Structural neuroimaging research methods in geriatric depression.

Geriatric depression consists of complex and heterogeneous behaviors unlikely to be caused by a single brain lesion. However, there is evidence that abnormalities in specific brain structures and their interconnections confer vulnerability to the development of late-life depression. Structural magnetic resonance imaging methods can be used to identify and quantify brain abnormalities predisposing to geriatric depression and in prediction of treatment response. This article reviews several techniques, including morphometric approaches, study of white matter hyperintensities, diffusion tensor imaging, magnetization transfer imaging, t2 relaxography, and spectroscopy, that have been used to examine these brain abnormalities with a focus on the type of information obtained by each method as well as each method's limitations. The authors argue that the available methods provide complementary information and that, when combined judiciously, can increase the knowledge gained from neuroimaging findings and conceptually advance the field of geriatric depression.     

Subspecialty certification in geriatric psychiatry.

OBJECTIVE: The authors describe the development of certification and recertification processes for geriatric psychiatry, the American Board of Psychiatry and Neurology's second subspecialty in psychiatry. METHODS: Authors referenced databases of the certifying organizations and consulted published surveys of examinees. RESULTS: Since the first certification examination was administered in 1991, 2,595 certificates have been awarded. Because the certificates are time-limited, diplomates must sit for recertification every 10 years. Thus far, about 63% of the diplomates who have needed to do so have been recertified. CONCLUSION: It is estimated that 5,000 geriatric psychiatrists will be needed to meet future healthcare needs. Thus, the demand for this expertise will be increasing, and it is anticipated that board-certified geriatric psychiatrists will continue to play leading roles in educating practitioners from multiple disciplines.     

Population pharmacokinetics in geriatric psychiatry.

Although geriatric patients are the major recipients of drugs, most research during drug development is conducted in healthy younger adults. Safe and effective drug therapy in the elderly requires an understanding of both drug disposition and response in older individuals. One of the major issues in studying the elderly relates to the ability to study a large number of people in a minimally invasive way. Population pharmacokinetics can be used to model drug concentrations from a large population of sparsely sampled individuals. Population pharmacokinetics characterizes both the interindividual (between-subject) and intraindividual (within-subject) variability, and can identify factors that contribute to pharmacokinetic and pharmacodynamic variability. Population pharmacokinetics can be used to aid in designing large clinical trials by simulating virtual data based on the study design. It can also be used to assess consistency of drug exposure and evaluate its effect on clinical outcome. This article reviews the methods used in pharmacokinetic modeling, as well as providing examples of population pharmacokinetic modeling, highlighting its application to geriatric psychiatry.     

Functional neuroimaging in child psychiatry

Functional neuroimaging in child psychiatry presents unique scientific, ethical, and technical challenges. The study of childhood disorders presupposes knowledge of neurodevelopment and brain maturation. However, much of human brain science is based on inferences from animal work and indirect neurochemical measures from body fluids. Neuroimaging can examine brain development directly in humans. The benefits can be enormous for learning how and when to intervene to prevent or treat a disorder. These unprecedented potential gains are countered by complex and difficult ethical issues. Technical advances can reduce ethical concerns by minimizing risks. They also promise to enhance the sensitivity and specificity of the measures (eg, by improving spatial and temporal resolution). Judiciously designed investigations will permit the testing of a priori hypotheses built on rational models of neuropathology. Finally, it is the integration of scientific knowledge across the various fields of neuroscience and clinical research that will push the limits of our understanding of health and disease.     

Concept of disease in geriatric psychiatry.

The concept of disease in geriatric psychiatry has to keep up with the rapid expansion in knowledge about the putative etiology of various diseases of interest. This article reviews the new knowledge that has been acquired about dementia. The proposed classification system has two axes: one for clinical manifestations and the other for etiology. Implementing this nomenclature will allow rapid adaptation of new knowledge for causation while at the same time communicating information on the clinical state. This should improve our ability to incorporate and communicate new knowledge in a dynamic format. In turn, this strategy should improve our ability to discern particular features of a disease and refine our notion of its clinical presentation and lead toward novel and improved treatments for our patients.     

Current awareness in geriatric psychiatry. Bibliography

In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Books, Reviews & Symposia; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted     

Herbals and botanicals in geriatric psychiatry.

There is high prevalence of herbal medicine use among elderly people. Most patients do not reveal their herbal use to their physicians and pharmacists. The authors describe some commonly used herbal remedies in terms of their potential benefits and known adverse effects. The review also highlights the potentially serious risk of herb-drug interactions and discusses communication issues and regulatory concerns associated with use of herbal medicines. Health practitioners should remember to include herbal use history in their routine drug histories and remain informed of the beneficial and harmful effects of these treatments.     

Current awareness in geriatric psychiatry. Bibliography

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley &: Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Books, Reviews &: Symposia; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted     

Pharmacokinetics in geriatric psychiatry

Safe, effective drug therapy in older adults requires an understanding of drug disposition and response in this population. Evidence suggests that physiologic changes during aging, including hepatic or renal function changes, contribute to pharmacokinetic differences. A major issue surrounding the study of older adults relates to the ability to study a large number of people in a minimally invasive way. Population pharmacokinetics provides a potential means of addressing this issue and a tool to evaluate drug exposure’s magnitude and consistency. This article highlights examples of pharmacokinetic studies in psychiatry, in particular those conducted in older adults. It also reviews new drugs approved for treatment in psychiatry or neurology, many of which were developed as novel formulations (eg, extended-release transdermal film) with improved pharmacokinetic profiles or developed with regard to the actions of a specific enantiomer or metabolite.     

Uses of intravenous valproate in geriatric psychiatry.

The authors describe the use of intravenous sodium valproate (Depacon) to treat three geriatric inpatients: two acutely manic patients who refused oral medication and one dementia patient with agitation and dysphagia receiving end-of-life care for Alzheimer's disease.     

Making sense of neuroimaging in psychiatry

Objective: Neuroimaging of psychiatric disorders has increased exponentially in the last decade; however, much of the uptake thus far has been in the realm of research. We anticipate that clinical use of neuroimaging modalities in psychiatry will increase dramatically in the near future and suggest that clinicians need to be aware of the potential applications. Method: The authors conducted an extensive MEDLINE, EMBASE, PubMED and PsychInfo search of the published literature (1965–2007) using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further scrutinised for publications of interest, as were indices of books. Articles that reported clinically significant findings and research reports conducted using pertinent neuroimaging modalities were reviewed in detail. Results: The review suggests that exciting neuroimaging advances are being made that have relevance to psychiatry. Novel neuroimaging applications with potential clinical utility are rapidly emerging and the accessibility and use of these technologies will increase in coming years. Clinically meaningful findings have begun to emerge in mood disorders, post‐traumatic stress disorder, schizophrenia and dementia. Coupling multimodal imaging with genetics and pharmacotherapeutic studies will further assist in understanding the pathophysiology of neuropsychiatric disorders. Conclusion: It is important that clinicians understand the benefits and limitations of modern neuroimaging techniques and are also suitably equipped to appraise future developments. The use of neuroimaging in evaluating psychopathology is likely to impact upon the future nosology of psychiatric disorders, and assist in diagnosis and clinical management. The integrated use of neuroimaging in conjunction with clinical assessments promises to improve clinical care and markedly alter psychiatric practice.