Skip to main content
SpringerLink
Log in

Psychiatry of Older Adults

  • Chapter
  • First Online:
Book cover Diseases in the Elderly

  • 2134 Accesses

Abstract

Although the psychiatric disorders of the elderly have some special features, they do not significantly differ from younger adults. However, the elderly have unique features that may confound the diagnosis. Primary depressive disorder has been divided into early-onset depression (EOD) and late-onset depression (LOD). A family history of depression is more likely with EOD, and LOD is closely linked to clinical and neuroimaging evidence of cerebrovascular disease, and hence the term ‘vascular depression’ is used to describe LOD. A number of neurotransmitters have important roles – serotonin, dopamine, norepinephrine and glutamate. Dysregulation of neurotransmission and hypothalamus-pituitary-adrenal axis together with immunological and morphological alterations has been postulated in major depression. Late-onset mania is a heterogeneous group of neurological disorder, and there is a strong resemblance of mania to disinhibition syndrome. Newly onset anxiety of the elderly with exception of phobia is usually combined with physical disorder, depression, cognitive dysfunction or personality disorder. Suicidal rate increases progressively with age. Suicidal behaviour is associated with serotonin neurotransmitter system, hyperactivity of the hypothalamus-pituitary-adrenal axis and noradrenergic neurotransmission. Substance abuse in the elderly includes alcohol and, to a lesser degree, illicit substances, prescription medicines and over-the-counter medications. In the elderly the pattern of alcohol consumption may not change, yet age-related changes may increase the likelihood of adverse reactions to alcohol.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

Introduction

  1. Psychiatry of old age. http://www.cchs.net/health/health-info/docs/2200/2268.asp?index+9313. Accessed 14 Sept 2007.

  2. Beckman AT, Copeland JR, Prince MJ. Review of community prevalence of depression late life. Br J Psychiatry. 1999;174:307–11.

    Article  Google Scholar 

  3. Callahan EJ, Bertakis KD, Azari R, Helms LJ, Robbins J, Miller J. Depression in primary care patient, factors that influence recognition. Fam Med. 1997;29:172–6.

    PubMed  CAS  Google Scholar 

  4. Karim S, Byrne EJ. Treatment of psychosis in elderly people. Br J Psychiatry. 2005;11:286–96.

    Google Scholar 

Mood Disorders (Major Depression, Bipolar Disorder)

  1. McAlister-Williams H. Classification of depression website: http://www.netdoctor.co.uk/diseases/depression/classification_000001.htm.

  2. Vacheron-Trystram MN, Braitman A, Cheref S, Auffray L. Antipsychotics in bipolar disorders. Encephalae. 2004;30(5):417–24 (abstract).

    Article  Google Scholar 

  3. Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:363–98.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Baldwin RC, O’Brien J. Vascular basis of late-onset depressive disorder. Br J Psychiatry. 2002;180:157–60.

    Article  PubMed  Google Scholar 

  5. Brodaty H, Luscombe G, Parke G, Wihem K, Hickie I, Austin MP, et al. Early and late onset depression in old age: different aetiology same phenomenology. J Affect Disord. 2001;66:225–56.

    Article  PubMed  CAS  Google Scholar 

  6. Devanandan DP, Adorno E, Cheng J, Burt T, Pelton GH, Roose SP, et al. Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients. J Affect Disord. 2004;78:259–67.

    Article  Google Scholar 

  7. Huen R, Papassotiropoulos A, Jessen F, Maier W, Breitner JC, et al. A family study of Alzheimer disease and early- and late-onset depression in elderly patients. Arch Gen Psychiatry. 2001;58:190–6.

    Article  Google Scholar 

  8. Hickie I, Naismuth S, Ward PB, Turner K, Scott E, Mitchell P, et al. Reduced hippocampal volumes and memory loss in patients with early – and late-onset depression. Br J Psychiatry. 2005;186:197–202.

    Article  PubMed  Google Scholar 

  9. Alexopolous GS, Meyers BS, Young RC, Kakuma T, Silbersweig D, Charlson M. Clinically defined vascular depression. Am J Psychiatry. 1997;154:497–501.

    Article  Google Scholar 

  10. Mast BT, MacNeill SE, Litchenberg PA. Post-stroke and clinically defined vascular depression in geriatric rehabilitation. Am J Geriatr Psychiatry. 2004;12(1):84–92.

    Article  PubMed  Google Scholar 

  11. Hickie IB. Reducing the burdens of depression: are we making progress in Australia? Med J Aust. 2004;181:S4–5.

    PubMed  Google Scholar 

  12. Starkstein SE, Robinson ER. Affective disorders in cerebrovascular disease. Br J Psychiatry. 1989;154:170–82.

    Article  PubMed  CAS  Google Scholar 

  13. Carod-Artel F. Post-stroke depression (ii): its differential diagnosis, complications and treatment. Rev Neurol. 2006;42(4):238–44.

    Google Scholar 

  14. Robinson RG, Starkstein SE. Mood disorders following stroke: new findings and future directions. J Geriatr Psychiatry. 1989;22(1):1–15.

    PubMed  CAS  Google Scholar 

  15. Hama S, Yamashita H, Shigenobu M, Watanabe A, Hiramoto K, Taimoto Y, et al. Post-stroke affective or apathetic depression and lesion location: left frontal lobe and bilateral basal ganglia. Eur Arch Psychiatry Clin Neurosci. 2007;257:149–52.

    Article  PubMed  Google Scholar 

  16. House A, Dennis M, Warlow C, Hanton K, Molyneux A. Mood disorders after stroke and their relation to lesion location. Brain. 1990;113:1113–29.

    Article  PubMed  Google Scholar 

  17. Sharpe M, Hawton K, House A. Mood disorders in long-term survivors of stroke associations with brain lesion location and volume. Psychol Med. 1990;20:815–28.

    Article  PubMed  CAS  Google Scholar 

  18. Takahashi K, Oshima A, Ida I, Kumano H, Yuuki N, Fukuda M, et al. Relationship between age at onset and magnetic resonance image-defined hyperintensities in mood disorders. J Psychiatr Res. 2008;42:443–50.

    Article  PubMed  CAS  Google Scholar 

  19. Lin HF, Kuo YT, Chiang IC, Chen HM, Chen CS. Structural abnormality on brain magnetic resonance imaging in late-onset major depressive disorder. Kaohsiung J Med Sci. 2006;21:405–11.

    Article  Google Scholar 

  20. Papazacharias A, Logroscino G, Barulli MR, Nardini M. Late life depression and late onset depression: are the same clinical and pathological picture? Psychiatr Danub. 2010;22 Suppl 1:108–10.

    Google Scholar 

  21. Naismuth SL, Hickie IB, Ward PB, Scott EM, Little CL. Impaired implicit sequence learning in depression: a probe for frontostriatal dysfunction? Psychol Med. 2006;36:313–23.

    Article  Google Scholar 

  22. Hickie B, Naismuth SL, Ward PB, Little CL, Pearson M, Scott EM, et al. Psychomotor slowing in older patients with major depression: relationships with blood flow in the caudate nucleus and white matter lesions. Psychiatry Res. 2007;155:211–20.

    Article  PubMed  Google Scholar 

  23. Gottfries CG, Blennon K, Karisson I, Wallin A. The neurochemistry of vascular dementia. Dementia. 1994;5:163–7.

    PubMed  CAS  Google Scholar 

  24. Allard P, Englund E, Marcusson J. Reduced number of caudate nucleus dopamine uptake sites in vascular dementia. Dement Geriatr Cogn Disord. 1999;10:77–80.

    Article  PubMed  CAS  Google Scholar 

  25. Huffman JC, Stern TA. Poststroke neuropsychiatric symptoms and pseudoseizures: a discussion. J Clin Psychiatry. 2003;5(2):85–8.

    Google Scholar 

  26. Hickie IB, Naismuth SL, Norrie LM, Scott EM. Managing depression across the life cycle: new strategies for clinicians and their patients. Intern Med J. 2009;39:720–3.

    Article  PubMed  CAS  Google Scholar 

  27. Dunlop BW, Nemeroff CB. The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry. 2007;64:327–37.

    Article  PubMed  CAS  Google Scholar 

  28. Nemeroff CB. Recent findings in the pathophysiology of depression. FOCUS. 2008;6:3–14.

    Article  Google Scholar 

  29. Mann JJ, Malone KM, Psych MR, Sweeney JA, Brown RP, Linnolin M, et al. Attempted suicide characteristics and cerebrospinal fluid amine metabolites in depressed patients. Neuropsychopharmacology. 1996;15:576–86.

    Article  PubMed  CAS  Google Scholar 

  30. Drevets WC, Frank E, Price JC, Kupler DJ, Holt D, Greer PJ, et al. PET imaging of serotonin 1A receptor binding in depression. Biol Psychiatry. 1999;46:1375–87.

    Article  PubMed  CAS  Google Scholar 

  31. Ressler KJ, Nemeroff CB. Role of norepinephrine in the pathophysiology of neuropsychiatric disorders. CNS Spectr. 2001;6:663–6.

    PubMed  CAS  Google Scholar 

  32. Muller N, Schwarz MJ. The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression. Mol Psychiatry. 2007;12:988–1000.

    Article  PubMed  CAS  Google Scholar 

Mania in Old Age

  1. Aziz R, Lorberg B, Tampi RR. Treatments for late life bipolar disorder. Am J Geriatr Pharmacother. 2006;4(4):347–64 (abstract).

    Article  PubMed  CAS  Google Scholar 

  2. Shulman KL, Hermann N. The nature and management of mania in old age. Psychiatr Clin North Am. 1999;22:649–63.

    Article  PubMed  CAS  Google Scholar 

  3. Hickie I, Scott E, Wilhelm K, Brodaty H. Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression-a longitudinal evaluation. Biol Psychiatry. 1997;42:367–74.

    Article  PubMed  CAS  Google Scholar 

  4. Kennedy GJ. Bipolar disorder in late life: mania. Primary Psychiatry. website: http://www.primarypsychiatry.com/aspx/atrticledetail.aspx?artiicleid+=1404.

  5. Nagaratnam N, Wong K-K, Patel I. Secondary mania of vascular origin in elderly patients: a report of two clinical cases. Arch Gerontol Geriatr. 2006;43:223–32.

    Article  PubMed  Google Scholar 

  6. Fujikawa T, Yamasaki S, Touhouda Y. Silent cerebral infarctions in patients with late-onset mania. Stroke. 1995;26:946–9.

    Article  PubMed  CAS  Google Scholar 

  7. Herlihy Jr CE, Herlihy CE. Lithium and organic brain syndrome. J Clin Psychiatry. 1979;40:455 (Letter to editor).

    PubMed  Google Scholar 

  8. Fenn D, George R. Post-stroke mania late in life involving the left hemisphere. Aust N Z J Psychiatry. 1999;33:598–608.

    Article  PubMed  CAS  Google Scholar 

  9. Turecki G, De Mari J, Porto JAD. Bipolar disorder following a left basal ganglia stroke. Br J Psychiatry. 1993;163:690.

    Article  PubMed  CAS  Google Scholar 

  10. Liu CY, Wang SJ, Fuh JL, Yang YY, Lin HC. Bipolar disorder following a stroke involving the left hemisphere. Aust N Z J Psychiatry. 1996;30:688–91.

    Article  PubMed  CAS  Google Scholar 

  11. Drake Jr ME, Pakalnis A, Phillips B. Secondary mania after ventral pontine infarction. J Neuropsychiatry Clin Neurosci. 1990;2:322–5.

    Article  PubMed  Google Scholar 

  12. Bogousslavasky J, Ferrazzani M, Regli F, Assal G, Tanabe H, Delaloyebischof A. Manic delirium and frontal-lobe syndrome with paramedian infarction of the right thalamus. J Neurol Neurosurg Psychiatry. 1988;51:116–9.

    Article  Google Scholar 

  13. Cummings JL. Organic delusions, phenomenology, anatomical evaluation and review. Br J Psychiatry. 1985;146:184–97.

    Article  PubMed  CAS  Google Scholar 

  14. Starksein SE, Fedoroff P, Berthier ML, Robinson RG. Manic depressive and pure manic states after brain lesions. Biol Psychiatry. 1991;29:149–58.

    Article  Google Scholar 

  15. Nagaratnam N, Lim R, Chowdhury M. Aberrant sexual behaviour following stroke. Eur J Int Med. 1998;9:207–9.

    Google Scholar 

  16. Cummings JL, Mendez MF. Secondary mania with focal cerebrovascular lesions. Am J Psychiatry. 1984;141:1084–7.

    Article  PubMed  CAS  Google Scholar 

  17. Laplane D, Levasseur M, Pillon B, Dubois B, Baulac M, Mazoyer B, et al. Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. A neuropsychological, magnetic resonance imaging and positron tomography study. Brain. 1989;6:237–55.

    Google Scholar 

  18. Young RC, Kiosses D, Heo M, Schulberg HC, Murphy C, Klimstra S, et al. Age and ratings of manic psychopathology. Bipolar Disord. 2007;9(3):301–4.

    Article  PubMed  Google Scholar 

  19. Carlson GA, Goodwin FK. The stages of mania. Arch Gen Psychaitry. 1973;23:221–2.

    Article  Google Scholar 

  20. Shulman KI. Mania in old age: a neuropsychiatric syndrome. Geriatrics Aging. 2004;7:34–7.

    Google Scholar 

  21. Steffens DC, Krishnan KRR. Structural neuroimaging and mood disorders. Recent findings, implications for classification, and future directions. Biol Psychiatry. 1991;43:705–12.

    Article  Google Scholar 

  22. Nagaratnam N, Wong V, Jeyaratnam D. Left anterior choroidal artery infarction and uncontrollable crying. J Stroke Cerebrovasc Dis. 1998;7:263–4.

    Article  PubMed  CAS  Google Scholar 

  23. Nagaratnam N, Gayagay G. Hypersexuality in nursing care facilities- a descriptive study. Arch Gerontol Geriatr. 2002;35:195–203.

    Article  PubMed  Google Scholar 

Anxiety and Anxiety Disorders

  1. Somers JM, Goldner EM, Waraich P, Hsu L. Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry. 2006;51(2):100–13.

    PubMed  Google Scholar 

  2. Lepine JP. The epidemiology of anxiety disorders: prevalence and social codes. J Clin Psychiatry. 2002;63 Suppl 14:1–4 (abstract).

    Google Scholar 

  3. Kimiziogh Y, Dogar O, Kugn N, Akyuz G. Prevention of anxiety disorders among the elderly. Int J Geriatr Psychiatry. 2009;24(9):1026–33.

    Article  Google Scholar 

  4. Beckman AT, Bremmer MA, Deig DJ, van Balkom AM, Smit JH, De Beurs E, et al. Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry. 1998;13(10):717–26 (abstract).

    Article  Google Scholar 

  5. Beckman AT, de Beurs S, van Balkom AJL, Deeg DJ, van Dyck R, Tilburg W. Anxiety and depression in later life. Co-occurrence and commonality of risk factors. Am J Psychiatry. 2000;157:89–95.

    Article  Google Scholar 

  6. Mental Health Council Inc and ORYGEN, Australian Government Department of Employment and Work Place Relations. Research Centre; 2000.

    Google Scholar 

  7. Flint AJ. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry. 1994;15(15):640–9 (abstract).

    Google Scholar 

  8. Satcher D. Mental Health: a report of the Surgeon General US Government. Washington, DC: Department of Health and Human Services; 1999.

    Google Scholar 

  9. Wills JC, Tien AY, Garrisa R, Eaton W. Risk factors with incidence of social phobia as determined by Diagnostic Intervention Schedule in a Population-based study. Acta Psychiatr Scand. 1994;90:84–90.

    Article  Google Scholar 

  10. Sadavoy J, Lellar JK. Treatment of anxiety disorders in late life. Can J Psychiatry. 1997;42 Suppl 1:28S–34.

    PubMed  Google Scholar 

  11. Jefferson JW, Marshall JR, editors. Neuropsychiatric features of mental disorders. New York: Plenum; 1981. p. 6–7.

    Google Scholar 

  12. Hentz P. Separating anxiety from physical illness. The Clinical Advisor. 2008. www.clinicaladvisor.com.

  13. Friedman MB, Furst L, Gellis Zvi D, Williams K. Social Work Today. 2013;13(4):10.

    Google Scholar 

  14. Anxiety in the elderly. www.healthyplace.com/anxety-panic/articles/anxiety-in-the-elderly.

  15. Sable JA, Jeste DV. Anxiety disorders in older adults. Curr Psychiatry Rep. 2001;3(4):302–7.

    Article  PubMed  CAS  Google Scholar 

  16. Gilles Zvi D, Kim EG, McCracken SG. Master’s Advanced Curriculum (MAC) Project. Mental health and aging resource review, 2014. Revision. Chap 2. Anxiety disorders in older adults. Literature review. www.CSWE.org/File.aspx?id=23485.

  17. Nobili A, Garattini S, Mannuci PM. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorbidity. 2011;7:28–44.

    Article  Google Scholar 

  18. Hek K, Tiemeier H, Newman RS, Luijendijk H, Hofman A, Mudder CL. Anxiety disorders and comorbid depression in community dwelling older adults. Int J Methods Rev. 2011;20(3):157–68.

    Google Scholar 

  19. Nakra B, Grossberg G. Management of anxiety in the elderly. Compr Ther. 1986;12:53–80.

    PubMed  CAS  Google Scholar 

  20. Hall RCW, Hall RCW. Anxiety and endocrine disease. www.drrichardhall.com/Article/anxiety.pdf. Accessed 7 Jan 2016.

Suicide in the Elderly

  1. WHO. http://www.who.int/topics/suicide/en/. Retrieved 22 Sept 2103.

  2. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Cross-rational prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192:98–115.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Shneidman ES. The definition of suicide. New York/London: Wiley; 1985.

    Google Scholar 

  4. Read K, Purse M. Suicidal ideation. About.com.Bipolar Disorder. http://bipolar.about.con/od/suicide/g/suicidalideatio.htm. Retrieved 3 July 2006.

  5. American Psychiatric Association. Practice guidelines for the assessment and treatment of patients with suicide behaviours. Am J Psychiatry. 2003;160 suppl 11:1–30.

    Google Scholar 

  6. Jacobs D, Baldessarini R, Conwell Y, Fawcett JA, Horton L, Meltzer H, et al. Practice guidelines for the assessment and treatment of patients with suicidal behaviours. Psychiatric Online http://psycho.silverchair.com/contentsaspx?De57699. Retrieved 23 Sept 2013.

  7. Havens LL. Diagnosis of suicidal intent. 2009 Annual Review website: annualreview.org/aroutine.

  8. National Strategy for Suicide Prevention. Suicide in the elderly. http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp. Accessed 3 Oct 2009.

  9. Duckworth G, Mcbride H. Suicide in old age: a tragedy of neglect. Can J Psychiatry. 1996;41(4):217–22 (abstract).

    PubMed  CAS  Google Scholar 

  10. Anderson RN, Smith BL. Deaths: leading causes for 2001. Natl Vital Stat Rep. 2003;52(9):1–47.

    Google Scholar 

  11. National Advisory Council in Suicide prevention Draft 6. It’s all about living. A National partnership for the prevention of suicide and self harm 1999. Phillip ACT: Department of Health and Ageing; 1999.

    Google Scholar 

  12. Dombroyski AY, Szanto K. Prevention of suicide in the elderly. Ann Long term Care. website: http://www.annalsolongtermcare.com/article/5082. Accessed 3.10.09.

  13. McIntosh JL. Suicide among the elderly; levels and trends. J Orthopsychiatry. 1985;55:75–82.

    Article  Google Scholar 

  14. Suicide DE. A study in sociology. New York: The Free Press; 1997. Translated by John A Spaulding and George Simpson ed George Simpson, 1997.

    Google Scholar 

  15. Jones JS, Stanley B, Mann JJ, Francis AJ, Guido JR, Traskinan-Bendz L, et al. CSF-5-HIAA and HVA concentrations in elderly depressed patients who attempted suicide. Am J Psychiatry. 1990;147:1225–7.

    Article  PubMed  CAS  Google Scholar 

  16. Cattell H. Suicide in the elderly. Adv Psychiatr Treat. 2000;6:102–8. doi:10.1192/apt.6.2.102.

    Article  Google Scholar 

  17. Van Heiringen K. Neurobiology of suicide and suicidality. Can J Psychiatry. 2003;48:292–300.

    Google Scholar 

  18. Nordstrom P, Samuelsson M, Asberg M, Traskinan-Bendz L, Alberg-Wistedt A, Nordin C, et al. CSF 5-HIAA predicts suicide risk after attempted suicide. Suicide Life Threat Behav. 1994;24:1–9.

    PubMed  CAS  Google Scholar 

  19. Barraclough B. Suicide in the elderly. In: Kay DWK, Walk A, editors. Recent developments in psychogeriatrics. Ashford: Headley Bros; 1971. p. 87–9.

    Google Scholar 

  20. Institute of Medicine. Reducing scale. A national imperative. Washington DC: The National Academic Press; 2002. website: http://darwin.nap.edu. Accessed 24 July 2006.

Substance Abuse in the Elderly

  1. King CJ, Ven Hasselt VB, Segal DL, Hersen M. Diagnosis and treatment of substance abuse in older adults. Correct strategies and issues. Addict Behav. 1994;19:41–55.

    Article  PubMed  CAS  Google Scholar 

  2. Blow FC, Walton MA, Chermacvk ST, Mudd SA, Brower KJ. Older adult treatment outcome following elder-specific in patient alcoholism treatment. J Subst Abuse Treat. 2000;19(1):67–75.

    Article  PubMed  CAS  Google Scholar 

  3. Johnson I. Alcohol problems in old age: a review of recent epidemiological research. Int J Geriatr Psychiatry. 2000;15(7):575–81.

    Article  PubMed  CAS  Google Scholar 

  4. Henderson LA. Age differences in multiple drug use. National Admissions to Publicly Funded Substance Abuse Treatment. Chap 4 http://www.ors.sanihsn.gov/aging/chap4.htm.

  5. Koenig HG, George LK, Schneider R. Mental health care for older adults in the year 2020. A dangerous and topic. Gerontologist. 1994;34:674–9.

    Article  PubMed  CAS  Google Scholar 

  6. Levin SM, Kruger J. editors. Substance abuse among older adults: a guide for social service providers. Rockville: Substance abuse and Mental Health Services Administration; 2000.

    Google Scholar 

  7. Smith JW. Medical manifestations of alcoholism in the elderly. Int J Addit. 1995;309(13-14):174–1798.

    Google Scholar 

  8. Seitz HK, Egerer G, Simanowski VA, Waldherr R, Eckey R, Agarwal DP, et al. Human gastric alcohol dehydrogenase activity: effect of age, sex and alcoholism. Gut. 1993;34(10):1433–7.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  9. Pozzato G, Moretti M, Franzin F, Groce LS, Lacchin T, Benedetti G, et al. Ethanol metabolism and aging. The role of ‘first pass metabolism’ and gastric acohol dehydrogenase activity. J Gerontol A Biol Sci Med Sci. 1995. doi:10.1093/gerona/50A.3.8135.

    PubMed  Google Scholar 

  10. Newman AB, Lee JS, Visser M, Goodpaster BH, Kritchevsky SB, Tylavsky FA, et al. Weight change and conservation of lean mass in old age: the Health Aging and Body Composition Study. 1’2’3. Am Soc Clin Nutr. 2005;82(4):872–8.

    CAS  Google Scholar 

  11. Skovenborg E. Alcohol consumption and the elderly, do adult responsible drinking guidelines apply? www.aim-digest.com/digest/members%20over%20yr/skovraged.pdf. Accessed 6 Jan 2016.

  12. Dufour M, Archer L, Gordis E. Alcohol and the elderly. Clin Geriatr Med. 1992;8(1):127–41.

    PubMed  CAS  Google Scholar 

  13. NIH Senior Health. Alcohol use and older adults. http://nihseniorhealth.gov/alcoholuse/alcoholandaging/0.1html. Accessed 5 Jan 2016.

  14. Suddendorf RF. Research on alcohol metabolism among Asians and its implications for understanding causes of alcoholism. Public Health Rep. 1989;104(6):615–20 (abstract).

    PubMed Central  PubMed  CAS  Google Scholar 

  15. Agarwal DP, Goedde HVV. Pharmacogenetics of alcohol metabolism and alcoholism. Pharmacogenetics. 1992;3(2):48–62 (abstract).

    Article  Google Scholar 

  16. Stewart S, Jones D, Day CP. Alcoholic liver disease: new insights into mechanisms and preventive strategies. Trends Mol Med. 2001;7:408–13.

    Article  PubMed  CAS  Google Scholar 

  17. Crabb DW, Matsumoto M, Chang D, You M. Overview of the role of alcohol dehydrogenase and aldehyde dehydrogenase and their variants in the genesis of alcohol-related pathology. Proc Nutr Soc. 2004;63(1):49–63 (abstract).

    Article  PubMed  CAS  Google Scholar 

  18. Ginter E, Simko V. Alcoholism: recent advances in epidemiology, biochemistry and genetics. Bratisl Lek Listy. 2009;110(5):307–11 (abstract).

    PubMed  CAS  Google Scholar 

  19. Li TK. Pharmacogenetics of responses to alcohol and genes that influence alcohol drinking. J Stud Alcohol. 2000;61(1):5–12 (abstract).

    Article  PubMed  CAS  Google Scholar 

  20. Moussas G, Christodoulou C, Donzenia A. A short review on the aetiology and pathophysiology of alcoholism. Ann Gen Psychiatry. 2009;8:10. doi:10.1186/1744-850-8-10 (abstract).

    Article  PubMed Central  PubMed  Google Scholar 

  21. Zhon Z, Wang L, Song Z, Lambert JC, McClain CJ, Kong YJ. A critical involvement of oxidative stress in acute alcohol induced hepatic tumour-necrosis factor-alpha production. Am J Path. 2003;163:1137–46.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sydney Medical School (Westmead), The University of Sydney, North Rocks, Australia

    Nages Nagaratnam

  2. Norwest Specialist Medical Group, Bella Vista, New South Wales, Australia

    Kujan Nagaratnam

  3. Blacktown-Mt Druitt Hospital, Blacktown, New South Wales, Australia

    Gary Cheuk

Authors
  1. Nages Nagaratnam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kujan Nagaratnam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gary Cheuk
    View author publications

    You can also search for this author in PubMed Google Scholar

Appendices

Multiple Choice Questions

  1. 1.

    The following are true with depression in the elderly, EXCEPT:

    1. A.

      Late-onset depression (LOD) is due to age-associated neurobiological changes, stressful events, a higher interaction with cognitive decline and impaired effect of genes.

    2. B.

      A family history of depression is more likely with early-onset depression (EOD) than late-onset depression.

    3. C.

      Late-onset depression is closely linked to clinical and neuroimaging evidence of cerebrovascular disease.

    4. D.

      Structural imaging changes vary considerably between LOD and EOD with more severe vascular pathology associated with EOD compared to LOD.

  2. 2.

    The following statements are true with mania in late life, EXCEPT:

    1. A.

      After many years of depression, many are converted to bipolarity and suffer from mania in late life.

    2. B.

      Late-onset mania is closely associated with medical disorders, most commonly stroke, dementia or hypothyroidism and also the use of medications.

    3. C.

      Secondary manias are used to describe late-onset mania associated with medical and pharmacological states.

    4. D.

      There is no supporting clinical and neuroimaging evidence of cerebrovascular disease that link it with ‘late-onset’ depression.

  3. 3.

    The following are true in relation to major depression, EXCEPT:

    1. A.

      Serotonergic activity is reduced in depression.

    2. B.

      There is overproduction of glutamate.

    3. C.

      Dopamine circuits do not have any role in depression.

    4. D.

      Noradrenergic containing circuits are involved in the aetiology of mood disorders.

  4. 4.

    The following are true in the metabolism of alcohol in the elderly, EXCEPT:

    1. A.

      Age-related changes may increase the likelihood of adverse reactions with alcohol consumption.

    2. B.

      Gastric ADH is decreased with ageing so much so the amount of alcohol metabolised in the stomach is reduced resulting in an increase in the load to the liver.

    3. C.

      The liver however will not be able to metabolise the extra alcohol and the blood levels of alcohol will rise.

    4. D.

      Alcohol is distributed only in the body fat.

  5. 5.

    The following that are associated with suicidal behaviour in the elderly are true, EXCEPT:

    1. A.

      There is hyperactivity of the hypothalamic-pituitary-adrenal axis.

    2. B.

      Suicide is generally associated with major depression and is a major problem in the elderly especially elderly females.

    3. C.

      Factors such as bereavement, serious illness, isolation, retirement and organic brain disease contribute to suicide in older people.

    4. D.

      There is dysregulation of the serotonergic system.

Answers to MCQs

1 = D; 2 = D; 3 = C, 4 = D; 5 = B.

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2016). Psychiatry of Older Adults. In: Diseases in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-25787-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-25787-7_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-25785-3

  • Online ISBN: 978-3-319-25787-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation