System | Nervous system, Mental health |
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Significant diseases | Alzheimer'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 tests | Mental status examination, Cognitive testing, Neuroimaging |
Specialist | Geriatric 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] [3] Geriatric psychiatry as a subspecialty has significant overlap with the specialties of geriatric medicine, behavioural neurology, neuropsychiatry, neurology, and general psychiatry. Geriatric psychiatry has become an official subspecialty of psychiatry with a defined curriculum of study and core competencies. [4]
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. These plaques and tangles were later identified as being responsible for her behavioural symptoms, short-term memory loss, and psychiatric symptoms. [5] These brain anomalies would become identifiers of what later became known as Alzheimer's disease. [6]
The subspecialty of geriatric psychiatry originated in the United Kingdom in the 1950s. [7]
The geropsychiatric unit, the term for a hospital-based geriatric psychiatry program, was first introduced in 1984 by Norman White MD, when he opened New England's first specialized program at a community hospital in Rochester, New Hampshire. White is a pioneer in geriatric psychiatry, being among the first psychiatrists nationally to achieve board certification in the field. The prefix psycho- had been proposed for the geriatric program, but White, knowing New Englanders' aversion to anything psycho- lobbied successfully for the name geropsychiatric rather than psychogeriatrics.[ citation needed ]
Diseases and disorders diagnosed or managed by geriatric psychiatrists include: [8] [9] [10]
Occupation | |
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Names | Doctor, Medical Specialist |
Occupation type | Specialty |
Activity sectors | Medicine |
Description | |
Education required |
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Fields of employment | Hospitals, Clinics |
A geriatric psychiatrist is a physician who specializes in the field of medical sub-specialty called geriatric psychiatrist. A geriatric psychiatrist holds a board certification after specialized training after attaining a medical degree, residency, and an additional geriatric psychiatry fellowship training program. The requirements may vary by countries. Geriatric psychiatrist are also psychiatrists who are qualified in the general diagnosis and treatment of psychiatric disorders. Some geriatric psychiatrists also conduct research to determine the cause and better treatments for neurodegenerative disorders and late-life mental health disorders. [11]
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. [12]
The International Psychogeriatric Association is an international community of scientists and healthcare geriatric professionals working for mental health in aging. [13] International Psychogeriatrics is the official journal of the International Psychogeriatric Association. [14]
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. [8]
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. [15]
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 [16] is the official journal of the AAGP. [17] The American Board of Psychiatry and Neurology and the American Osteopathic Board of Neurology and Psychiatry both issue a board certification in geriatric psychiatry. [18] [19]
After a 4-year residency in psychiatry, a psychiatrist can complete a one-year fellowship in geriatric psychiatry. Many fellowships in geriatric psychiatry exist. [20]
Neurology is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.
A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians and evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.
Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that impacts a person's ability to perform everyday activities. This typically involves problems with memory, thinking, behavior, and motor control. Aside from memory impairment and a disruption in thought patterns, the most common symptoms of dementia include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, their caregivers, and their social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than might be caused by the normal aging process.
Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neuropsychiatry, the mind is considered "as an emergent property of the brain", whereas other behavioral and neurological specialties might consider the two as separate entities. Those disciplines are typically practiced separately.
Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and recovery of persons with addiction, of those with substance-related and addictive disorders, and of people who show unhealthy use of substances including alcohol, nicotine, prescription medicine and other illicit and licit drugs. The medical subspecialty often crosses over into other areas, since various aspects of addiction fall within the fields of public health, psychology, social work, mental health counseling, psychiatry, and internal medicine, among others. Incorporated within the specialty are the processes of detoxification, rehabilitation, harm reduction, abstinence-based treatment, individual and group therapies, oversight of halfway houses, treatment of withdrawal-related symptoms, acute intervention, and long term therapies designed to reduce likelihood of relapse. Some specialists, primarily those who also have expertise in family medicine or internal medicine, also provide treatment for disease states commonly associated with substance use, such as hepatitis and HIV infection.
Alcohol-related dementia (ARD) is a form of dementia caused by long-term, excessive consumption of alcohol, resulting in neurological damage and impaired cognitive function.
Pseudodementia is a condition where mental cognition can be temporarily decreased. The term pseudodementia is applied to the range of functional psychiatric conditions such as depression, schizophrenia and other psychosis, mania, dissociative disorder and conversion disorder that may mimic organic dementia, but are essentially reversible on treatment. Pseudodementia typically involves three cognitive components: memory issues, deficits in executive functioning, and deficits in speech and language. Specific cognitive symptoms might include trouble recalling words or remembering things in general, decreased attentional control and concentration, difficulty completing tasks or making decisions, decreased speed and fluency of speech, and impaired processing speed. People with pseudodementia are typically very distressed about the cognitive impairment they experience. Two treatments found to be effective for the treatment of depression may also be beneficial in the treatment of pseudodementia: Cognitive behavioral therapy (CBT) which identifies behaviors that positively and negatively impact mood, and Interpersonal therapy which focuses on identifying ways in which interpersonal relationships contribute to depression.
Solomon Carter Fuller was a pioneering Liberian neurologist, psychiatrist, pathologist, and professor. Born in Monrovia, Liberia, he completed his college education and medical degree (MD) in the United States. He studied psychiatry in Munich, Germany, then returned to the United States, where he worked for much of his career at Westborough State Hospital in Westborough, Massachusetts.
Steven T. DeKosky is the Aerts-Cosper Professor of Alzheimer's Research at the University of Florida (UF) College of Medicine, deputy director of UF’s Evelyn F. and William L. McKnight Brain Institute (MBI) and associate director of the 1Florida Alzheimer’s Disease Research Center.
Sundowning, or sundown syndrome, is a neurological phenomenon associated with increased confusion and restlessness in people with delirium or some form of dementia. It is most commonly associated with Alzheimer's disease but also found in those with other forms of dementia. The term "sundowning" was coined by nurse Lois K. Evans in 1987 due to the timing of the person's increased confusion beginning in the late afternoon and early evening. For people with sundown syndrome, a multitude of behavioral problems begin to occur and are associated with long term adverse outcomes. Sundowning seems to occur more frequently during the middle stages of Alzheimer's disease and mixed dementia and seems to subside with the progression of the person's dementia. People are generally able to understand that this behavioral pattern is abnormal. Research shows that 20–45% of people with Alzheimer's will experience some variation of sundowning confusion. However, despite lack of an official diagnosis of sundown syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there is currently a wide range of reported prevalence.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.
Geriatric neurology is the branch of medicine that studies neurologic disorders in elderly.
Addiction psychiatry is a medical subspecialty within psychiatry that focuses on the evaluation, diagnosis, and treatment of people who have one or more disorders related to addiction. This may include disorders involving legal and illegal drugs, gambling, sex, food, and other impulse control disorders. Addiction psychiatrists are substance use disorder experts. Growing amounts of scientific knowledge, such as the health effects and treatments for substance use disorders, have led to advancements in the field of addiction psychiatry. These advancements in understanding the neurobiology of rewarding behavior, along with federal funding, has allowed for ample opportunity for research in the discipline of addiction psychiatry. Addiction psychiatry is an expanding field, and currently there is a high demand for substance use disorder experts in both the private and public sector.
Dilip V. Jeste is an American geriatric neuropsychiatrist, who specializes in successful aging as well as schizophrenia and other psychotic disorders in older adults. He was senior associate dean for healthy aging and senior care, distinguished professor of psychiatry and neurosciences, Estelle and Edgar Levi Memorial Chair in Aging, director of the Sam and Rose Stein Institute for Research on Aging, and co-director of the IBM-UCSD Artificial Intelligence Center for Healthy Living at the University of California, San Diego School of Medicine. after serving for 36 years, he retired from UC San Diego on July 1, 2022.
Perminder Sachdev is an Indian neuropsychiatrist based in Australia. He is a professor of neuropsychiatry at the University of New South Wales (UNSW), co-director of the UNSW Centre for Healthy Brain Aging, and clinical director of the Neuropsychiatric Institute at the Prince of Wales Hospital, Sydney. He is considered a trailblazer in the field of neuropsychiatry. Sachdev's research interests include ageing, vascular cognitive disorders such as vascular dementia, and psychiatric disorders.
The following outline is provided as an overview of and topical guide to psychiatry:
Kristine Yaffe is an American Cognitive decline and dementia researcher. She is the Scola Endowed Chair and Vice Chair and Professor of Psychiatry, Neurology and Epidemiology and the Director of the Center for Population Brain Health at the University of California, San Francisco. In 2019, Yaffe was elected to the National Academy of Medicine.
Geriatric psychology is a subfield of psychology that specializes in the mental and physical health of individuals in the later stages of life. These specialized psychologists study a variety of psychological abilities that deplete as aging occurs such as memory, learning capabilities, and coordination. Geriatric psychologists work with elderly clients to conduct the diagnosis, study, and treatment of certain mental illnesses in a variety of workplace settings. Common areas of practice include loneliness in old age, depression, dementia, Alzheimer's disease, vascular dementia, and Parkinson's disease.
Constantine G. Lyketsos is the Elizabeth Plank Althouse Professor in Alzheimer's Disease Research in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University, Baltimore, Maryland, United States. He is the founding director of the Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, and an associate director of the Johns Hopkins Alzheimer's Disease Research Center (ADRC).
Anthony Jorm is an Australian researcher who has made contributions in the areas of psychology, psychiatry and gerontology. He also co-founded mental health first aid training with mental health educator Betty Kitchener.