Rapid Telepsychiatry Implementation During COVID-19: Increased Attendance at the Largest Health System in the United States
OBJECTIVE/UNASSIGNED:This study aimed to examine differences in completion rates between telepsychiatry and in-person visits during the COVID-19 pandemic and a prior reference period. METHODS/UNASSIGNED:The authors used electronic medical record data along with chi-squared or t tests to compare patients' demographic characteristics. Generalized estimating equations for estimating the odds of primary and secondary outcomes were used, controlling for demographic characteristics. RESULTS/UNASSIGNED:During COVID-19, the odds of completing a telepsychiatry visit (N=26,715) were 6.68 times the odds of completing an in-person visit (N=11,094). The odds of completing a telepsychiatry visit during COVID-19 were 3.00 times the odds of completing an in-person visit during the pre-COVID-19 reference period (N=40,318). CONCLUSIONS/UNASSIGNED:In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.
Systematic review of benzodiazepines for anxiety disorders in late life
BACKGROUND:Benzodiazepines are currently the most commonly prescribed medication for the treatment of anxiety in older adults, although there is a dearth of good-quality data on this subject. The aim of this review was to systematically review studies examining the efficacy and tolerability of benzodiazepines for the treatment of anxiety disorders among older adults. METHODS:The authors conducted a systematic review, searching PubMed, Ovid MEDLINE, Ovid Embase, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. All searches were limited to English-language articles. The quality of each study was appraised using criteria developed by the Centre for Evidence-Based Medicine for randomized controlled trials. RESULTS:A total of 8,785 citations were retrieved and pooled in EndNote and de-duplicated to 3,753. This set was uploaded to Covidence for screening. Two separate screeners (AG and SAF) evaluated the titles, abstracts, and full text of the eligible articles. Five studies met the inclusion criteria. Across all studies, benzodiazepines were associated with decreased anxiety at the end of the study period. The limited tolerability data show mild adverse effects from the benzodiazepines studied. Limitations of the trials included limited data on the long-term use of benzodiazepines for anxiety and a preponderance of trials examining generalized anxiety disorder, with relatively less data on other anxiety disorders. CONCLUSIONS:Benzodiazepines are effective for treating anxiety disorders in late life, at least in the short term, but more data is needed to establish tolerability and their long-term benefits.
ADHD IN OLDER ADULTS: A CASE REPORT LITERATURE AND REVIEW OF THE [Meeting Abstract]
Introduction: The prevalence of attention deficit hyperactivity disorder (ADHD) in older adults is estimated to be between 1.5 - 3.3 % across studies (Kooji et al, 2016). Older adults constitute a group in which ADHD is frequently underdiagnosed, undertreated, and often overlooked in both clinical practice and research. It is believed that older adults may have experienced longitudinal impact and a lifelong consequences of ADHD symptoms, in the absence of support for their problems in child- or adulthood (Michielson et al, 2015). Nadeau reported that age related cognitive changes, worsening physical health, and the lack of structure that often comes with retirement frequently tend to perpetuate symptoms of inattention (Nadeau, 2018). We present the case of an elderly man with ADHD. This will be followed by a review of the literature on ADHD in older adults.
Method(s): Case of Mr. R: We present the case of Mr. R, a 75-year old man who presented for evaluation of cognitive complaints. He reported chronic difficulties with attention and concentration, with recent worsening of focus, attention, concentration, and memory. Assessment consisted of evaluation of the patient, collateral information from his wife, brain imaging, and neuropsychological testing. His presentation was felt to be consistent with chronic untreated ADHD, now superimposed with mild cognitive changes across other domains. A trial of low dose methylphenidate was associated with marked improvement in his ability to focus, to follow conversations, and his working memory. The subjective changes were corroborated on the Montreal cognitive assessment (MOCA) which showed improvement in his scores, especially in the area of attention. Electronic searches of The Cochrane Central Register of Controlled Trials and the standard bibliographic databases PubMed, MEDLINE, EMBASE, and PsycINFO will be performed for papers which focus on ADHD in older adults. Keywords include "late life," "elderly," "aged," "senior citizen," or "geriatric" combined with the keywords "ADHD" or "attention deficit," Original research, case reports, and reviews will be included.
Result(s): Preliminary search conducted yielded five papers. Data from the included papers will be extracted. The epidemiology of ADHD in older adults will be discussed. This will be followed by a description of diagnostic assessment and diagnostic issues specific to older adults. The impact of ADHD in older adults will be outlined, which emphasis on its difference from that in the younger population. This will be followed by treatment considerations unique to older adults. Finally, the relationship between ADHD and cognitive impairment will be explored.
Conclusion(s): ADHD is frequently underdiagnosed and undertreated in older adults. Timely and accurate diagnosis followed by treatment results in significant improvement in symptoms and functionality. This research was funded by: None
Session 400 [Meeting Abstract]
Programs that train professionals in geriatric mental health expect the trainees to engage in scholarly activities including writing scientific manuscripts and getting them published either in books or journals. However, the training provided to achieve and or maintain academic and scholarly productivity is limited. Additionally, there is no standard format or curriculum to teach the trainees on how to acquire their own skill set to develop and implement their own academic portfolio. Furthermore, these deficiencies in developing scholarly productivity continue to hinder the career growth of the professional caring for older adults with mental health disorders. The clinical and administrative work load for these professionals often presents additional challenges that prevent them from acquiring the skill set to develop a writing and publishing career. In this symposium, we will discuss ideas and methods on how a geriatric mental health professional can develop and implement their own scientific writing and publishing career. We will provide step by step instructions on how scientific manuscripts can be developed and published. Additionally, the faculty presenting at this symposium will provide case examples from their academic portfolio to illustrate how specific manuscripts were developed and published.
Antidepressants for anxiety disorders in late-life: A systematic review
BACKGROUND:An association between cerebrovascular events and psychiatric disorders has been reported. However, the focus has centered on stroke, and there has been a lack of attention to a possible relationship between transient ischemic attacks (TIAs) and depression. METHODS:We conducted a review of studies that looked specifically at the risk of depression after TIAs and the risk of TIAs in patients with depression. A total of 8 studies were identified, 4 examining the occurrence of depression following a TIA, and 4 examining the occurrence of TIAs after the onset of depression. RESULTS:There was a bidirectional effect: 3 of 4 studies showed an increased risk of TIAs in patients with depression, and 4 of 4 studies found an increase of depression following a TIA. The percentage of patients having a TIA from the pool of patients with depression was 3.18%. The percentage of patients who developed depression after a TIA in the pooled samples was 6.88%. CONCLUSIONS:Both depression and TIAs are serious medical disorders and they appear to have a bidirectional relationship. Further clinical and neurobiological studies in this area are warranted.
Innovations and Challenges of Training in Geriatric Mental Health [Editorial]
Personality and the risk factors for developing behavioral and psychological symptoms of dementia: a narrative review
Premorbid personality traits have been implicated as risk factors for the development of behavioral and psychological symptoms of dementia (BPSD), although there is a paucity of studies investigating this relationship. In this narrative review, a number of studies found that premorbid neuroticism has consistently been observed to have a significant association with the development of BPSD symptoms while premorbid conscientiousness, extraversion, openness and agreeableness may be protective factors against future BPSD symptoms. In conclusion, premorbid personality traits appear to affect the risk of BPSD symptoms among individuals with dementia.
WRITING AND GETTING PUBLISHED: DEVELOPING THIS IMPORTANT SKILL SET FOR GERIATRIC MENTAL HEALTH PROFESSIONALS: Session 106 [Meeting Abstract]
Programs that train professionals in geriatric mental health expect the trainees to engage in scholarly activities including writing scientific manuscripts and getting them published either in books or journals. However, the training provided to achieve and or maintain academic and scholarly productivity is limited. Additionally, there is no standard format or curriculum to teach the trainees on how to acquire their own skill set to develop and implement their own academic portfolio. Furthermore, these deficiencies in developing scholarly productivity continue to hinder the career growth of the professional caring for older adults with mental health disorders. The clinical and administrative work load for these professionals often present additional challenges that prevents them from acquiring the skill set to develop a writing and publishing career. In this symposium, we will discuss ideas and methods on how a geriatric mental health professional can develop and implement their own scientific writing and publishing career. We will provide step by step instructions on how scientific manuscripts can be developed and published. Additionally, the faculty presenting at this symposium will provide case examples from their academic portfolio to illustrate how specific manuscripts were developed and published.]
HOW THEY MEASURE UP: RATING SCALES IN GERIATRIC PSYCHIATRY: Session 110 [Meeting Abstract]
Clinical assessment in geriatric psychiatry is complex. It involves detection of subtle signs, separation of psychiatric symptoms from co-occurring medical and neurological manifestations, and work with families. Rating scales are a useful complement to clinical skills in ensuring all relevant questions have been asked, objectively detecting the presence or absence of an illness, quantifying its severity, as well as tracking response to treatment, and the course of an illness over time. This presentation will touch upon multiple available rating scales, with focus on the ones which will be of use to the busy clinician. The first section of the presentation will be a discussion on rating scales for depression, namely the Geriatric Depression Rating Scale (GDS), the Cornell Scale for Depression in Dementia (CSDD), the Hamilton Depression Scale (HDS), and the Montgomery Asberg Depression Rating Scale (MADRS). In the next section, we will describe an overview of the various types of assessment scales for dementia, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), St. Louis University Mental Status Exam (SLUMS), Alzheimer's Disease Assessment Scale - Cognitive sub-scale (ADAS-cog), and the Modified Mini-Mental State Examination (3-MS). The third section of the presentation will constitute a discussion of rating scales to detect neuropsychiatric disturbances, such as the Neuropsychiatry Inventory (NPI), the Neurobehavioral Rating Scale (NBRS), and the Cohen Mansfield Agitation Inventory (CMAI). The final section will be a discussion of common rating scales used in assessing anxiety such as the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This section will also explore caregiver burden scales, with focus on the Zarit Caregiver Burden Interview. Every sub-section of the presentation will provide an overview of the literature and comparison in terms of clinical utility, practicality, and psychometric properties. Since primary care physicians provide majority of the medical care for the elderly, screening tools for primary care that can be incorporated in a busy clinical practice will also be discussed.
A look at the orexin receptor antagonism approach for the treatment of insomnia [Review]