Handbook of Geriatric Psychopharmacology
I will confess up front that I am a psychopharmacology geek. Of the many resources available to keep abreast of new developments in the field, I have a special fondness for good handbooks. A good handbook should provide a readable, concise overview of the field, while being easy to consult in the course of a busy clinic day. This particular text may be pushing the upper limit of length for a handbook, coming in at just under 500 pages. However, it is definitely a handbook in spirit—it is chock full of practical, accessible information presented in a highly readable format.
The book consists of eight chapters arranged in three parts. The first chapter is an extraordinarily well-written overview of pharmacokinetics and pharmacodynamics in the older adult and ends with a nice section of pearls about practicing geriatric psychopharmacology. The next four chapters review major drug classes, and the text concludes with three chapters on treatment of substance abuse, movement disorders, and dementias.
The chapters are laid out for easy reading and reference. A particularly useful feature of the book is that each chapter ends with a 1-page summary of the highlights followed by a series of tables, one to a page, of the drugs discussed in that chapter. These provide many practical facts about the compounds (to mention a few: formulations, starting dose, titration schedule, dosage range) and a comments box where individual quirks of each agent are briefly discussed. The tables alone make the book a handy reference. A useful addition to these tables would be the average wholesale price of each drug. Psychiatrists need to keep themselves informed about the often drastic differences in price among drugs in the same class.
A special challenge in geriatric psychopharmacology is to apply the available facts in an artful way. My only quibbles with the book involved a few instances where knowledge taken from studies with younger patients was applied to older adults. One example is the description of using a typical antipsychotic as a “lead-in” to atypical use, with overlap and then discontinuation of the typical medication (p. 45). This is a strategy that I tend to avoid, but the authors cite their successful experience with the technique. Because this type of recommendation rests on personal experience, it is likely to be influenced by the particular group of elderly patients one sees. In general, however, I was in full agreement with the clinical management recommendations.
There are probably too many pages devoted to the tricyclic antidepressants, given their declining use. This information served to remind me what courage was required to be a geriatric psychopharmacologist in the past. Inevitably, the book also has a few facts that are outdated because of the gap between authorship and publication. This was most noticeable in the chapter on the dementias. None of these minor concerns should overshadow the fact that this useful handbook provides a fine overview for a broad audience that could range from medical students to practicing psychiatrists.
