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Pharmacological Interventions in Older Adults

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Primary Care Mental Health in Older People

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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.

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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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Authors and Affiliations

  1. Department of Neurology and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA

    Jay J. Patel, Dale W. Smith, John Heafner & Christopher NG

  2. Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA

    George T. Grossberg

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  1. Jay J. Patel
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  2. Dale W. Smith
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  3. John Heafner
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  4. Christopher NG
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  5. George T. Grossberg
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Correspondence to Jay J. Patel .

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Editors and Affiliations

  1. Unité de Psychiatrie et de Psychothérapie, Centre Les Toises, Lausanne, Switzerland

    Carlos Augusto de Mendonça Lima

  2. Mental Health and Population Health, NOVA University Lisbon, Lisbon, Portugal

    Gabriel Ivbijaro

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Patel, J.J., Smith, D.W., Heafner, J., NG, C., Grossberg, G.T. (2019). Pharmacological Interventions in Older Adults. In: de Mendonça Lima, C., Ivbijaro, G. (eds) Primary Care Mental Health in Older People. Springer, Cham. https://doi.org/10.1007/978-3-030-10814-4_9

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