Clinical Case Studies in Long-Term Care Psychiatry Navigating Common Mental Health Challenges in Geriatric Care
Book contents
- Clinical Case Studies in Long-Term Care Psychiatry
- Clinical Case Studies in Long-Term Care Psychiatry
- Copyright page
- Contents
- Preface
- Section 1 Neurocognitive Disorders
- Case 2 “I Think I Hit My Head”
- Case 3 “It’s like She’s a Different Person”
- Case 4 “I Am Tired All the Time”
- Case 5 “I Am Okay”
- Case 6 “Leave Me Alone”
- Case 7 “I Am Fine”
- Case 8 “Those Children Are Cute”
- Case 9 “Those Terrible Men Have Left”
- Case 10 “I Saw the Heavenly Gates”
- Case 11 “Leave Me Alone”
- Section 2 Mood Disorders
- Case 13 “My Mom Looks Like a Zombie!”
- Case 14 “My Soul Is in England”
- Case 15 “I Feel Terrible”
- Case 16 “I Don’t Care”
- Case 17 “I Feel Very Lonely”
- Case 18 “I Don’t Feel Right”
- Case 19 “I Am Feeling Great”
- Case 20 “I Am Staying Here Illegally”
- Section 3 Psychotic Disorders
- Case 22 “He Just Won’t Get Up”
- Case 23 “My Body Is Being Taken over by a Fungus!”
- Case 24 “This Is Humiliating”
- Case 25 “I Want to Go Home”
- Case 26 “I Am a Worrier”
- Case 27 “Get out of My House”
- Section 4 Anxiety and Related Disorders
- Case 29 “My Vision Has Been Worsening in the Last Two Weeks”
- Case 30 “I Am Not Addicted to Valium”
- Case 31 “Of Course, I Worry about Him”
- Case 32 “Bombs Are Falling! Run, Run!”
- Section 5 Substance Abuse Disorders
- Section 6 Personality Disorders
- Case 35 “I Cannot Wait to Get out of This Miserable Place”
- Section 7 Miscellaneous Neuropsychiatric Disorders Affecting Patients in Long-Term Care
- Case 37 “Everyone Is Just So Good to Me!”
- Case 38 “Why Do They Say I Have Dementia?”
- Case 39 “I Hate That Guy … I Can’t Get Any Sleep!”
- Case 40 “Just One Kiss”
- Case 41 “I Don’t Feel Well”
- Case 42 “I Like Food”
- Case 43 “I Like the Way She Laughs”
- Case 44 “This Is So Hard”
- Index
- References
Case 15 - “I Feel Terrible”
SSRIs and Treatment-Resistant Depression
Published online by Cambridge University Press: 31 October 2024
Book contents
- Clinical Case Studies in Long-Term Care Psychiatry
- Clinical Case Studies in Long-Term Care Psychiatry
- Copyright page
- Contents
- Preface
- Section 1 Neurocognitive Disorders
- Case 2 “I Think I Hit My Head”
- Case 3 “It’s like She’s a Different Person”
- Case 4 “I Am Tired All the Time”
- Case 5 “I Am Okay”
- Case 6 “Leave Me Alone”
- Case 7 “I Am Fine”
- Case 8 “Those Children Are Cute”
- Case 9 “Those Terrible Men Have Left”
- Case 10 “I Saw the Heavenly Gates”
- Case 11 “Leave Me Alone”
- Section 2 Mood Disorders
- Case 13 “My Mom Looks Like a Zombie!”
- Case 14 “My Soul Is in England”
- Case 15 “I Feel Terrible”
- Case 16 “I Don’t Care”
- Case 17 “I Feel Very Lonely”
- Case 18 “I Don’t Feel Right”
- Case 19 “I Am Feeling Great”
- Case 20 “I Am Staying Here Illegally”
- Section 3 Psychotic Disorders
- Case 22 “He Just Won’t Get Up”
- Case 23 “My Body Is Being Taken over by a Fungus!”
- Case 24 “This Is Humiliating”
- Case 25 “I Want to Go Home”
- Case 26 “I Am a Worrier”
- Case 27 “Get out of My House”
- Section 4 Anxiety and Related Disorders
- Case 29 “My Vision Has Been Worsening in the Last Two Weeks”
- Case 30 “I Am Not Addicted to Valium”
- Case 31 “Of Course, I Worry about Him”
- Case 32 “Bombs Are Falling! Run, Run!”
- Section 5 Substance Abuse Disorders
- Section 6 Personality Disorders
- Case 35 “I Cannot Wait to Get out of This Miserable Place”
- Section 7 Miscellaneous Neuropsychiatric Disorders Affecting Patients in Long-Term Care
- Case 37 “Everyone Is Just So Good to Me!”
- Case 38 “Why Do They Say I Have Dementia?”
- Case 39 “I Hate That Guy … I Can’t Get Any Sleep!”
- Case 40 “Just One Kiss”
- Case 41 “I Don’t Feel Well”
- Case 42 “I Like Food”
- Case 43 “I Like the Way She Laughs”
- Case 44 “This Is So Hard”
- Index
- References
Summary
Current guidelines still support the use of an SSRI as first choice for the treatment of depression in older adults. Clinicians should keep in mind the old adage “Start low, go slow, but go” with regard to the prescribing of antidepressants in older patients. With older adults, it is a good idea to start at half or quarter of the normal adult starting dose but to increase the dose to well within the therapeutic range for a given antidepressant. Depression is prevalent in older adults in long-term care with estimated prevalence from 11-45%. Depression is associated with poor overall health outcomes and poor quality of life. Interventions are often effective if these patients are identified but treatment can be challenging and require multiple adjustments in medications or treatment strategies.
Keywords
- Type
- Chapter
- Information
- Clinical Case Studies in Long-Term Care PsychiatryNavigating Common Mental Health Challenges in Geriatric Care, pp. 73 - 77Publisher: Cambridge University PressPrint publication year: 2024
References
References
Lenze, E. J., Mulsant, B. H., Roose, S. P., Lavretsky, H., Reynolds, C. F. III, Blumberger, D. M., & Karp, J. F. (2023). Antidepressant augmentation versus switch in treatment-resistant geriatric depression. New England Journal of Medicine, 388 (12), 1067–1079.CrossRefGoogle ScholarPubMed
Lee, S. L., Pearce, E., Ajnakina, O., Johnson, S., Lewis, G., Mann, F., Pitman, A., Solmi, F., Sommerlad, A., Steptoe, A., Tymoszuk, U., & Lewis, G. (2021). The association between loneliness and depressive symptoms among adults aged 50 years and older: A 12-year population-based cohort study. Lancet Psychiatry, 8 (1), 48–57. doi: 10.1016/S2215-0366(20)30383-7. Epub 2020 Nov 9. PMID: 33181096; PMCID: PMC8009277.CrossRefGoogle Scholar
National Academies of Sciences, Engineering, and Medicine. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press.Google Scholar
Watt, J. A., Goodarzi, Z., Veroniki, A. A., Nincic, V., Khan, P. A., Ghassemi, M., Lai, Y., Treister, V., Thompson, Y., Schneider, R., Tricco, A. C., & Straus, S. E. (2020). Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: Systematic review and network meta-analysis. The BMJ, 372. https://doi.org/10.1136/bmj.n532Google Scholar
Macleod, F., Storey, L., Rushe, T., & McLaughlin, K. (2021). Towards an increased understanding of reminiscence therapy for people with dementia: A narrative analysis. Dementia (London, England), 20 (4), 1375–1407. https://doi.org/10.1177/1471301220941275Google ScholarPubMed
Al-Karawi, D., & Jubair, L. (2016). Bright light therapy for nonseasonal depression: Meta-analysis of clinical trials. Journal of Affective Disorders, 198, 64–71.CrossRefGoogle ScholarPubMed
Riddle, M., Potter, G. G., McQuoid, D. R., Steffens, D. C., Beyer, J. L., & Taylor, W. D. (2017). Longitudinal cognitive outcomes of clinical phenotypes of late-life depression. The American Journal of Geriatric Psychiatry, 25 (10), 1123–1134.CrossRefGoogle ScholarPubMed
Zaremba, D., Kalthoff, I. S., Förster, K., Redlich, R., Grotegerd, D., Leehr, E. J., & Dannlowski, U. (2019). The effects of processing speed on memory impairment in patients with major depressive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 92, 494–500.CrossRefGoogle ScholarPubMed
Further Reading
Conroy, R., Golden, J., Jeffares, I., O’Neill, D., & Mcgee, H. (2010). Boredom-proneness, loneliness, social engagement and depression and their association with cognitive function in older people: A population study. Psychology, Health & Medicine. 15, 463–473. 10.1080/13548506.2010.487103.CrossRefGoogle ScholarPubMed
Domènech-Abella, J., Mundó, J., Haro, J. M., & Rubio-Valera, M. (2019). Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA). Journal of Affective Disorders, 246, 82–88.CrossRefGoogle ScholarPubMed
Furukawa, Y., Hamza, T., Cipriani, A., Furukawa, T., Salanti, G., & Ostinelli, E. (2022). Optimal dose of aripiprazole for augmentation therapy of antidepressant-refractory depression: Preliminary findings based on a systematic review and dose–effect meta-analysis. The British Journal of Psychiatry, 221 (2), 440–447. doi:10.1192/bjp.2021.165CrossRefGoogle ScholarPubMed