What is a Geriatric Psychiatrist?
A Geriatric Psychiatrist is a medical doctor with special training in the diagnosis and treatment of mental disorders and symptoms that may occur in older adults. Geriatric Psychiatrists have completed full training in Adult Psychiatry, followed by additional training in Geropsychiatry.
Older adults with a variety of concerns see a Geriatric Psychiatrist. These concerns include difficulty coping with change, stress, death, depression, memory problems, family history of dementia, anxiety, or agitation associated with dementia or poor sleep. Sometimes emotional problems occur for the first time in older adults who suffer with chronic pain, Parkinson’s disease, heart disease, diabetes, stroke, or other medical disorders. The geriatric psychiatrist offers valuable help to older adults who are coping with changes in health and function.
What is the difference between Dementia and Alzheimer’s Disease?
Dementia is a general term for progressive cognitive impairment resulting in a decline of functional abilities. Alzheimer’s Disease (or Alzheimer’s “Dementia”) is by far the most common type of Dementia. Frequent early symptoms in Alzheimer’s Dementia include memory loss and language changes, resulting in difficulty with usual activities like performing work duties, managing the bills, or driving the car. Behavioral changes or symptoms also frequently occur early on.
What are some other types of Dementia (besides Alzheimer’s)?
Some other types of Dementia include Lewy Body Dementia, Frontotemoporal Dementia, Vascular Dementia, and in the later stages of illness, Parkinson’s and Huntington’s Dementia. These are mostly neurodegenerative disorders which ultimately result in cognitive impairment, in addition to their other well known symptom patterns. In some of these conditions, the early cognitive symptoms are usually not memory loss. For example, in Frontotemporal Dementia, early symptoms are often language or personality changes (with intact memory).
Isn’t memory loss just part of “normal aging”?
The typical cognitive changes associated with normal aging include slower speed in processing new information, and mild forgetfulness with things like where an item was placed (keys or glasses), an acquaintances’ name, or forgetting why you entered a room. With normal aging, the individual is aware that they can’t remember. Normal aging does not involve more serious cognitive changes or functional impairment (like an inability to manage the checkbook, getting lost in familiar neighborhoods, forgetting how to do things that you’ve done many times, or repeating the same story over and over).
What is “Pseudodementia”?
Pseudodementia is a term that usually describes when someone is experiencing cognitive deficits as part of a mood disorder (Depression), rather than a progressive cognitive decline (Dementia). This is very important to diagnose, because Depression has much better treatment outcomes than Dementia. In Pseudodementia, the related cognitive impairment typically improves as the Depression resolves with treatment.
Psychiatrists will always look for reversible (treatable) causes of cognitive impairment, such as Depression, vitamin deficiencies, hormone (ie thyroid) abnormalities, and medication side-effects when assessing for the possibility of a Dementia.
What are some of the “behavioral” or “psychiatric” symptoms that can occur with Dementia?
In addition to the well known symptoms of memory loss and confusion that can occur in Dementia, behavioral symptoms are very common and can include: agitation, aggression, hallucinations, paranoia, delusions, confused time relationships (mixing up the past and present), insomnia, reversed sleep cycle (up all night and sleeping all day), not recognizing their own home or family, and apathy (little interest in anything, but mood is not depressed).
What is “Depression”? Is it different in the elderly?
Depression (“Major Depression”) is a serious mood disorder that can result in difficulty functioning due to symptoms like sadness, low energy, insomnia or sleep changes, poor appetite, and cognitive deficits. In severe cases it can include symptoms like feelings of worthlessness, feelings that life is not worth living, and thoughts of ending one’s life.
Depression in the elderly can sometimes manifest differently than in younger individuals, with less feelings of “sadness”, and more feelings of boredom, lacking interest in things one might normally be interested in (anhedonia), social withdrawal and isolation, cognitive deficits (pseudodementia). Sometimes an older individual does not realize they are depressed because they are not feeling “sad” or “blue” (but meanwhile, they are experiencing many of the other symptoms described).
Are there research trials for potential new treatments for Alzheimer’s Disease?
Yes, there are many treatment trials seeking safer and more effective treatments for Alzheimer’s Disease. Dr. Barnas is a clinical investigator for some of these potential new treatments.
What is the role of a Geriatric Psychiatrist in Rehabilitation and Skilled Nursing Facilities?
Frequently, after an individual is hospitalized with health problems, they are admitted for a short-term stay at a skilled nursing facility (SNF) for a course of physical therapy and continued medical care.
There are many reasons why a Psychiatrist may be consulted to assess a patient. On arrival to the SNF, sometimes the rehabilitation patient may not be progressing in therapy as expected, with Depression suspected. Sometimes the patient may have an abrupt onset of confusion and psychiatric symptoms (with no past Psychiatric history) and Delirium is suspected. If the patient was on a “sleeping pill” or an “as-needed anxiety pill” while in the hospital, something this ordinary will often trigger a consult, to see if the medication remains appropriate, if it is still needed, if any adjustments or reduction need to be made, etc. Obviously if the patient has an established Psychiatric history or is on a more traditional psychiatric medication (like an antidepressant or antipsychotic), this will also trigger a psychiatric consult for the same reasons.
Individuals are also admitted to SNF’s for long term care due to serious health problems, which can include Dementia. Psychiatrists are frequently asked to assess these individuals for similar reasons.
Typically, the Psychiatrist will receive information from the patient’s referring physician, will speak to the nurse and social worker, review the chart (including the patient’s recent hospital course, medical history, allergies, medications, etc), in addition to interviewing the patient. The Psychiatrist will then make recommendations based on his formulation of all the information.
Frequently, the patients in these SNF settings are older adults, so a Geriatric Psychiatrist’s additional training and expertise is helpful in treating this population.
What insurance plans do you accept?
Pelorus Elder & Behavioral Health is an “in-network” provider for Medicare, Evercare, Cigna, Aetna, and Horizon Blue Cross-Blue Shield**.
**Horizon BCBS members only, please note: Some policies “carve out” the mental health coverage to a separate company called Value Options. Pelorus Elder & Behavioral Health is NOT an in-network provider for Value Options. You will only be able to find out if your Blue Cross-Blue Shield policy is associated with Value Options by calling the contact number for “mental health services”, and asking if Value Options is associated with your policy. Calling the general “member services” number on your card may not provide you with the accurate information regarding your mental health coverage (they may not know that your policy uses Value Options). Again, you must call the phone number specifically listed for “mental health services” on your insurance card to determine whether Value Options provides the mental health coverage for your Horizon Blue Cross-Blue Shield policy.