Book Review
Geriatric Psychiatry
Psychiatry and the Elderly. 3rd Edition. Robin Jacoby, Catherine Oppenheimer, editors. New York: Oxford University Press; 1997. 991p. CAN$135.13
Reviewer
rating*: Good
Review by Matt Robillard, MD, FRCPC
Toronto, Ontario
This textbook provides a comprehensive review of geriatric psychiatry in 5 sections: basic science, clinical practice, psychiatric services, specific disorders and sexuality, ethics and medicolegal issues. This third edition maintains a fresh slant on the various topics reviewed in earlier editions and allows opportunities for new authors to describe the important aspects of geriatric care. All chapters by contributing authors of the second edition have been revised and updated. This book reflects the development of geriatric psychiatry over the last 5 years (1997 to 2001). Fascinating to read was that a Russian translation of this series’ second edition is almost complete and will be published and distributed free of charge in Russian-speaking countries.
Drawn from all specialties and disciplines, 43 authors wrote this book. It was hoped that having multiple authors would allow for diverse style and perspective.
The cover of the book, however, did not impress me in that the colours did seem drab and unexciting. The book displays a drawing of an elderly couple sitting on what appears to be a firm sofa, and some of the joints in their hands and fingers are visibly large and deformed. Because there are no watches on the wrists of these individuals, I wonder whether time was at all important to them. Further, it is unclear how much energy, drive, mobility, or ability these people possessed to enjoy pleasurable pursuits. A memo stuck on the wall behind the sofa may represent some sort of reminder or memory aid for this couple. I imagine that either one or both of these people were living with some type of cognitive impairment. The expression on their faces seems somewhat distant, conveying a lack of life or passion. Certainly, there are patients such as these in all our practices. I would have preferred a sketch of livelier people with abundant energy, good spirits, and joy of life. Nevertheless, the book’s content makes up for this portrayal of the elderly; the authors’ energy and interest convey that the field of geriatric psychiatry is flourishing.
The basic science section includes chapters on the following subjects: biological aspects of human aging, the sociology of aging, cognitive change in old age, epidemiology, neuropathology, neurochemical pathology of neurodegenerative disorders in old age, molecular genetics and molecular biology of dementia, and the economics of health care provision for elderly people with dementia.
The clinical practice section comprises the following subjects: psychiatric and clinical cognitive assessment, physical assessment of older patients, psychological assessment and treatment, neuroimaging in the elderly, psycho- pharmacology, social work, psychometric assessment, dynamic therapy, family therapy with aging families, primary care, and consultation-liaison old-age psychiatry in the general hospital.
The psychiatric services section includes the following chapters: “Principles of Service provision,” “Carers’ Lives,” and “Expect More: Making a Place for People with Dementia.”
The specific disorders sections include chapters on the following subjects: dementia, delirium, depressive disorders, suicide, manic syndromes, neurotic disorders, psychiatric aspects of personality in later life, late-onset schizophrenia, very late-onset schizophrenic-like psychosis, “graduates” (the term applied to people who entered mental hospitals as nonelderly patients and stayed on in the institution, “graduating” to elderly status), and substance abuse.
The final section includes the following topics: sexuality, ethics, elder maltreatment, psychiatric aspects of crime, testamentary capacity, competence, managing the financial affairs of mentally incapacitated persons in the UK and Ireland, and driving and psychiatric illness in later life.
It is not unusual for a clinician to first look at sections on psychopharmacology, depressive disorders, manic syndromes, and clinical aspects of dementia when scanning a geriatric psychiatry textbook for the first time. In fact, I took this approach. The chapters differ with respect to current data and overall approach. However, some of the important work in geriatric psychopharmacology was not included. For example, there is a discussion about tardive dyskinesia, but there is no mention of the work done by Dr Jeste, UCLA. Similarly, work done by Dr Flint at the University of Toronto on lithium augmentation was not listed. I imagine that the ideas and contents of each chapter will be reviewed and revised with each new edition. I also wonder why some of what I consider important clinical practice patterns were not included. For instance, when the author describes the use of tricyclic antidepressants, no emphasis is placed on agent selection. It is fair to say that nortriptyline and desipramine are preferentially used and that doxepin, amitriptyline, and maprotoline (which is listed in one of the tables) are rarely used, at least in North America. I wish discussion had transpired on some of the more pressing clinical concerns, such as how to select the initial antidepressant, what to do if there is no response to one medicine, and the relative advantages and disadvantages of antidepressant augmentation, compared with substitution. I was interested to read that chloral hydrate is still used as a hypnotic, considering that it has been difficult, if not impossible, to obtain.
The chapter on psychopharmacology briefly describes the use of anticonvulsants—sodium valproate and carbamazepine—with little, if any mention, of some of the newer anticonvulsants, such as lamotrigine, topirimate, and gabapentin. The chapter includes a description of amphetamines, stating
they have an extremely restricted use in the elderly since they have the potential to induce addictive and psychotic states, but occasional use under strict supervision has been advocated to activate and enhance mood (Clarke 1978).
This shows that there is no universal agreement on this opinion and on the attitude toward psycho- stimulants.
I thoroughly enjoyed the chapters on depression and manic syndromes. I was impressed with the clarity and organization of Dr Shulman’s and Dr Herrmann’s writing on the manic syndromes. The material is easy to read, to the point, and written in a concise manner.
The chapters on clinical aspects of dementia are thorough and span 91 pages. Interesting discussions emerged on the advances of molecular biology and on our understanding of the pathogenesis of the dementias. The authors comment that, over the past 5 years or so, the search for a cure for Alzheimer’s dementia has become passionate, comparable with the search for a cancer cure.
The chapter covering sexuality, an important subject, impressed me. Dr Oppenheimer took the time and effort to describe the lives and mental health issues of some gay and lesbian older adults. Bravo!
In summary, this is a comprehensive 991- page book. The book should be used to review topics at length, but avoid using it as a quick reference guide.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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