Mental Health in the Older Adult

Many physicians assume that the practice of geriatric psychiatry is focussed on managing the behavioural problems so often associated with dementia. While this is of course an important part of the practice of most geriatric psychiatrists, the older adult can suffer from a wide range of mental illnesses. In these non-dementia cases, the expertise of a geriatric psychiatrist over a general psychiatrist is the ability to separate the psychiatric symptoms from the background noise of comorbidity, which frequently alters the presentation of the disorder and its response to treatment. Thus, the practice of geriatric psychiatry requires at least an understanding of general medical issues and an ability to efficiently recognize them in practice.

This month’s issue has three articles on psychiatric issues in the older adult. All are relevant to primary care practitioners, but the article by Drs. Kannayiram Alagia-krishnan and Cheryl Wiens discusses a topic that is comes up almost every day for those doctors with a substantial geriatric practice. The article is entitled “Psychiatric Side Effects of Nonpsychiatric Medications.” Atypical presentation of disease is one of the hallmarks of geriatric medicine. My belief is that it is comorbidity more than just advanced age that causes this, but in any event psychiatric illness can present in unusual ways. Dr. James Silvius discusses this in his article entitled “Atypical Presentation of Depression.” Our final focus article, by Drs. Patricia Hall and Verinder Sharma, addresses the “Diagnosis and Management of Bipolar Disorder in Older Adults.”

Our regular columns are particularly interesting this month. The cardiovascular column is on a new type of technology, “Implantable Cardioverter-Defibrillators in Older Adults with Coronary Artery Disease” by Drs. Abdul Razakjr Omar and Kumaraswamy Nanthakumar. Having just attended a brilliant presentation by Dr. Nanthakumar, I am pleased to see that his article meets the same high standard. The pain article in this issue is on the “Treatment of Pain in the Older Adult” by Drs. Hershl Berman and Shawna Silver. Control of pain is one of the major reasons why older people see their family doctors. The dementia column is on one of the hot topics in neurology, namely “Office Diagnosis of Mild Cognitive Impairment” by Drs. Andrew Frank and Ronald Petersen. Falls are one of the most important issues facing older adults, and the topic of “Opthalmic Interventions to Help Prevent Falls” is covered by Drs. John Buckley and David Elliott this month. Our movement disorders column is “Multiple System Atrophy: An Update” by Drs. Felix Geser and Gregor Wenning.

The case study this month is on “Acute Low Back Pain: A Clinical Experience with Acupuncture” by Drs. Sanjeev Rastogi and Rajieev Rastogi. As well, we have a book review by one of our senior editorial staff, Lesley McKarney. The book, by Dr. Ernest Rosenbaum and Isadora Rosenbaum, is entitled “Everyone’s Guide to Cancer Supportive Care: A Comprehensive Handbook for Patients and Their Families.”

Enjoy this issue,
Barry Goldlist