Mental health disorders in terms of an aging population are discussed in this review. Statistics on depression in later life are presented with discussion of physical health comorbidities. This presentation postulates that the healthcare infrastructure currently in place is inadequate to meet the present, much less the future needs of this population. The care of the depressed elder will require the coordinated effort of psychiatrists, psychologists, social workers, Nurse Practitioners and Advanced Practice Psychiatric Nurses, internal medicine gerontologists, internal medicine and family medicine general physicians, community agencies and volunteers.
Late life depression; Aging population; Depressive symptoms; Healthcare resources
The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression, and describe their clinical significance. We then summarize the complex relationship between geriatric depression and dementia and discuss possible shared mechanisms. Last, we present evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation.
Geriatric depression; dementia; cognitive dysfunction; executive function; remission; cognitive remediation
late-life depression; costs; caregiver burden; retirement; public health
The rapid increase in the numbers of older adults worldwide makes a focus on mental disorders and aging both timely and imperative. According to the 2010 census, in the United States, there were 40.3 million adults aged 65 years and older. This number represented an increase of 5.3 million over the 2000 census. Between 2000 and 2010, the number of elders increased at a faster rate (15.1%) than the total US population (9.7%).1 These numbers are projected to continue to diverge, and the disparity between age groups will widen further as a consequence. By 2050, an estimated 20.2% of the population will be 65 years of age and older.2
Late life; Geriatric; Depression; Psychological; Social factors in late life
Addiction treatment; Depot naltrexone; Opioid dependence; Relapse
Awareness of the impact of disasters globally on mental health is increasing. Known difficulties in preparing communities for disasters and a lack of focus on relationship building and organizational capacity in preparedness and response have led to a greater policy focus on community resiliency as a key public health approach to disaster response. This perspective emphasizes relationships, trust and engagement as core competencies for disaster preparedness and response/recovery. In this paper, we describe how an approach to community engagement for improving mental health services, disaster recovery, and preparedness from a community resiliency perspective emerged from our work in applying a partnered, participatory research framework, iteratively, in Los Angeles County and the City of New Orleans. Our approach has a specific focus on behavioral health and relationship building across diverse sectors and stakeholders concerned with under-resourced communities. We use as examples both research studies and services demonstrations discuss the lessons learned and implications for providers, communities, and policymakers pertaining to both improving mental health outcomes and addressing disaster preparedness and response.
Disasters; Disaster response; Community engagement; Community health; Behavioral health
COMMENTARY ON METHAMPHETAMINE ABUSE FOR PSYCHIATRIC PRACTICE
Every decade seems to have its own unique drug problem. The 1970s had hallucinogens, the 1980s had crack cocaine, the 1990s had designer drugs, the 2000s had methamphetamine (Meth), and in the 2010s we are dealing with the scourge of prescription drug abuse. While each of these drug epidemics has distinctive problems and history, the one with perhaps the greatest impact on the practice of Psychiatry is Meth. By increasing the extracellular concentrations of dopamine while slowly damaging the dopaminergic neurotransmission, Meth is a powerfully addictive drug whose chronic use preferentially causes psychiatric complications. Chronic Meth users have deficits in memory and executive functioning as well as higher rates of anxiety, depression, and most notably psychosis. It is because of addiction and chronic psychosis from Meth abuse that the Meth user is most likely to come to the attention of the practicing Psychiatrist/Psychologist.
Understanding the chronic neurologic manifestations of Meth abuse will better arm practitioners with the diagnostic and therapeutic tools needed to make the Meth epidemic one of historical interest only.
Methamphetamine abuse; Psychosis; Parkinson’s; Choreoathetoid; Punding; Formication
Mental health; Quality of life; Nonpharmacologic; Complementary and alternative medicine; Integrative medicine; Tai Chi; Qigong
Fatigue; Sleep; Pain; Sickness behavior; Inflammation; Somatization
Schizophrenia; Cognitive Enhancement; Pharmacological treatment
Services that provide comprehensive, early intervention (EI) have shown promise in improving long-term outcomes in schizophrenia. This paper reviews the rationale and salient concepts relevant to understanding the growing EI literature. A selective review of studies evaluating the effectiveness of integrated EI is followed by a discussion of feasibility, especially in the U.S. context. Finally, the authors present a framework that seeks to integrate activities traditionally categorized and separated as discovery and implementation. This framework is offered as one way to advance both goals.
first episode psychosis; critical period; schizophrenia; early intervention; knowledge translation
There is a large literature on the neuroanatomy of late-life depression which continues to grow with the discovery of novel structural imaging techniques along with innovative methods to analyze the images. Such advances have helped identify specific areas as well characteristic lesions in the brain and changes in the chemical composition in these regions that might be important in the pathophysiology of this complex disease. In this article we review the relevant findings by each structural neuroimaging technique. When validated across many studies, such findings can serve as neuroanatomic markers that can help generate rational hypotheses for future studies to further our understanding of geriatric depression.
Geriatric depression; late life depression; neuroimaging; MRI; white matter hyperintensities; magnetic resonance spectroscopy
Antipsychotic; Polypharmacy; Combination; Reasons; Rationale; Correlates; Schizophrenia
Amygdala; Generalized anxiety disorder; Posttraumatic stress disorder; Panic disorder; Social anxiety disorder; Corticotropin-releasing factor
The authors present an overview of empirically supported psychosocial interventions for individuals with substance use disorders (SUDs), including recent advances in the field. They also identify barriers to the adoption of evidence-based psychosocial treatments in community-based systems of care, and the promise of leveraging technology (computers, web, mobile phone, and emerging technologies) to markedly enhance the reach of these treatments. Technology-based interventions may provide “on-demand,” ubiquitous access to therapeutic support in diverse settings. A brief discussion of important next steps in developing, refining, and disseminating technology-delivered psychosocial interventions concludes the review.
computer; psychosocial treatment; addiction; technology; mobile
This article reviews established and emerging treatment options for cannabis dependence. Cannabis dependence poses some distinct challenges for treatment providers. The evolving sociocultural context of cannabis use for medical purposes, policy liberalization, and societal normalization has contributed to decreased perceived risk and increased acceptability of use. Simultaneously, the comparatively lower “severity” of cannabis-associated consequences makes it more difficult for some users to recognize the impact of their use and establish an enduring commitment to change. As a result, many treatment seekers are reluctant to accept traditional abstinence-based goals.
Among treatment providers, consensus has not been established about the value of non-abstinence goals, such as moderation and harm reduction. Notwithstanding these challenges, the high prevalence of cannabis dependence, its strong association with co-morbid mental health problems, and the difficulty of achieving cannabis cessation ensure that many psychiatrists will face patients with cannabis dependence. While no pharmacotherapy has been approved for cannabis dependence, a number of promising approaches are in development. Psychotherapy studies are establishing a number of evidence-based models and techniques in the treatment resources for patients in need.
Cannabis; Marijuana; Endocannabinoids; Dependence; Withdrawal; Treatment; Therapy
Drug abuse; Drug dependence; Drug use; Epidemiology
Cocaine dependence continues to be a significant public health problem and no clearly effective pharmacotherapy has yet been identified. Substitution pharmacotherapy is an effective approach for treating opioid and nicotine dependence, and accumulating evidence indicates that stimulant pharmacotherapy for cocaine dependence is a promising strategy. Broadly, stimulant medications that produce behavioral arousal, and medications across several therapeutic classes can be considered psychostimulants. To date, the available evidence is strongest for amphetamine analogs or dopaminergic agents combined with contingency management behavioral interventions as potential psychostimulant treatments for cocaine dependence. Most psychostimulants are controlled substances with inherent risks of misuse and diversion, and their use in patients with active substance use disorders is complex. As stimulant substitution treatment models for cocaine dependence are developed, particular attention to patient risk stratification is needed.
Cocaine dependence; Psychostimulant; Substance abuse
Data are reviewed on the societal costs of major depressive disorder (MDD). Early-onset MDD is found to predict difficulties in subsequent role transitions, including low educational attainment, high risk of teen child-bearing, marital disruption, and unstable employment. Among people with specific social and productive roles, MDD is found to predict significant decrements in role functioning (e.g., low marital quality, low work performance, low earnings). MDD is also associated with elevated risk of onset, persistence, and severity of a wide range of chronic physical disorders as well as with increased early mortality due to an even wider range of physical disorders and to suicide. Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.
Absenteeism; costs of illness; disability; illness burden; impairment; major depressive disorder
evening hyperphagia; nocturnal ingestions; eating disorder-not otherwise specified; cognitive behavior therapy; selective serotonin reuptake inhibitors; light therapy
The central nervous system control of energy balance is a multi-determined process involving a distributed and redundant network of communication that exists between various brain regions and the body. The brain continuously receives, processes, and issues autonomic and behavioral output commands to respond to internal signals of energy availability. These signals are communicated to the brain either through a humoral pathway via the circulatory system, or through neuronal communication via the vagus and spinal nerves. Environmental, emotional, rewarding, and learned factors influence the brain’s perception of these internal signals and ultimately promote behaviors that drive the system to conserve energy and ingest energy-dense foods in excess. Therefore, this review discusses the energy balance system under normal physiological conditions, as well as the processes that have evolutionarily developed to promote energy surplus.
Despite growing recognition of the problem, the obesity epidemic continues in the U.S., and obesity rates are increasing around the world. The latest estimates are that approximately 34% of adults and 15–20% of children and adolescents in the U.S. are obese. Obesity affects every segment of the U.S. population. Obesity increases the risk of many chronic diseases in children and adults. The epidemic of obesity arose gradually over time, apparently from a small, consistent degree of positive energy balance. Substantial public health efforts are being directed toward addressing obesity, but there is not yet clear evidence of success. Because of the complexity of obesity, it is likely to be one of the most difficult public health issues our society has faced.