by Sandra A. Jacobson, M.D., Ronald W. Pies, M.D., Ira R. Katz, M.D., Ph.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2007, 289 pages, $74 softcover
Dr. Alami is a geriatric psychiatry fellow at Columbia University, New York City.
Medication management in the field of geriatric psychiatry is a real and constant challenge. Elderly patients tend to be on multiple medications, have multiple comorbidities, be more sensitive to side effects, and have issues that can impair their adherence to treatment. To make matters worse, there is a lack of empirical evidence that can guide the clinician because a majority of clinical trials for psychotropic medications are done with young individuals. These elements make the decision to start psychotropic treatment of an elderly patient a real challenge because the clinician has to assess the risk-benefit ratio.
In the first chapter of this book, the authors give valuable general advice on how to maximize the therapeutic effects of the medications, how to minimize the adverse side effects, and how to simplify the treatment plan in order to improve adherence. The basics of geriatric psychopharmacology are covered in the second chapter, with useful figures and tables. The chapter could have been more extensive, but the purpose of this book is, after all, to be an easy-to-use book, thorough yet practical. Each major class of psychotropic medication—antipsychotics, antidepressants, mood stabilizers, and sedative-hypnotic drugs—gets a full chapter. Each chapter has treatment algorithms, rating scales, tables covering the adverse side effects, and quick-reference summaries on selected drugs.
The last chapters are dedicated to the treatment of substance-related disorders, movement disorder, dementia, and cognitive disorders. Finally, a full chapter is dedicated to analgesic medications. Some may be surprised to find a full chapter covering analgesic medications. This is quite appropriate because a large percentage of the elderly population, often in nursing homes, have an underlying pain condition. The authors could have spent some time discussing how to prescribe in the context of the constraint of Medicare Part D. Because elderly patients may end up receiving electroconvulsive therapy, covering the management of medications for a patient about to receive or undergoing electroconvulsive therapy could also be useful.
If the authors were trying to come up with a reference that is easy to read yet thorough, a book that can be used by all health professionals working closely with elderly patients regardless of the setting—inpatient, outpatient, nursing home—then they did a great job.