Handbook of Geriatric Psychopharmacology

by Jacobson, Sandra A.

• ISBN13: 9780880488235
• ISBN10: 0880488239
• Edition: 1st
• Format: Paperback
• Copyright: 2002-01-01
• Publisher: Amer Psychiatric Pub Inc

Summary

Tufts Univ., Boston, MA. Pocket-sized handbook for residents, fellows, and practitioners in psychiatry and medicine who treat patients with psychiatric and neuropsychiatric conditions. Practical guide to clinical geriatric prescribing. Includes clinical pearls. Softcover. DNLM: Drug Therapy--Aged.

Author Biography

Sandra A. Jacobson, M.D., is Assistant Professor of Psychiatry and Director of the Geriatric Psychiatry Fellowship Training Program at Tufts University School of Medicine in Boston, Massachusetts Ronald W. Pies, M.D., is Clinical Professor of Psychiatry at Tufts University School of Medicine in Boston, Massachusetts David J. Greenblatt, M.D., is Chairman of the Department of Pharmacology and Experimental Therapeutics at Tufts University School of Medicine in Boston, Massachusetts

Table of Contents

About the Authors	xiii
Preface	xv
Introduction to Geriatric Psychopharmacology	1	(30)
Pharmacokinetics and Aging	1	(14)
Absorption	1	(2)
Distribution	3	(2)
Metabolism	5	(7)
Protein Binding	12	(1)
Clearance	12	(2)
Drug Half-Life	14	(1)
Pharmacodynamics and Aging	15	(1)
The Practice of Geriatric Psychopharmacology	16	(7)
Maximizing Therapeutic Effects	16	(3)
Improving Compliance	19	(2)
Minimizing Adverse Effects	21	(1)
Containing Costs	22	(1)
Summary Guidelines: The Practice of Geriatric Psychopharmacology	23	(2)
Chapter Summary	25	(1)
References	26	(5)
PART 1 Major Psychotropic Drug Classes
Antipsychotics	31	(70)
Pharmacokinetics	32	(1)
Pharmacodynamics and Mechanism of Action	33	(2)
Drug Interactions	35	(1)
Indications	35	(4)
Efficacy	39	(1)
Clinical Use	39	(15)
Choice of Antipsychotic	39	(7)
Alternative Formulations	46	(1)
Baseline Laboratory Studies	47	(1)
Dose and Dose Titration	47	(1)
PRN Use of Antipsychotics	48	(1)
Monitoring Treatment	49	(1)
Serum Antipsychotic Levels	50	(1)
Managing Treatment Resistance	50	(4)
Switching Antipsychotics	54	(1)
Adjunctive Treatments	55	(1)
Discontinuation of Antipsychotics	56	(1)
Antipsychotic Overdose in Elderly Patients	56	(1)
Side Effects	57	(13)
Treatment of Selected Syndromes and Disorders with Antipsychotics	70	(9)
Delirium	70	(2)
Delusional Disorder	72	(1)
Dementia with Psychotic Symptoms	72	(1)
Depression with Psychotic Symptoms	73	(1)
Mania	73	(1)
Parkinson's Disease with Psychosis	74	(1)
Personality Disorders	75	(1)
Schizoaffective Disorder	75	(1)
Schizophrenia	75	(1)
Secondary Psychotic Syndromes	76	(1)
Substance Intoxication and Withdrawal	76	(3)
Chapter Summary	79	(1)
References	80	(5)
Antipsychotics: Specific Drugs	85	(16)
Antidepressants	101	(86)
Pharmacokinetics	103	(3)
Pharmacodynamics and Mechanism of Action	106	(1)
Drug Interactions	107	(1)
Efficacy	108	(4)
Clinical Use	112	(21)
Choice of Antidepressant	113	(8)
Alternative Formulations	121	(1)
Baseline Laboratory Studies and Clinical Evaluation	122	(2)
Dose and Dose Titration	124	(1)
Course of Antidepressant Response	125	(1)
Monitoring Antidepressant Therapy	126	(2)
Duration of Treatment	128	(1)
Managing Treatment Resistance	129	(4)
Discontinuation of Antidepressants	133	(1)
Antidepressant Overdose	133	(1)
Side Effects	133	(16)
Overview of Side Effects by Medication Class	134	(5)
System-Specific Side Effects	139	(10)
Treatment of Selected Syndromes and Disorders With Antidepressants	149	(12)
Anxiety Disorders	149	(2)
Depressive Disorders	151	(10)
Chapter Summary	161	(2)
References	163	(6)
Antidepressants: Specific Drugs	169	(18)
Mood Stabilizers	187	(62)
Pharmacokinetics	189	(1)
Pharmacodynamics and Mechanism of Action	189	(3)
Drug Interactions	192	(5)
Efficacy	197	(1)
Clinical Use	198	(11)
Choice of Drug	198	(1)
Alternative Formulations	199	(1)
Baseline Laboratory Studies and Clinical Evaluation	200	(1)
Dose and Dose Titration	200	(1)
Course of Response	201	(1)
Monitoring Treatment	201	(2)
Duration of Treatment	203	(1)
Managing Treatment Resistance	204	(2)
Discontinuation of Mood Stabilizers	206	(1)
Overdose/Overmedication	207	(2)
Side Effects	209	(9)
Side Effects of Specific Agents	209	(4)
System-Specific Side Effects	213	(5)
Treatment of Selected Syndromes and Disorders with Mood Stabilizers	218	(9)
Aggression in Dementia	219	(1)
Alcohol/Sedative Withdrawal	220	(1)
Bipolar Depression	220	(1)
Bipolar Mania	221	(1)
Bipolar Mixed State	222	(1)
Bipolar Disorder Prophylaxis	222	(1)
Pain Syndromes	223	(1)
Personality Disorders	223	(1)
Posttraumatic Stress Disorder	224	(1)
Rapid Cycling	224	(1)
Restless Legs Syndrome	224	(1)
Schizoaffective Disorder	224	(1)
Secondary Mania	225	(1)
Unipolar Depression	226	(1)
Chapter Summary	227	(2)
References	229	(6)
Mood Stabilizers: Specific Drugs	235	(14)
Anxiolytic and Sedative-Hypnotic Medications	249	(66)
Pharmacokinetics	251	(1)
Pharmacodynamics and Mechanism of Action	252	(3)
Drug Interactions	255	(1)
Indications	255	(2)
Efficacy	257	(1)
Clinical Use	258	(11)
Nonpharmacological Therapies	258	(1)
Choice of Drug	259	(2)
Patient Education	261	(1)
Baseline Laboratory and Diagnostic Studies	262	(1)
Dose and Dose Titration	263	(1)
Duration of Treatment	264	(1)
Monitoring Treatment	264	(1)
Management of Nonresponse	265	(1)
Switching Drugs	265	(1)
Overdose	266	(1)
Tolerance and Abuse	266	(1)
Dependence, Discontinuation, and Withdrawal Syndromes	267	(2)
Side Effects	269	(4)
Treatment of Selected Syndromes and Disorders with Anxiolytics and Sedative-Hypnotics	273	(10)
Anxiety Disorders	273	(4)
Sleep Disorders	277	(3)
Other Disorders	280	(3)
Chapter Summary	283	(2)
References	285	(6)
Anxiolytics and Sedative-Hypnotics: Specific Drugs	291	(24)
PART 2 Treatment of Other Geriatric Syndromes and Disorders
Treatment of Substance-Related Disorders	315	(28)
Substance Use Disorders	318	(8)
Diagnosis of Abuse and Dependence	318	(1)
Treatment	319	(7)
Substance-Induced Disorders	326	(9)
Alcohol-Related Syndromes	326	(9)
Chapter Summary	335	(2)
References	337	(6)
Treatment of Movement Disorders	343	(32)
Movement Abnormalities	343	(9)
Akinesia and Bradykinesia	344	(1)
Athetosis	344	(1)
Chorea	344	(1)
Dystonia	344	(4)
Hemiballismus	348	(1)
Myoclonus	348	(1)
Rigidity	348	(1)
Tics	348	(2)
Tremor	350	(2)
Treatment of Selected Movement Disorders	352	(15)
Degenerative Disorders	352	(6)
Drug-Induced Syndromes	358	(7)
Other Movement Abnormalities	365	(2)
Chapter Summary	367	(2)
References	369	(6)
Treatment of Dementias and Other Cognitive Syndromes	375	(42)
Evaluation of the Cognitively Impaired Elder	376	(1)
Treatment of Specific Cognitive Disorders	377	(10)
Alcohol-Related Dementia (Alcohol-Induced Persisting Dementia)	377	(1)
Alzheimer's Disease	378	(3)
Amnestic Disorder	381	(1)
Delirium	381	(1)
Dementia of Depression	381	(1)
Frontotemporal Dementia (Frontal Lobe Dementia)	382	(1)
Dementia With Lewy Bodies (Lewy Body Dementia)	382	(1)
Mental Retardation	383	(1)
Mild Cognitive Dysfunction	384	(1)
Parkinson's Disease With Dementia	384	(1)
Schizophrenia-Related Cognitive Dysfunction	384	(1)
Vascular Dementia	385	(2)
Treatment of Behavioral Disturbances in Dementia	387	(8)
Agitation and Aggression	387	(4)
Hypersexuality and Inappropriate Sexual Behaviors	391	(1)
Sundowning	392	(3)
Chapter Summary	395	(2)
References	397	(8)
Dementias and Other Cognitive Syndromes: Specific Drugs	405	(12)
Index	417