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Pharmacological Interventions in Older Adults

  • Jay J. PatelEmail author
  • Dale W. Smith
  • John Heafner
  • Christopher NG
  • George T. Grossberg
Chapter

Abstract

In this chapter, we discuss the different pharmacological interventions for psychiatric diseases in the geriatric population. We specifically divide these treatments into five categories: anxiolytics and sedative-hypnotics, antipsychotics, antidepressants, mood stabilizers, and cognitive enhancers. These categories are further divided into disease-specific medications. The utility, general recommendations, mechanism of action, dosing, and adverse reactions of drugs are covered for the medications in this chapter. The treatment of mental illness in the geriatric population is a complicated process due to the physiologic changes of metabolism, drug absorption, and drug excretion. These transformations specifically alter the dosing of pharmacological treatments in older adults. The shift in metabolism inherently changes the side effect profile of medications compared to the general adult population, which further complicates the utilization of pharmaceutical interventions for older adults with psychiatric conditions. It is our goal to provide a solid background for clinicians to make prudent decisions in the treatment approach of psychiatric diseases in the geriatric population.

Keywords

Adverse reactions of mood stabilizers Antidepressants for older adults Antipsychotics for older adults Anxiolytics for older adults Cholinesterase inhibitors Cognitive enhancers in older adults Lithium for older adults Mood stabilizers for older adults NMDA in older adults Non-benzodiazepines for older adults SIADH in older adults SSRIs for older adults 

Abbreviations

ACE

Angiotensin-converting enzyme

AD

Alzheimer’s disease

ADCS-ADL

Alzheimer’s disease cooperative study/activities of daily living inventory score

ADLs

Activities of daily living

AED

Antiepileptic drug

APA

American Psychiatric Association

BADL-S

Bristol Activities of Daily Living score

BUN

Blood urea nitrogen

BZDs

Benzodiazepines

CBC

Complete blood count

CBT

Cognitive behavioral therapy

CKD

Chronic kidney disease

CNS

Central nervous system

ECG

Electrocardiogram

ECT

Electro-compulsive therapy

eGFR

Glomerular filtration rate

GABA

Gamma-aminobutyric acid

GAD

Generalized anxiety disorder

GIS

Global impression score

HAMD-17

Hamilton Depression Rating Scale score

HIV

Human immunodeficiency virus

LFT

Liver function test

MADRS

Montgomery Asberg Depression Rating Scale

MAOI

Monoamine oxidase inhibitor

MMSE

Mini mental status exam

MNCD

Major neurocognitive disorder

NMDA

N-methyl-d-aspartate

NPI

Neuropsychiatric inventory

OCD

Obsessive compulsive disorder

OSA

Obstructive sleep apnea

PTSD

Post-traumatic stress disorder

SAD-S

Social avoidance and distress scale

SIADH

Syndrome of inappropriate antidiuretic hormone secretion

SIB

Severe impairment battery scale

SJS

Steven-Johnson syndrome

SNRI

Serotonin-norepinephrine reuptake inhibitor

SSRI

Selective serotonin reuptake inhibitor

SSRIs

Selective serotonin reuptake inhibitors

TCA

Tricyclic antidepressant

TENS

Toxic epidermal necrolysis syndrome

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jay J. Patel
    • 1
    Email author
  • Dale W. Smith
    • 1
  • John Heafner
    • 1
  • Christopher NG
    • 1
  • George T. Grossberg
    • 2
  1. 1.Department of Neurology and Behavioral NeuroscienceSaint Louis University School of MedicineSt. LouisUSA
  2. 2.Department of Psychiatry and Behavioral NeuroscienceSaint Louis University School of MedicineSt. LouisUSA

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