This chapter discusses depression in the context of alcoholism and other substance-use disorders. Independent depression syndrome describes a patient who meets criteria for major depression or dysthymia, and it is clear in the history that the depression is independent of effects of substances. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) introduced substance-induced depression to recognize the existence of syndromes of depression that cannot be established to be independent, but that nonetheless appear to exceed the usual effects of substance intoxication or withdrawal and require clinical attention. A number of other psychiatric disorders e.g. bipolar disorder, ADHD, PTSD, and some other anxiety disorders, antisocial and borderline personality, co-occur with substance-use disorders and may account for some of the association between depression and substance abuse. Chronic medical disorders, especially those producing chronic pain, also need to be considered.

This chapter provides some guidance on how to manage sleep apnea in the elderly. It focuses on obstructive and central sleep apnea. Sleep disordered breathing includes obstructive sleep apnea (OSA), central sleep apnea including Cheyne-Stokes respiration (CSR), and sleep hypoventilation. The underlying mechanisms that promote the development of sleep apnea in the elderly can be classified into three broad categories, namely: (1) replication of the pathophysiology of sleep apnea in middle-aged adults; (2) physiological changes that are uniquely associated with aging; and (3) consequences of chronic medical disorders and/or medications. Elderly patients with sleep apnea can present with typical clinical features such as snoring, choking or gasping respirations, witnessed apneas, morning headaches, hypertension, and daytime sleepiness. After the identification and treatment of any underlying medical disorders that contribute to sleep apnea, such as hypothyroidism and acromegaly, weight reduction, and postural therapy can be considered.