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Chapter 35. Treatment of Seniors

Dan Blazer, M.D., Ph.D.; David Steffens, M.D., M.H.S.
DOI: 10.1176/appi.books.9781585625031.733535

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Excerpt

Psychiatrists who work with older adults encounter diagnostic and therapeutic problems that are more complex than those encountered in young adult and middle-aged patients. Most older patients with psychiatric disorders do not fit easily into the diagnostic categories of DSM-5 (American Psychiatric Association 2013) because they experience multiple symptoms that affect both physical and psychiatric functioning. This is especially true for the oldest members of this population (Blazer 2000). Once the problem is formulated by the clinician, usual treatment approaches must be modified both to manage the functional disability that results from the psychiatric problem and to reverse the underlying disorder.

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Geriatric psychiatric syndromes
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Characteristics of acute confusion
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Common external biological stressors that precipitate acute confusion in the at-risk older adult
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Other cognitive impairments that may be present in older adults experiencing memory loss
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Differential diagnosis of memory loss
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Diagnostic workup of memory loss
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Sleep disturbances leading to insomnia in older adults
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Diagnostic workup of insomnia in later life
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Sleep hygiene in older adults
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Medications and recommended doses for treating late‑life insomnia
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Medical causes of anxiety in older adults
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Medications and typical starting dosages for treating anxiety in older adults
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Causes of suspiciousness, delusions, and agitation in older adults
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Medications for the management of suspiciousness and agitation in older adults
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Suggestions for preventing aggressive and violent behavior in older adults
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Characteristics of older adults with depression
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Laboratory workup of the depressed older adult
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Antidepressant therapy for older adults, with typical starting dosages
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Common signs and symptoms of substance use disorders in older adults
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Risk factors for substance use disorders in older adults
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Treatment of substance use disorders in older adults

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