Pub Date : 2020-10-01DOI: 10.1093/med/9780199644957.003.0063
K. Wheat
This chapter examines two key areas of law relating to medical treatment and care of those with mental disorder. The question of decision-making capacity is important for health care professionals, as well as other carers and agents dealing with older people. The law relating to this is covered by the Mental Capacity Act 2005 supplemented by previous case law where this is still relevant, and the key aspect of the law is the ability to treat people without capacity in their best interests. However, in the case of some patients, it may be necessary to use the Mental Health Act 1983. This legislation is focused, not on the capacity of the patient, but upon the effect that a mental disorder can have upon the patient risking damage to their own wellbeing, or to the wellbeing of others. The relationship between the two areas is not always clear.
{"title":"The law relating to mental capacity and mental health","authors":"K. Wheat","doi":"10.1093/med/9780199644957.003.0063","DOIUrl":"https://doi.org/10.1093/med/9780199644957.003.0063","url":null,"abstract":"This chapter examines two key areas of law relating to medical treatment and care of those with mental disorder. The question of decision-making capacity is important for health care professionals, as well as other carers and agents dealing with older people. The law relating to this is covered by the Mental Capacity Act 2005 supplemented by previous case law where this is still relevant, and the key aspect of the law is the ability to treat people without capacity in their best interests. However, in the case of some patients, it may be necessary to use the Mental Health Act 1983. This legislation is focused, not on the capacity of the patient, but upon the effect that a mental disorder can have upon the patient risking damage to their own wellbeing, or to the wellbeing of others. The relationship between the two areas is not always clear.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120986532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0039
Alan J. Thomas
Depression remains common in older people. It is strongly associated with physical illnesses and with cognitive impairment and has a complex set of relationships with dementia. Its aetiology involves a complex interplay of physical and psychosocial risk and protective factors. Its neurobiology includes a strong relationship with vascular diseases, neuroendocrine abnormalities, an increase in MRI white matter hyperintense lesions, a reduction in volume of the hippocampus and frontal and subcortical structures, and neuronal abnormalities in such structures. Management involves physical (mainly drugs but also ECT) and psychological treatments. In the acute phase, remission is the aim, and following this, continuation and maintenance stages should continue with the same treatments indefinitely. Prognosis overall is not as good as in younger adults, but this is largely due to the presence of cognitive deficits and physical ill health.
{"title":"Depression in older people","authors":"Alan J. Thomas","doi":"10.1093/MED/9780198807292.003.0039","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0039","url":null,"abstract":"Depression remains common in older people. It is strongly associated with physical illnesses and with cognitive impairment and has a complex set of relationships with dementia. Its aetiology involves a complex interplay of physical and psychosocial risk and protective factors. Its neurobiology includes a strong relationship with vascular diseases, neuroendocrine abnormalities, an increase in MRI white matter hyperintense lesions, a reduction in volume of the hippocampus and frontal and subcortical structures, and neuronal abnormalities in such structures. Management involves physical (mainly drugs but also ECT) and psychological treatments. In the acute phase, remission is the aim, and following this, continuation and maintenance stages should continue with the same treatments indefinitely. Prognosis overall is not as good as in younger adults, but this is largely due to the presence of cognitive deficits and physical ill health.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126587642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0034
A. Graham
Dementia in old age is usually due to Alzheimer’s disease, cerebrovascular disease, or mixed pathology. Dementia due to other neurological disorders is uncommon, but important to recognize because management may be very different to that in primary or vascular dementia. This chapter surveys five neurological conditions that may present with dementia in later life: idiopathic normal pressure hydrocephalus (INPH); Huntington’s disease (HD); multiple sclerosis (MS); autoimmune limbic encephalitis (LE); and prion disease. For each disorder it reviews the epidemiology, clinical features, investigations, and treatment, with examples of the characteristic brain imaging changes. Accurate diagnosis of these conditions can be challenging even for physicians with a special interest in dementia, and often requires a neurological referral.
{"title":"Neurological dementias","authors":"A. Graham","doi":"10.1093/med/9780198807292.003.0034","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0034","url":null,"abstract":"Dementia in old age is usually due to Alzheimer’s disease, cerebrovascular disease, or mixed pathology. Dementia due to other neurological disorders is uncommon, but important to recognize because management may be very different to that in primary or vascular dementia. This chapter surveys five neurological conditions that may present with dementia in later life: idiopathic normal pressure hydrocephalus (INPH); Huntington’s disease (HD); multiple sclerosis (MS); autoimmune limbic encephalitis (LE); and prion disease. For each disorder it reviews the epidemiology, clinical features, investigations, and treatment, with examples of the characteristic brain imaging changes. Accurate diagnosis of these conditions can be challenging even for physicians with a special interest in dementia, and often requires a neurological referral.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114778362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/MED/9780198807292.003.0027
E. Sampson, K. Dening
Our ageing population and changes in cause of death mean that increasing number of people will die in old age. In many countries, older people have had poor access to good-quality end-of-life care. Many will develop multiple comorbidities associated with age—dementia, mental health problems, and general frailty. Palliative care is an approach that aims to relieve suffering and take account of a person’s physical, psychosocial, and spiritual needs as they near the end of life. Advanced dementia is now being perceived as a ‘terminal illness’. Interventions such as antibiotics and enteral tube feeding remain in use despite little evidence that they improve quality of life or other outcomes. A person-centred approach from a multi-disciplinary team is vital in providing good-quality end-of-life care in a range of settings. The acknowledgement of anticipatory grief and provision of bereavement support are vital for some family carers.
{"title":"Palliative and end-of-life care","authors":"E. Sampson, K. Dening","doi":"10.1093/MED/9780198807292.003.0027","DOIUrl":"https://doi.org/10.1093/MED/9780198807292.003.0027","url":null,"abstract":"Our ageing population and changes in cause of death mean that increasing number of people will die in old age. In many countries, older people have had poor access to good-quality end-of-life care. Many will develop multiple comorbidities associated with age—dementia, mental health problems, and general frailty. Palliative care is an approach that aims to relieve suffering and take account of a person’s physical, psychosocial, and spiritual needs as they near the end of life. Advanced dementia is now being perceived as a ‘terminal illness’. Interventions such as antibiotics and enteral tube feeding remain in use despite little evidence that they improve quality of life or other outcomes. A person-centred approach from a multi-disciplinary team is vital in providing good-quality end-of-life care in a range of settings. The acknowledgement of anticipatory grief and provision of bereavement support are vital for some family carers.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129405807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0018
P. Wilkinson, K. Laidlaw
This chapter on interpersonal psychotherapy (IPT) describes the theory and practice of this structured psychological treatment. It discusses the implementation of IPT with older people. Next it reviews the applications of IPT with a main focus on the treatment of depression in older adults and distinguishes between the treatment of depression with and without cognitive impairment. It summarizes the structure of IPT and the use of specific techniques, and it then addresses the main therapeutic foci encountered in treatment (grief, interpersonal role disputes, role transitions, and interpersonal deficits). Finally, it briefly reviews the evidence base for IPT with older people.
{"title":"Interpersonal psychotherapy","authors":"P. Wilkinson, K. Laidlaw","doi":"10.1093/med/9780198807292.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0018","url":null,"abstract":"This chapter on interpersonal psychotherapy (IPT) describes the theory and practice of this structured psychological treatment. It discusses the implementation of IPT with older people. Next it reviews the applications of IPT with a main focus on the treatment of depression in older adults and distinguishes between the treatment of depression with and without cognitive impairment. It summarizes the structure of IPT and the use of specific techniques, and it then addresses the main therapeutic foci encountered in treatment (grief, interpersonal role disputes, role transitions, and interpersonal deficits). Finally, it briefly reviews the evidence base for IPT with older people.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129745639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0043
Ellen E. Lee, Baichun Hou, I. Vahia, D. Jeste
Late-onset schizophrenia remains an understudied subtype of schizophrenia, despite growing recognition of its impact and distinction from early-onset schizophrenia. This chapter reviews the existing literature on late-onset schizophrenia including beginning with the nomenclature and epidemiology. Then we provide a review of key risk factors and correlates—including genetic risk, sex differences, comorbid sensory loss and physical illness, cognitive and psychiatric symptoms, sociodemographic factors, adverse life events, neuropathology, and inflammation. The chapter ends with clinical issues, including symptoms, differential diagnosis, treatments, and prognosis. Recent studies have examined the role of oestrogen treatments and a new therapy for tardive dyskinesia therapy as well as inflammatory mechanisms in schizophrenia.
{"title":"Late-onset schizophrenia","authors":"Ellen E. Lee, Baichun Hou, I. Vahia, D. Jeste","doi":"10.1093/med/9780198807292.003.0043","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0043","url":null,"abstract":"Late-onset schizophrenia remains an understudied subtype of schizophrenia, despite growing recognition of its impact and distinction from early-onset schizophrenia. This chapter reviews the existing literature on late-onset schizophrenia including beginning with the nomenclature and epidemiology. Then we provide a review of key risk factors and correlates—including genetic risk, sex differences, comorbid sensory loss and physical illness, cognitive and psychiatric symptoms, sociodemographic factors, adverse life events, neuropathology, and inflammation. The chapter ends with clinical issues, including symptoms, differential diagnosis, treatments, and prognosis. Recent studies have examined the role of oestrogen treatments and a new therapy for tardive dyskinesia therapy as well as inflammatory mechanisms in schizophrenia.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125107067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780199644957.003.0057
C. Hertogh, J. Steen
The gradual progression of dementia means there has to be a constant search for a reasonable balance between supporting autonomy and ensuring proper representation. Good end-of-life care for people with dementia depends on adequate advance care planning (ACP), starting early in the disease process. Where possible, it involves striving for joint decision-making with the patient and next-of-kin about (future) medical treatment and (future) care. Written advance directives may support representatives of incompetent patients in their role of surrogate decision maker, but the contents of the directive require interpretation in the context of ACP. The concept of ‘palliative care’ offers a (policy) framework for ACP as well as moral guideline for dealing with written advance directives of patients with dementia.
{"title":"Ethics of living and dying with dementia","authors":"C. Hertogh, J. Steen","doi":"10.1093/med/9780199644957.003.0057","DOIUrl":"https://doi.org/10.1093/med/9780199644957.003.0057","url":null,"abstract":"The gradual progression of dementia means there has to be a constant search for a reasonable balance between supporting autonomy and ensuring proper representation. Good end-of-life care for people with dementia depends on adequate advance care planning (ACP), starting early in the disease process. Where possible, it involves striving for joint decision-making with the patient and next-of-kin about (future) medical treatment and (future) care. Written advance directives may support representatives of incompetent patients in their role of surrogate decision maker, but the contents of the directive require interpretation in the context of ACP. The concept of ‘palliative care’ offers a (policy) framework for ACP as well as moral guideline for dealing with written advance directives of patients with dementia.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133876066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0055
J. Manthorpe
Old age psychiatrists will encounter situations of elder abuse in their practice. Whatever their work and professional policies they will need to think the unthinkable and to provide leadership to teams and across services. Asking and observing what is happening are key elements of their role. There is further need to work collaboratively to support older people at risk and to empower then by fostering or sustaining resilience. Old age psychiatrists can assist in prevention and in the building of supportive communities. They have a key role to play in furthering research and the creation of effective interventions for perpetrators. Their engagement with staff and residents in care homes may prevent poor practice and diminish opportunities for abuse and neglect.
{"title":"Elder abuse","authors":"J. Manthorpe","doi":"10.1093/med/9780198807292.003.0055","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0055","url":null,"abstract":"Old age psychiatrists will encounter situations of elder abuse in their practice. Whatever their work and professional policies they will need to think the unthinkable and to provide leadership to teams and across services. Asking and observing what is happening are key elements of their role. There is further need to work collaboratively to support older people at risk and to empower then by fostering or sustaining resilience. Old age psychiatrists can assist in prevention and in the building of supportive communities. They have a key role to play in furthering research and the creation of effective interventions for perpetrators. Their engagement with staff and residents in care homes may prevent poor practice and diminish opportunities for abuse and neglect.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133075340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780198807292.003.0014
D. O'Connor, C. Plakiotis, P. Farnbach
Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) all entail the delivery of electrical impulses to the brain with the aim of relieving mental disorders. ECT is an effective treatment of depression, mania and catatonia and, to a lesser extent, of schizophrenia. Its side effects, principally cognitive impairment, are mitigated through the use of individually tailored, unilateral delivery. TMS is more convenient but of lesser effectiveness. DBS, while reversible and thus safer than lesional surgery, is a major undertaking that is reserved at present for profoundly disabling depression, obsessive-compulsive disorder (OCD), and Tourette’s syndrome.
{"title":"Neurostimulation therapies","authors":"D. O'Connor, C. Plakiotis, P. Farnbach","doi":"10.1093/med/9780198807292.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780198807292.003.0014","url":null,"abstract":"Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) all entail the delivery of electrical impulses to the brain with the aim of relieving mental disorders. ECT is an effective treatment of depression, mania and catatonia and, to a lesser extent, of schizophrenia. Its side effects, principally cognitive impairment, are mitigated through the use of individually tailored, unilateral delivery. TMS is more convenient but of lesser effectiveness. DBS, while reversible and thus safer than lesional surgery, is a major undertaking that is reserved at present for profoundly disabling depression, obsessive-compulsive disorder (OCD), and Tourette’s syndrome.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"1994 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131355425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780199644957.003.0038
Roy W Jones
This chapter summarizes the available clinical evidence for pharmacological treatments for dementia with an emphasis on practical considerations and realistic expectations of currently available antidementia drugs. It covers the treatment of both cognitive and non-cognitive symptoms. The search for specific treatments for dementia has inevitably concentrated on Alzheimer’s disease (AD), partly because it is the commonest cause of dementia and partly because scientific progress has provided more potential therapeutic targets for AD than other dementias. AD is treated with AChEIs (donepezil, galantamine, or rivastigmine) and the goals of treatment should be explained at the commencement of treatment. For dementia with Lewy bodies (DLB) use AChEI, especially for hallucinations and other behavioural disturbance and consider memantine or increasing dose if BPSD symptoms persist. For vascular dementia (VaD) look for sources of emboli (e.g. carotid disease) and consider anticoagulation for atrial fibrillation, and low-dose aspirin. Ensure other relevant conditions (e.g. hypertension and diabetes) are being managed appropriately.
{"title":"Pharmacological treatment of dementia","authors":"Roy W Jones","doi":"10.1093/med/9780199644957.003.0038","DOIUrl":"https://doi.org/10.1093/med/9780199644957.003.0038","url":null,"abstract":"This chapter summarizes the available clinical evidence for pharmacological treatments for dementia with an emphasis on practical considerations and realistic expectations of currently available antidementia drugs. It covers the treatment of both cognitive and non-cognitive symptoms. The search for specific treatments for dementia has inevitably concentrated on Alzheimer’s disease (AD), partly because it is the commonest cause of dementia and partly because scientific progress has provided more potential therapeutic targets for AD than other dementias. AD is treated with AChEIs (donepezil, galantamine, or rivastigmine) and the goals of treatment should be explained at the commencement of treatment. For dementia with Lewy bodies (DLB) use AChEI, especially for hallucinations and other behavioural disturbance and consider memantine or increasing dose if BPSD symptoms persist. For vascular dementia (VaD) look for sources of emboli (e.g. carotid disease) and consider anticoagulation for atrial fibrillation, and low-dose aspirin. Ensure other relevant conditions (e.g. hypertension and diabetes) are being managed appropriately.","PeriodicalId":256260,"journal":{"name":"Oxford Textbook of Old Age Psychiatry","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115026248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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