| Preface | p. vii |
| Contributors | p. ix |
| Overview | |
| Older Americans and Mental Illness | p. 3 |
| Characteristics of U.S. Elderly | p. 3 |
| Benefits of Treatment | p. 6 |
| Rates of Mental Disorders | p. 6 |
| Problems in the Use of Psychotropic Drugs | p. 11 |
| Treatment Settings | p. 13 |
| Clinician Misperceptions in Use of Psychotropic Medications | p. 15 |
| Drug Prescribing, Adverse Reactions, and Compliance in Elderly Patients | p. 23 |
| Prescription-Drug Use Concerns | p. 23 |
| Over-the-Counter Medication Concerns | p. 25 |
| Prevalence of Psychotropic Drug Use | p. 26 |
| Psychotropic Prescribing Practices in Selected Settings | p. 26 |
| Approaches to Improving Prescription Practices | p. 28 |
| Common Side Effects of Psychotropic Drug Use | p. 32 |
| Ageism, Polypharmacy, and Adverse Drug Reactions | p. 35 |
| Nutritional Status and Drug Effects | p. 37 |
| Compliance | p. 37 |
| Conclusion | p. 42 |
| The Cost of Psychotropic Drug Use for the Elderly | p. 49 |
| 2003 Medicare Prescription Drug Legislation | p. 51 |
| Rise in Prescription Drug Costs | p. 52 |
| Psychotropic Drug Utilization | p. 55 |
| Psychotropic Drug Costs and Compromised Patients | p. 56 |
| Conclusions | p. 58 |
| The Aging Process and Response to Psychotropic Drugs | |
| Neurotransmission in the Aging Central Nervous System | p. 63 |
| The Neurotransmission Process | p. 64 |
| Effect of Age on Neurotransmitters | p. 66 |
| Effect of Psychotropic Drugs on Neurotransmission | p. 76 |
| Age-Related Central Nervous System Alterations in Receptor Sensitivity and Psychotropic Drug Effects | p. 77 |
| Kinetics and Dynamics of Psychotropic Drugs in the Elderly | p. 87 |
| Basic Pharmacokinetic Principles and the Aging Process | p. 88 |
| Pharmacokinetics of Specific Drug Groups | p. 96 |
| Using Pharmacokinetic Information in Prescribing Psychotropic Drugs | p. 105 |
| Comment | p. 106 |
| Geriatric Agitation and Behavior Disorders | |
| Diagnosis of Late-Life Disordered Behavior, Agitation, and Psychosis | p. 117 |
| Characteristics of Disordered Behavior | p. 117 |
| Causes of Behavioral Symptoms | p. 117 |
| Conclusion | p. 124 |
| Treatment of Late-Life Disordered Behavior, Agitation, and Psychosis | p. 129 |
| General Principles for Antipsychotic Treatment | p. 129 |
| Side Effects of Antipsychotics | p. 133 |
| Choice of Antipsychotics | p. 143 |
| Treatment of Agitation with Non-Antipsychotic Drugs | p. 160 |
| Use of Antipsychotics in Difficult Clinical Situations | p. 170 |
| Affective Disorders | |
| Diagnosis of Late-Life Depression | p. 199 |
| Epidemiology | p. 199 |
| Diagnosis as Process | p. 200 |
| Onset of Depression | p. 206 |
| Major Depressive Episode | p. 206 |
| Nonmajor Depressive Disorders | p. 210 |
| Neuropsychiatry of Late-Life Depression | p. 212 |
| Consequences of Depression | p. 217 |
| Treatment of Depression with Tricyclic Antidepressants, MAOIs, and Psychostimulants | p. 233 |
| Tricyclic Antidepressants | p. 233 |
| Monoamine Oxidase Inhibitors | p. 267 |
| Psychostimulants | p. 275 |
| Treatment of Psychotic Depression | p. 277 |
| Augmenting Strategies | p. 278 |
| Treatment of Depression with New and Atypical Antidepressants | p. 305 |
| Selective Serotonin Reuptake Inhibitors | p. 305 |
| Other Atypical Antidepressants | p. 316 |
| Treatment Duration | p. 321 |
| Treatment of Late-Life Depression Associated with Medical Illness | p. 335 |
| Comorbidity of Depression with Medical Illness | p. 335 |
| Cardiovascular Disease | p. 336 |
| Hypertension | p. 339 |
| Stroke | p. 339 |
| Parkinson's Disease and Depression | p. 340 |
| Cancer | p. 342 |
| Treatment of Depression in Dementia | p. 344 |
| Diagnosis and Treatment of Late-Life Bipolar Disorder | p. 353 |
| Epidemiology | p. 353 |
| Clinical Presentation and Diagnosis | p. 353 |
| Course of Illness | p. 354 |
| Etiology | p. 355 |
| General Treatment Principles | p. 356 |
| Acute Treatment of Mania | p. 356 |
| Treatment with Lithium | p. 358 |
| Treatment with Anticonvulsants | p. 364 |
| Treatment of Mania with Antipsychotics | p. 367 |
| Treatment with other Agents | p. 369 |
| Electroconvulsive Therapy | p. 369 |
| Electroconvulsive Therapy in Late-Life Depression | p. 385 |
| Indications for ECT | p. 386 |
| Efficacy | p. 387 |
| Medical Complications and Relative Contraindications | p. 397 |
| Cognitive Side Effects | p. 397 |
| ECT for Depressed Patients with Neurologic Disorders | p. 403 |
| Response Prediction, Maintenance Treatment, and Late-Life Depression | p. 423 |
| Clinical Correlates of Treatment Response and Prediction | p. 423 |
| Neurobiologic Correlates of Outcome and Prediction | p. 425 |
| Prediction of Relapse, Recurrence, and Remission | p. 427 |
| Maintenance Treatment | p. 428 |
| Conclusions | p. 429 |
| Anxiety and Related Disorders (Panic, Obsessive Compulsive, Phobias) | |
| Diagnosis of Anxiety and Anxiety-Related Disorders | p. 437 |
| Epidemiology | p. 437 |
| Characteristics of Late-Life Anxiety | p. 438 |
| Differential Diagnosis | p. 438 |
| Diagnostic Evaluation | p. 442 |
| Neurobiologic Mechanisms of Anxiety | p. 443 |
| Panic Anxiety, Obsessive-Compulsive Disorders, Phobias | p. 444 |
| Conclusions | p. 446 |
| Treatment of Anxiety and Anxiety-Related Disorders | p. 449 |
| Acute Anxiety and Generalized Anxiety Disorder | p. 449 |
| Anxiety Spectrum Disorders | p. 465 |
| Sleep Disorders | |
| The Impact of Age on Sleep and Sleep Disorders | p. 483 |
| Neurobiologic and Chronobiologic of Normal Sleep | p. 483 |
| Normal Age-Related Changes in Sleep and Wakefulness | p. 488 |
| Napping Behaviors and Excessive Daytime Sleepiness | p. 489 |
| Formal Evaluation of Sleep Disorders | p. 490 |
| Types of Sleep-Wake Disorders | p. 493 |
| Special Issues and Sleep-Wake Patterns in The Elderly | p. 499 |
| Dementia and Sleep | p. 501 |
| Conclusion | p. 501 |
| Treatment of Insomnia in the Elderly | p. 513 |
| Insomnia Complaints and Use of Medications | p. 515 |
| Treating Insomnia in Later Life | p. 515 |
| Pharmacologic Treatment of Late-Life Insomnia | p. 520 |
| Principles/Recommendations for Treatment | p. 521 |
| Behavioral Treatments of Chronic Primary Insomnia | p. 529 |
| Conclusion | p. 529 |
| Dementia and Memory Disorders | |
| Neurobiology of Alzheimer's Disease | p. 543 |
| Neuropathology | p. 543 |
| Constituents of Senile Plaques and Neurofibrillary Tangles | p. 547 |
| Biology of Amyloid | p. 548 |
| Neurotransmitters and Their Receptors | p. 550 |
| Energy Metabolism | p. 556 |
| Cell Membranes | p. 557 |
| Inflammation and Immune Mechanisms | p. 560 |
| Infectious Agents and Toxins | p. 561 |
| Mechanisms of Cell Death | p. 563 |
| Genetics of Alzheimer's Disease | p. 563 |
| Etiologic Model | p. 568 |
| Conclusions and Future Directions | p. 572 |
| Treatment of Dementia | p. 595 |
| Treatment Implications of Alzheimer's Disease Pathology | p. 595 |
| Cholinergic Restitutive Therapies | p. 596 |
| Other Neurotransmitter-Based Approaches | p. 603 |
| Nonneurotransmitter Treatment Strategies | p. 605 |
| Nootropics | p. 608 |
| Combination Treatments | p. 608 |
| Current Clinical Considerations | p. 608 |
| Prescribing Information | p. 625 |
| Enzyme Metabolism and Drug Interaction | p. 631 |
| Drug Interactions with Psychotropic Medications | p. 643 |
| Index | p. 677 |
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