of Psychiatry. 16 (3): 267-289. doi:10.1177/0957154X05050075.
  21. ^ Grossberg, George (2010). "Geriatric psychiatry--an emerging specialty". Missouri Medicine The Journal of the Missouri State Medical Association. 107 (6): 401-405. PMID 21319689.
  22. ^ "Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview". the american journal of geriatric psychiatry. 25 (5): 445-453. May 2017. doi:10.1016/j.jagp.2016.12.018. PMID 28214074.
  23. ^ a b "Clock Drawing Performance in Cognitively Normal Elderly". Archives of Clinical Neuropsychology. 23 (3): 295-327. doi:10.1016/j.acn.2007.12.003. PMID 18243644.
  24. ^ "Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly". The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie. 61 (9): 588-603. 2016. doi:10.1177/0706743716659276. PMID 27486149.
  25. ^ a b "Management of Depression in Older Adults A Review". JAMA. 317 (20): 2114-2122. doi:10.1001/jama.2017.5706.
  26. ^ Meyer, Swetter, Kellner, Justine, Samantha, Charles (2020-05-01). "Electroconvulsive Therapy in Geriatric Psychiatry". Clinics in Geriatric Medicine. 36 (2): Pages 265-279.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. ^ "International Psychogeriatric Association". www.ipa-online.org.
  28. ^ "Psychogeriatrics journal". www.blackwellpublishing.com. Archived from the original on 2012-09-29. Retrieved 2008-10-24.
  29. ^ http://ajgponline.org/ The American Journal of Geriatric Psychiatry
  30. ^ "American Association for Geriatric Psychiatry". www.aagponline.org.
  31. ^ "Geriatric Psychiatry". American Board of Psychiatry and Neurology.
  32. ^ "Specialties & Subspecialties". American Osteopathic Association. Retrieved 23 September 2012.
  33. ^ "Geriatric psychiatry fellowship". Archived from the original on 2008-12-30. Retrieved 2008-10-24.
  • Media related to Geriatric psychiatry at Wikimedia Commons
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