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The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th ed.
Reviewed by Helen C. Kales, M.D.
Am J Psychiatry 2010;167:604-604. doi:10.1176/appi.ajp.2009.09091340
View Author and Article Information
Ann Arbor, Mich.

The author reports no financial relationships with commercial interests.

Accepted September , 2009.

Copyright © American Psychiatric Association

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Our nation is entering a "tsunami" of aging. By 2030, it is estimated that over 80 million Americans, or 20 percent of the population, will be 65 years of age or older. With advancing age comes medical and neurological complexity, and given that there is a shortage of geriatric psychiatry specialists, it will be increasingly necessary for general psychiatrists to have a working knowledge of issues germane to the care of the many older patients in their practices.

The fourth edition of the American Psychiatric Publishing Textbook of Geriatric Psychiatry is a timely and relevant addition to the literature for both geriatric and general psychiatrists, as well as other providers who treat older patients. As with the third edition published in 2004, the text is divided into five sections (basic science, diagnostic interviewing, later-life psychiatric disorders, treatment, and legal, ethical, and policy issues) but is revised and expanded. Newly added chapters include those on delirium, dementia and other cognitive syndromes, and bipolar disorder in later life. Also new to this edition are helpful summary points and suggested additional readings at the end of each chapter.

All of the chapters provide solid and eminently readable reviews of the topics covered, but there are a number of chapters that are standouts. The chapter on neuroanatomy by Taylor, Moore, and Chin provides a stellar review for the clinician, with clear and concise descriptions of the anatomical regions of the brain and associated neuropathological changes seen in later-life conditions, accompanied by illustrative figures and pictures. The subsequent chapter on chemical messengers by Kilts et al. presents the major neurotransmitters and their localizations and highlights their physiological impacts. A chapter by Fearing and Inouye covers delirium and provides an understanding for the pathophysiology surrounding this all-too-familiar syndrome seen in older patients, as well as the current evidence base relevant to prevention and treatment for this condition. Lyketsos authored the masterful chapter on dementia, which includes a decoding for the nonspecialist of the various terms used to describe memory disturbances, such as cortical versus subcortical subsyndromes, and descriptions of the major types of dementia as well as presentation of the "four pillars of dementia care" (disease management, symptom management, supportive patient care, and attention to caregiver issues). The chapter on anxiety disorders by Lenze and Wetherell nicely organizes later-life syndromes into those characterized by worry/distress (generalized anxiety disorder, posttraumatic stress disorder), fear (panic disorder, agoraphobia, social phobia, and specific phobias), and obsessive-compulsive disorder. The section on clinical management of anxious older patients is excellent and includes the observation that medication "intolerance" in many anxious patients may often result from anticipatory side effect worries and hypervigilance about bodily sensations. Providers seeing older psychiatric patients would benefit from reading Oslin and Mavandadi's chapter on recognizing and treating alcohol and drug problems in older adults to help them understand the impact of the aging baby-boomer generation on our practices. The chapter on psychopharmacology by Mulsant and Pollack is outstanding, discussing all the commonly used agents in later-life psychiatric conditions, including their cytochrome P450 actions. They also provide thorough coverage of the morbidity and mortality concerns of using antipsychotics in the elderly. Other highlights included in the text are chapters on nutrition and physical activity and their links to mental and cognitive health; adapting psychotherapies to older adults; and working with families of older adults (including how to deal with the difficult issue of limitations on driving).

There are a few areas that could be improved. Given the heterogeneity of later-life depression, areas that would merit more coverage include how the clinical presentation of depression can differ from standard DSM criteria; the concept of executive dysfunction, including bedside assessment; problems of adherence to treatment; and the areas of prevention and positive or successful aging. It is likely that these issues will be more fully addressed in the coming years in subsequent editions by the editors and contributors to this excellent textbook.




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