Neuropsychiatric disorders in the elderly, such as dementia, depression, anxiety, and psychosis, may occur alone or in combination with neurologic or medical illness. Geriatricians must be familiar not only with diagnostic issues but also with treatment options and medication-induced alterations in mental status.
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References
1.
JenikeMA. Geriatric psychiatry and psychopharmacology: a clinical approach. Chicago: Yearbook Medical Publishing, 1989
2.
SomerfieldMRWeismanCSUryWPhysician practices in the diagnosis of dementing disorders. J Am Geriatr Soc1991; 39: 172175
3.
McKhannGDrachmanDFolsteinMClinical diagnosis of Alzheimer's disease: report of he NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services task force on Alzheimer's disease. Neurology1984; 34: 939944
4.
CarciaCARedingMJBlassJP. Overdiagnosis of dementia. J Am Geriatr Soc1981; 29: 407
5.
O'ConnorDWPollittPAHydeJBDo general practitioners miss dementia in elderly patients?BMJ1988; 297: 1107
6.
ForetteFHenryJFOrgogozoJMReliability of clinical criteria for the diagnosis of dementia. Arch Neurol1989; 46: 646
7.
FiataroneMAO'NeillEFRyanNDExercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med1994; 330: 17691775
8.
GurlandBJ. The comparative frequency of depression in various adult age groups. J Gerontol1976; 31: 283292
9.
BlazerD. Depression in late life. St Louis: CV Mosby, 1982
10.
FernandezFLevyJKLacharBLSmallGW. The management of depression and anxiety in the elderly. J Clin Psychiatry1995; 56 (suppl 2): 2029
LipseyJRPearlsonGDRobinsonRGNortriptyline treatment of poststroke depression: a double-blind study. Lancet1984; 1: 297300
13.
GelenbergAJ ed. Kinetic differences among SSRIs. In: Biological therapies in psychiatry newsletter. St. Louis: Mosby-Yearbook, 1993: 3435
14.
PatoMTMurphyDLDeVaneCL. Sustained plasma concentrations of fluoxetine and/or norfluoxetine four and eight weeks after fluoxetine discontinuation. J Clin Psychopharmacol1991; 11: 224–225. Letter
15.
SchoneW. Paroxetine vs. fluoxetine in the treatment of geriatric patients with major depression: a multicenter double-blind study. Presented at the Annual ACNP Meeting. San Juan, Puerto Rico, December 1992
16.
JenikeMABaerLMinichielloWE. Obsessive-compulsive dis-ordess: theory and management. 2nd Ed.Chicago: Yearbook Medical Publishers, 1990
17.
RobinsonDSDavisJMNiesARelation of sex and aging to monoamine oxidase activity of human brain, plasma, and platelets. Arch Gen Psychiatry1971; 24: 536539
18.
RobinsonDS. Changes in monoamine oxidase and monoamines with human development and aging. Fed Proc1975; 34: 103
19.
JenikeMA. MAO inhibitors as treatment for depressed patients with primary degenerative dementia (Alzheimer's disease). Am J Psychiatry1985; 142: 763764
20.
KronigMHRooseSPWalshBTBlood pressure effects of phenelzine. J Clin Psychopharmacol1983; 3: 307
21.
JenikeMA. The use of monoamine oxidase inhibitors in elderly depressed patients. J Am Geriatr Soc1984; 32: 571575
22.
JenikeMA. Alzheimer's disease and other dementias. In: JenikeMA. Geriatric psychiatry and psychopharmacology: a clinical approach. Chicago: Year Book Medical Publishing, 1989
23.
GreendykeRMSchusterDBWootenJA. Propranolol in the treatment of assaultive patients with organic brain disease. J Clin Psychopharmacol1984; 4: 282285
24.
JeffersonJW. Lithium and affective disorder in the elderly. Compr Psychiatry1983; 24: 166178
25.
GuzeBHBaxterLRJr.Neuroleptic malignant syndrome. N Engl J Med1985; 313: 163166
26.
WoodsSWTesarGEMurrayGBPsychostimulant treatment of depressive disorders secondary to medical illness. J Clin Psychiatry1986; 47: 1215
27.
JenikeMA. Psychiatric disorders in the elderly. In: AlbertMLKnoefelJE eds. Clinical neurology of aging. 2nd Ed.Oxford University Press, 1994: 396420
28.
deMontignyCGrunbergFMayerALithium induces rapid relief of depression in tricyclic antidepressant drug non-responders. Br J Psychiatry1981; 138: 252256
KushnirSL. Lithium-antidepressant combinations in the treatment of depressed, physically ill geriatric patients. Am J Psychiatry1986; 143: 378379
31.
GoodwinFKPrangeAJPostRMPotentiation of antidepressant effects of L-triiodothyronine in tricyclic nonresponders. Am J Psychiatry1982; 139: 3438
32.
GlasserMRabinsP. Mania in the elderly. Age Ageing1984; 13: 210213
33.
MoakGS. Characteristics of demented and nondemented geriatric admissions to a state hospital. Hosp Community Psychiatry1990; 41: 700701
34.
YassaRNairVNastaseCPrevalence of bipolar disorder in a psychogeriatric population. J Affect Disord1988; 14: 197201
35.
ShulmanKITohenMSatlinAMania compared to unipolar depression in old age. Am J Psychiatry1992; 149: 341345
36.
WeissmanMMBruceMLLeakPJAffective disorders. In: RobinsLNRegierDA eds. Psychiatric disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press, 1991: 5380
37.
KrauthammerCKlermanGL. Secondary mania. Arch Gen Psychiatry1978; 35: 13331339
38.
RobinsonRGBostonJDStarksteinSEComparison of mania and depression after brain injury: causal factors. Am J Psychiatry1988; 145: 172178
39.
StarksteinSEBostonJDRobinsonRG. Mechanisms of mania after brain injury: twelve case reports and review of the literature. J Nerv Ment Dis1989; 155: 7985
40.
StarksteinSEMaybergHSBerthierMLMania after brain injury: neuroradiological and metabolic findings. Arch Neurol1990; 27: 652659
41.
StarksteinSEPearlsonGDBostonJDMania after brain injury: a controlled study of causative factors. Ann Neurol1987; 44: 10691073
42.
BurnsteinA. Bipolar and pure mania disorders precipitated by head trauma. Psychosomatics1993; 34: 194195
43.
JorgeRERobinsonRGStarksteinSESecondary mania following traumatic brain injury. Am J Psychiatry1993; 150: 916921
44.
ShuklaSCookBLCookSMania following head trauma. Am J Psychiatry1987; 144: 9396
45.
ShulmanKI. Clinical aspects of mania in the elderly. In: Therapeutic strategies with the older adult. 1996; 2: 411
46.
DhingraURabinsPC. Mania in the elderly: a five- to seven-year follow-up. J Am Geriatr Soc1991; 39: 581583
47.
HardyBShulmanKMackenzieSPharmacokinetics of lithium in the elderly. J Clin Psychopharmacol1987; 7: 153158
48.
SmithREHelmsPM. Adverse effects of lithium therapy in the acutely ill elderly patient. J Clin Psychiatry1982; 43: 3
49.
MurrayNHopwoodSBalfourDJKInfluence of age on lithium efficacy and side effects in outpatients. Psychol Med1983; 13: 5360
GnamWFlintAJ. New-onset, rapid-cycling, bipolar disorder in an 87-year-old woman. Can J Psychiatry1993; 38: 324326
52.
McFarlandBHMillerMRStraumfjordAA. Valproate use in the older manic patient. J Clin Psychiatry1990; 51: 479481
53.
PopeHGJrMcElroySLKeckPEJrValproate in the treatment of acute mania: a placebo-controlled study. Arch Gen Psychiatry1991; 48: 6268
54.
MukherjeeSSacheimHASchnurDB. Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience. Am J Psychiatry1994; 151: 169176
55.
SuppesTBaldessariniRJFaeddaGIRisk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry1991; 48: 10821088
56.
KatonWRaskindM. Treatment of depression in the medically ill elderly with methylphenidate. Am J Psychiatry1980; 137: 963965
57.
WeinerRD. The role of electroconvulsive therapy in the treatment of depression in the elderly. J Am Geriatr Soc1982; 30: 710712
58.
ScovernAWKilmannPR. Status of ECT: A review of the outcome literature. Psychol Bull1980; 87: 260
59.
O'LearyDGillDGregorySShawcrossC. The effectiveness of real versus simulated electroconvulsive therapy in depressed elderly patients. Int J Geriatr Psychiatry1994; 9: 567571
60.
BlackwellBMerskeyHKellnerR. Somatoform pain disorders. In: KarasuTB ed. Treatments of psychiatric disorders. Washington, DC: American Psychiatric Association Press, 1989
61.
IndacoACarrieriP. Amitriptyline in the treatment of headache in patients with Parkinson's disease: a double-blind placebo-controlled study. Neurology1988; 38: 17201722
62.
PrienRFKupferDJ. Continuation drug therapy for major depressive episodes: How long should it be maintained?Am J Psychiatry1986; 143: 1823
63.
QuitkinFMRabkinJGRossD: Duration of antidepressant drug treatment. Arch Gen Psychiatry1984; 41: 238245
64.
GeorgotasAMcCueRE. The additional benefit of extending an antidepressant trial past seven weeks in the depressed elderly. Int J Geriatr Psychiatry1989; 4: 191195
65.
SosJCassemNH. Intravenous use of haloperidol for acute delirium in intensive care settings. In: SpeidelHRodewaldG eds. Psychic and neurological dysfunctions after open-heart surgery. Stuttgart: Thieme, 1980: 196199
66.
SmithJMBaldessariniRJ. Changes in prevalence, severity, and recovery in tardive dyskinesia with age. Arch Gen Psychiatry1980; 37: 1368
67.
GreendykeRMKanterDR. Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: a double-blind study. J Clin Psychiatry1986; 47: 423426
68.
BallengerJCPostRM. Carbamazepine in manic-depressive illness: a new treatment. Am J Psychiatry1980; 137: 782790
69.
FrankenburgFRTohenMCohenBMLong-term response to carbamazepine: a retrospective study. J Clin Psychopharmacol1988; 8: 130132
70.
McAllisterTW. Carbamazepine in mixed frontal lobe and psychiatric disorders. J Clin Psychiatry1985; 46: 393
71.
GreenwaldBSMarinDBSilvermanSM. Serotonergic treatment of screaming and banging in dementia. Lancet1986; 2: 14641465
72.
CollendaCC. Buspirone in treatment of agitated demented patients. Lancet1988; 1: 1169
73.
CaroffSN. The neuroleptic malignant syndrome. J Clin Psychiatry1980; 41: 7983
74.
GelenbergAJ. Psychosis. In: BassukELSchoonoverSCGelenbergAJ eds. The practitioners guide to psychoactive drugs. 2nd Ed.New York: Plenum, 1983
75.
PopeHGJrKeckPEJrMcElroySL. Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. Am J Psychiatry1986; 143: 1227, 1233
76.
CohenBMBaldessariniRJPopeHGJrNeuroleptic malignant syndrome. N Engl J Med1985; 313: 1293. (Letter)
77.
AddonizioGSusmanVLRothSD. Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients. Am J Psychiatry1986; 143: 15871590
78.
JunaidOBiswasAJonesRG. Neuroleptic malignant syndrome. Int J Geriatr Psychiatry1992; 8: 524531
79.
MyersJKWeissmanMMTischlerGLSix month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry1984; 41: 959967
80.
GelenbergAJBellinghausenBWojickJDA prospective survey of neuroleptic malignant syndrome in a short-term psychiatric hospital. Am J Psychiatry1988; 145: 517518
81.
KeckPEJrPopeHGJrMcElroyEL. Frequency and presentation of neuroleptic malignant syndrome: a prospective study. Am J Psychiatry1987; 144: 13441346
82.
FogelBSGoldbergRJ. Neuroleptic malignant syndrome. N Engl J Med1985; 313: 1292
83.
CoonsDJHillmanFJMarshallRW. Treatment of neuroleptic malignant syndrome with dantrolene sodium: a case report. Am J Psychiatry1982; 139: 944945
84.
GoekoopJGCarbaatPA. Treatment of neuroleptic malignant syndrome with dantrolene. Lancet1982; 2: 49–50. Letter
BlueMGSchneiderSMNoroSSuccessful treatment of neuroleptic malignant syndrome with sodium nitroprusside. Ann Intern Med1986; 104: 5657
87.
LazarusA. Treatment of neuroleptic malignant syndrome with electroconvulsive therapy. J Nerv Ment Dis1986; 174: 4749
88.
HughesJR. ECT during and after the neuroleptic malignant syndrome: a case report. J Clin Psychiatry1986; 47: 4243
89.
RosebushPIStewartTMazurekMF. The treatment of neuroleptic malignant syndrome. Are dantrolene and bromocriptine useful adjuncts to supportive care?Br J Psychiatry1991; 159: 709712
90.
ShalevAMunitzH. The neuroleptic malignant syndrome: agent and host interaction. Acta Psychiatr Scand1986; 73: 337347
91.
HelmsPM. Efficacy of antipsychotics in the treatment of the behavioral complications of dementia: a review of the literature. J Am Geriatr Soc1985; 33: 206209
92.
KahnNA. Clozapine for psychosis in Parkinson's patients. Clinical advances in the treatment of psychiatric disorders. New York: KSF Group Publication, 1990; 4: 1216
93.
FriedmanJHLannonMC. Clozapine in the treatment of psychosis in Parkinson's disease. Neurology1989; 39: 12191221
94.
WoltersECHurwitzTATealPClozapine in the treatment of parkinsonian patients with dopaminomimetic psychosis. Neurology1990; 40: 832834
95.
LaderM. Differential diagnosis of anxiety in the elderly. J Clin Psychiatry1982; 43: 47
96.
SheikhJIKingRJTaylorCB. Comparative phenomenology of early onset versus late onset panic attacks: a pilot survey. Am J Psychiatry1991; 148: 12311233
97.
RajBACorveaMHDagonEM. The clinical characteristics of panic disorder in the elderly: a retrospective study. J Clin Psychiatry1993;54: 150155
98.
LivingstonHMLivingstonMGBrooksDNElderly survivors of the Lockerbie air disaster. Int J Geriatr Psychiatry1992; 7: 725729
99.
LivingstonHMLivingstonMG Fell. The Lockerbie disaster: a 3-year follow-up of elderly victims. Int J Geriatr Psychiatry1994; 9: 989994
100.
ScottRBBrooksDNMcKinlayW. Post traumatic morbidity in a civilian community — a follow-up at three years. 1993 (in Press)
101.
RickelsKWeismanKNorstadNBuspirone and diazepam in anxiety: a controlled study. J Clin Psychiatry1982; 43: 8186
102.
JenikeMA. Obsessive-compulsive and related disorders: a hidden epidemic. N Engl J Med1989; 321: 539541
103.
LipowskiZJ. Delirium in the elderlypatient. N Engl J Med1989; 320: 578582
104.
FrancisJMartinDKapoorWN. A prospective study of delirium in hospitalized elderly. JAMA1990; 263: 10971111
105.
SolomonRPPendleburyWW. The nature of Alzheimer's disease and the use of tacrine in treatment. In: Therapeutic Strategies with the Older Adult. 1995; 2: 118
106.
KatzmanR. Alzheimer's disease. N Engl J Med1986; 314: 964973
107.
La RueAWatsonJPlotkinDA. First symptoms of dementia: a study of relatives' reports. Int J Geriatr Psychiatry1993; 8: 239245
108.
SchwartzMF. Neuropsychological studies of Alzheimer's disease: taking the symptoms seriously. Presented at a meeting of the Canadian Neurosciences Society, Montreal, Canada
109.
SimMSussmanI. Alzheimer disease: its natural history and differential diagnosis. J Nerv Ment Dis1962; 135: 489499
110.
BrustJCM. Vascular dementia is over diagnosed. Arch Neurol1988; 45: 799801
111.
O'BrienMD. Vascular dementia is under diagnosed. Arch Neurol1988; 45: 797798
112.
RonMATooneBKGarraldaMEDiagnostic accuracy in presenile dementia. Br J Psychiatry1979; 134: 161168
113.
WadeJPHMirsenTRHachinskiVCThe clinical diagnosis of Alzheimer's disease. Arch Neurol1987; 44: 2429
114.
RisseSCRaskindMANochlinDNeuropathological findings in patients with clinical diagnoses of probable Alzheimer's disease. Am J Psychiatry1990; 147: 168172
115.
ReisbergBFerrisSHDe LeonMJ. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry1982; 139: 11361139
116.
KhachaturianZS. Diagnosis of Alzheimer's disease. Arch Neurol1985; 42: 10971105
117.
MorrisJCMcKeelDWFullingKValidation of clinical diagnostic criteria for Alzheimer's disease. Ann Neurol1988; 24: 1722
118.
St. George-HyslopPHTanziREPolinskyRJThe genetic defect causing familial Alzheimer's disease maps on chromosome 21. Science1987; 235: 885889
119.
TurnbullJMTurnbullSK. Management of specific anxiety disorders in the elderly. Geriatrics1985; 8: 7582
120.
WolozinBLPruchnickiADicksonDWA neuronal antigen in the brains of Alzheimer patients. Science1986; 232: 648651
121.
WolozinBLDaviesP. Alzheimer-related neuronal protein A68: specificity and distribution. Ann Neurol1987; 22: 521526
122.
BartusRTDeanRLBeerRThe cholinergic hypothesis of geriatric memory dysfunction. Science1982; 217: 408416
123.
DavisKLThalLJGamzuERA double-blind, placebo-controlled multicenter study of tacrine for Alzheimer's disease. N Engl J Med1992; 327: 12531259
124.
CaineED. The neuropsychology of depression: The pseudodementia syndrome. In: GrantIAdamsKM eds. Neuropsychological assessment of neuropsychiatric disorders. New York: Oxford, 1986: 221243
125.
ZubenkoGSMoossyJMartinezAJA brain regional analysis of morphologic and cholinergic abnormalities in Alzheimer's disease. Arch Neurol1989; 46: 634638
