Update of geriatric psychiatry practices among American psychiatrists: Analysis of the 1996 National Survey of Psychiatric Practice.

Using data from the 1996 National Survey of Psychiatric Practice from the American Psychiatric Association (APA), the authors updated information on psychiatrists who are high geriatric providers (HGPs). In 1996, HGPs comprised 18% of the sample. Only 23% reported no geriatric patients in their practice, a 51% reduction from 1988-89; the proportion of HGPs is increasing. HGPs were more often male, minority, international medical school graduates, certified in geriatric psychiatry, and not medical school-affiliated. HGPs worked longer hours/week in direct patient care, had more patient visits/week, and saw more new patients/month, spending more time in hospitals and nursing homes and less time in office-based practice, and seeing more patients with mood disorders, psychotic disorders, and other disorders. Medicare was a proportionally higher payment source. Older psychiatrists were likely to have more patients over age 65. Tracking practice activities of HGPs may help inform policy discussion regarding staffing needs for geriatric patients with late-life mental disorders.     

The National Survey of Psychiatric Morbidity in Great Britain

Conclusion We have given a brief overview of the focus, objectives and methodology of the national psychiatric comorbidity survey of Great Britain, and the first reports of the results will follow shortly. The survey data will have considerable national value in providing information on mental health policy and implementation at both national and local levels, and they will also have international value, linking up with other surveys elsewhere in the world to demonstrate the heavy public health impact of mental disorders in terms of their high prevalence, associated social disability and comorbidity, and use of services (World Bank 1993).     

The National Survey of Psychiatric Morbidity in Great Britain

A national survey of psychiatric morbidity was carried out to estimate the prevalence of psychiatric morbidity among adults aged 16–64 in Great Britain, the nature and extent of associated social disability, the nature and extent of comorbidity, use of services, and to investigate recent precipitating factors of illness and their association with different lifestyles. Ten thousand adults living in private households were asked the revised Clinical Interview Schedule (CIS-R). Attempts were also made to estimate the prevalence of psychosis, drug, and alcohol dependence. The sample was designed to be nationally representative and interviewing procedures aimed at maximising response and producing high quality data.     

Psychiatric residents' experience and career interest in geriatric psychiatry: implications for training programs

A survey of residents' experience and career interest in geriatric psychiatry was carried out in Canadian training centres. Residents' exposure to specific training experiences in geriatric psychiatry has been steadily increasing, although a large proportion of residents continue to report insufficient amount of experience and supervision in this area. Residents viewed geriatric psychiatry as involving special skills and knowledge and half were in favour of a compulsory rotation in this area. Geriatric psychiatry was an infrequent career choice along with other areas of psychiatry that have had difficulty in recruiting. Alternative approaches to service provision and recommendations for meeting the manpower needs are discussed.     

The National Psychiatric Morbidity Surveys of Great Britain--initial findings from the Household Survey

This paper describes the Household Survey from the National Survey of Psychiatric Morbidity. This covered a sample drawn at random from the population of Britain, with the exception of the Highlands and Islands of Scotland. The Postcode Address File was used as the sampling frame. Nearly 13,000 adults aged 16-65 were selected for interview, of which 10,108 (79.4%) were successfully interviewed. Eight percent could not be contacted and 13% refused interview. Psychiatric assessment was carried out by lay interviewers using the CIS-R. Subjects were also screened for psychosis, and screen-positive individuals were examined by psychiatrists using SCAN. Sixteen per cent of subjects scored above the standard cut-off of 12 on the CIS-R. The overall one-week prevalence of neurotic disorder was 12.3% in males and 19.5% in females. Unmarried and post-marital groups had high rates of disorder, as did single parents and people living on their own. Respondents in Social Class I had notably lower rates of neurotic disorder than the remainder of the sample. Unemployment was strongly associated with disorder. Subjects living in urban areas had a higher overall prevalence, but there was no significant variation by region. Black respondents had higher rates of disorders that were entirely explained by their age, family type, and social class. Individual neurotic disorders were all significantly commoner in women, with the exception of panic disorder. The one-year prevalence of functional psychoses was four per 1000, with no sex difference. Alcohol and drug dependence was considerably more prevalent in men. For the first time, the survey provides data on the prevalence and correlates of psychiatric disorder on a nationwide sample that can be used to inform equitable and effective national psychiatric services.     

Psychiatric disorder and dysfunction in the UK National Survey of Psychiatric Morbidity

  Background: Psychiatric symptoms are widespread in the general population, but have little effect on performance. Deficits in performance and psychiatric symptoms may be the end point of processes common to both, or they may be caused by quite different factors. In this paper we examine the epidemiological distribution of psychiatric symptoms and performance deficits, as indicated by difficulties in activities of daily living (ADL). We hypothesised that ADL difficulties are partly independent of psychiatric symptoms, and that this is reflected in a different demographic distribution. Method: The household component of the National Surveys of Psychiatric Morbidity was based on a sample of around ten thousand subjects selected at random from the population of Great Britain. Psychiatric symptoms were elicited by lay interviewers using the revised Clinical Interview Schedule. Performance was assessed by asking about difficulties experienced in performing seven types of everyday activity. In this paper, our chosen variables were overall symptom and ADL deficit scores, and these were related to standard demographic variables. Results: There were significant differences in the epidemiological distribution of psychiatric symptoms and ADL difficulties. In particular, men experienced more ADL difficulties at a given symptom level than women. There were also differences in relation to social class, employment status, marital status, ethnic group and age. Conclusions: ADL deficits and psychiatric symptoms are related in the general population, and this probably represents common factors in their origin. However, discrepancies in the social distribution of these phenomena suggest there are also aetiological differences. These do not appear to be the result of the impact of physical illness on activities of daily living. Our results emphasise that ADL difficulties should be studied separately, particularly in investigations of treatment seeking. Accepted: 14 February 2000     

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.     

Comparison of adult and geriatric psychiatric practice patterns: findings from the American Psychiatric Association's Practice Research Network.

OBJECTIVE: The authors explored diagnostic and treatment patterns for patients under and over age 65 seen by a nationally representative sample of psychiatrists participating in the American Psychiatric Association's Practice Research Network. METHODS: Detailed patient information, including demographic and financial characteristics, diagnoses, service utilization, and treatment, was collected by 383 psychiatrists on 1,026 patients to assess the impact of patient age on pharmacotherapy and psychotherapy service use as well as treatment outcomes. RESULTS: Approximately 15% of the patient sample was over age 65. Compared with patients ages 19-64, a lower percentage of geriatric patients had Axis I comorbidity, but a higher percentage had Axis III comorbidity. Geriatric patients were more often treated in hospital settings, and older patients were less likely to have their visits adversely affected by financial pressures of the healthcare system. Over 60% of patients in both age-groups received antidepressants, but there was a disproportionately increased use of antipsychotics and antianxiety/benzodiazepine medications among geriatric patients. Being age 65+ was a strong predictor for "improved" clinician rating on general assessment scores, but failed to be a predictor of receiving psychotherapy or pharmacotherapy. CONCLUSION: There were important differences between subject groups. Overall, American psychiatrists treat a complex group of geriatric patients suffering from major mental disorders complicated by medical comorbidity. Additional studies would further enhance our understanding of the delivery of mental health services to elderly patients and improve training of psychiatrists who help care for our aging population.     

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.