Principles and Practice of Geriatric Psychiatry SECOND EDITION AAggrroonniinn__FFMM..iinndddd ii 44//1155//22001111 77::2233::5522 AAMM AAggrroonniinn__FFMM..iinndddd iiii 44//1155//22001111 77::2233::5522 AAMM Principles and Practice of Geriatric Psychiatry SECOND EDITION EDITORS MARC E. AGRONIN, M.D. Director of Mental Health and Clinical Research Miami Jewish Health Systems Affi liate Associate Professor of Psychiatry and Neurology University of Miami Miller School of Medicine Miami, Florida GABE J. MALETTA, Ph.D., M.D. Clinical Professor Department of Psychiatry Department of Family Medicine/Community Health University of Minnesota Medical School Minneapolis, Minnesota Consultant in Geriatric Psychiatry and Psychopharmacology Private Practice of Geriatric Psychiatry President, GAMA Psychiatric Services Inc. Edina, Minnesota AAggrroonniinn__FFMM..iinndddd iiiiii 44//1155//22001111 77::2233::5522 AAMM Acquisitions Editor: Charles Mitchell Product Manager: Tom Gibbons Vendor Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Angela Panetta Creative Director: Doug Smock Production Service: SPi Global Copyright ” 2011 by Lippincott Williams & Wilkins, A Wolters Kluwer Business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copy- right owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Principles and practice of geriatric psychiatry / [edited by] Marc E. Agronin, Gabe J. Maletta.—2nd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-60547-600-1 ISBN-10: 1-60547-600-5 1. Geriatric psychiatry. I. Agronin, Marc E. II. Maletta, Gabe J. [DNLM: 1. Geriatric Psychiatry—methods. 2. Aged. 3. Mental Disorders—diagno- sis. 4. Mental Disorders—therapy. 5. Psychotherapy—methods. WT 150] RC451.4.A5P725 2011 618.97'689—dc22 2010054171 Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recom- mendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warn- ings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 AAggrroonniinn__FFMM..iinndddd iivv 44//1155//22001111 77::2233::5522 AAMM Dr. Marc E. Agronin: Dedicated to My wife Robin My three sons Jacob, Max, and Sam And my parents Ronald and Belle Agronin, for the constant wellspring of love and support Dr. Gabe J. Maletta: For Barbara Jean Maletta, my wife of 48 years (io vivo per lei) AAggrroonniinn__FFMM..iinndddd vv 44//1155//22001111 77::2233::5522 AAMM AAggrroonniinn__FFMM..iinndddd vvii 44//1155//22001111 77::2233::5522 AAMM Contributors SUHKDEEP NINA AHUJA, M.D. DEBORAH K. ATTIX, Ph.D. Staff Psychiatrist Department of Psychiatry and Behavioral Sciences Nassau County Medical Center Division of Medical Psychology Long Island, New York Department of Medicine, Division of Neurology Duke University Medical Center MARC E. AGRONIN, M.D. Durham, North Carolina Director of Mental Health and Clinical Research Miami Jewish Health Systems YORAM BARAK, M.D., M.H.A. Affi liate Associate Professor of Psychiatry and Neurology Associate Professor of Psychiatry University of Miami Miller School of Medicine Sackler School of Medicine Miami, Florida Tel-Aviv University Tel-Aviv, Israel RIZWAN S. AKHTAR, M.D. Director, Psychogeriatrics Department of Neurology Abarbanel Mental Health Center University of Pennsylvania President of the Israel Association of Old-Age Philadelphia, Pennsylvania Psychiatry AMY S. ALOYSI, M.D. Bat-Yam, Israel Assistant Professor ASHOK J. BHARUCHA, M.D. Department of Psychiatry Adjunct Assistant Professor of Computer Science Mount Sinai School of Medicine Carnegie Mellon University New York, New York Hampton, Illinois STUART A. ANFANG, M.D. DAN G. BLAZER, M.D., Ph.D. Clinical Associate Professor of Psychiatry JP Gibbons Professor University of Massachusetts Medical School Department of Psychiatry and Behavioral Sciences Worcester, Massachusetts Duke University Medical Center Medical Director Durham, North Carolina Adult Outpatient Psychiatry Baystate Medical Center DONALD L. BLIWISE, Ph.D. Springfi eld, Massachusetts Professor of Neurology, Psychiatry/Behavioral Sciences, and Nursing FRANCESCA CANNAVO ANTOGNINI, Ph.D. Director, Program in Sleep, Aging and Chronobiology McLean Hospital Emory University School of Medicine Harvard Medical School Wesley Woods Health Center Boston, Massachusetts Atlanta, Georgia PAUL S. APPELBAUM, M.D. JASON BORENSTEIN, Ph.D. Elizabeth K. Dollard Professor of Psychiatry, Medicine and Director, Graduate Research Ethics Programs, School of Law Public Policy, Columbia University Georgia Institute of Technology Director, Division of Law, Ethics, and Psychiatry Atlanta, Georgia Columbia University College of Physicians and Surgeons New York State Psychiatric Institute SOO BORSON, M.D. New York, New York Professor of Psychiatry and Behavioral Sciences (Geriatrics) PATRICIA A. AREÁN, Ph.D. Director, Geropsychiatry Services Professor of Psychiatry University of Washington University of California, San Francisco Seattle, Washington San Francisco, California AAggrroonniinn__FFMM..iinndddd vviiii 44//1155//22001111 77::2233::5522 AAMM viii Contributors LISA L. BOYLE, M.D. GENE D. COHEN, M.D., Ph.D. Assistant Professor of Psychiatry Director, Washington DC Center on Aging, Health and Director, Geriatric Psychiatry Fellowship Humanities University of Rochester School of Medicine and Dentistry Professor of Health Care Sciences and Professor of Psychiatry Rochester, New York and Behavioral Sciences George Washington University ALISTAIR BURNS, M.B.Ch.B., F.R.C.P., F.R.C.Psych., M.D., M.Phil., Washington, District of Columbia D.H.M.S.A. University of Manchester HARVEY J. COHEN, M.D. Manchester, United Kingdom Walter Kempner Professor and Chairman of Medicine Duke University Medical Center M. CAROLINE BURTON, M.D. Director, Center for the Study of Aging and Human Assistant Professor of Medicine Development, Geriatrics Division Program Director, Hospital Internal Medicine Fellowship Duke University School of Medicine Division of Hospital Internal Medicine Durham, North Carolina Mayo Clinic Rochester, Minnesota ELIZABETH COLLUMB, M.D. SALLY CALLAHAN, M.S. Clinical Instructor of Psychiatry Assistant to the President University of California, San Diego Vice President of Faculty and Instruction La Jolla, California Massasoit Community College YEATES CONWELL, M.D. Brockton, Massachusetts Professor of Psychiatry DANIEL CARLAT, M.D. Co-Director, Center for the Study and Prevention of Suicide Associate Clinical Professor of Psychiatry University of Rochester School of Medicine and Dentistry Tufts University School of Medicine Rochester, New York Boston, Massachusetts JACQUELINE T. DAHL, M.D. ERIN L. CASSIDY-EAGLE, Ph.D. Department of Psychiatry and Psychology Director of Research Mayo Clinic,Rochester, Minnestota ETR Associates COLIN A. DEPP, Ph.D. Scotts Valley, California Department of Psychiatry Adjunct Clinical Assistant Professor of Psychiatry and University of California Behavioral Sciences San Diego, California Stanford University School of Medicine Stanford, California ABHILASH K. DESAI, M.D. Chief, Geriatric Psychiatry HELENA CHUI, M.D. Sheppard Pratt Raymond and Betty McCarron Endowed Chair Baltimore, Maryland Chairman, Department of Neurology Keck School of Medicine ISABELLE DESJARDINS, M.D. University of Southern California Department of Psychiatry Los Angeles, California University of Vermont College of Medicine RICHARD COCKERILL, B.A. Fletcher Allen Health Care Research Student in Neurology Burlington, Vermont Alzheimer’s Disease Research Center PAUL R. DUBERSTEIN, Ph.D. Mayo Clinic College of Medicine Professor of Psychiatry Rochester, Minnesota Director, Rochester Health Decision Making Research Group CARL I. COHEN, M.D. University of Rochester School of Medicine and Dentistry SUNY Distinguished Service Professor and Director Rochester, New York Division of Geriatric Psychiatry YOHANNES ENDESHAW, M.D., M.P.H., F.A.A.S.M. SUNY Downstate Medical Center Associated Professor of Aging and Geriatric Research Brooklyn, New York University of Florida College of Medicine DONNA COHEN, Ph.D. Gainesville, Florida Professor of Aging and Mental Health Disparities ANTHONY FERNANDO, M.B.B.S., M.R.C.Psych. Louis de la Parte Florida Mental Health Institute Specialist Registrar in Intellectual Disabilities College of Behavioral and Community Sciences The Greenfi elds, Kings Norton University of South Florida Birmingham, United Kingdom Tampa, Florida AAggrroonniinn__FFMM..iinndddd vviiiiii 44//1155//22001111 77::2233::5522 AAMM Contributors ix BRENT FORRESTER, M.D. AMBER GUM, Ph.D. Assistant Professor of Psychiatry Associate Professor of Aging and Mental Health Harvard Medical School Disparities Boston, Massachusetts Louis de la Parte Florida Mental Health Institute Director, Mood Disorders Division, Geriatric Psychiatry University of South Florida Research Program Tampa, Florida McLean Hospital JOSEPH T. HANLON, Pharm.D., M.S. Belmont, Massachusetts Professor, Department of Medicine (Geriatrics) and DOLORES GALLAGHER-THOMPSON, Ph.D. Department of Biomedical Informatics Department of Psychiatry and Behavioral Sciences Department of Pharmacy and Therapeutics, School of Stanford University Pharmacy Stanford, California Department of Epidemiology, School of Public Health University of Pittsburgh School of Medicine YONAS E. GEDA, M.D., M.Sc. Health Scientist, Center for Health Equity Research Associate Professor of Neurology and Psychiatry and GRECC, Veterans Affairs Pittsburgh Healthcare Vice Chair for Research, Department of Psychiatry System and Psychology Pittsburgh, Pennsylvania Consultant, Department of Health Sciences Research Mayo Clinic College of Medicine ANSAR M. HAROUN, M.D. Rochester, Minnesota Clinical Professor of Psychiatry and Pediatrics University of California, San Diego DAVID S. GELDMACHER, M.D., F.A.C.P. Adjunct Professor of Law, Department of Law Department of Neurology University of California, San Diego University of Virginia School of Medicine,Charlottesville, La Jolla, California Virginia LEONARD HAYFLICK, Ph.D. LAUREN V. GEORGE, Pharm.D., B.C.P.S Professor of Anatomy Clinical Pharmacist, Geriatrics University of California, San Francisco James A. Haley Veterans’ Hospital San Francisco, California Tampa, Florida MARNIN J. HEISEL, M.D. MARION ZUCKER GOLDSTEIN, M.S., M.D., F.A.C.Pych. Associate Professor of Psychiatry and of Epidemiology Professor of Psychiatry and Biostatistics Director, Division of Geriatric Psychiatry and Fellowship University of Western Ontario Geriatric Psychiatry Scientist, Lawson Health Research Institute New York State University at Buffalo School of Medicine and London, Ontario, Canada Biomedical Sciences Adjunct Assistant Professor of Psychiatry Consultant, Erie County Medical Center Corporation University of Rochester Medical Center (ECMCC) Rochester, New York Buffalo, New York JOHN P. HIRDES, Ph.D. KENNETH W. GOODMAN, Ph.D. Department of Health Research and Gerontology Professor and Director University of Waterloo University of Miami Bioethics Program Waterloo, Ontario, Canada Miami, Florida Homewood Research Institute SHELLY L. GRAY, Pharm.D., M.S. Guelph, Ontario, Canada Professor of Pharmacy ERIN L. HOMMEL, M.D. University of Washington Assistant Professor of Medicine Seattle, Washington Department of Internal Medicine, Division of Geriatrics ROBERT M. GREENBERG, M.D. University of Texas Medical Branch at Galveston Medical Director, Geriatric Psychiatry and ECT Services Galveston, Texas Hoboken University Medical Center STACY S. HORN, D.O. Hoboken, New Jersey Assistant Clinical Professor of Neurology Clinical Associate Professor of Psychiatry University of Pennsylvania UMDNJ School of Medicine Philadelphia, Pennsylvania Stratford, New Jersey AAggrroonniinn__FFMM..iinndddd iixx 44//1155//22001111 77::2233::5522 AAMM x Contributors M. SALEEM ISMAIL, M.D. DAVID KNOPMAN, M.D. Associate Professor of Psychiatry Professor of Neurology Director, Psychiatric Consultation Service Mayo Clinic College of Medicine AD-CARE/Monroe Community Hospital Rochester, Minnesota University of Rochester School of Medicine ELISABETH KOSS, Ph.D. and Dentistry National Center for Research Resources Rochester, New York National Institutes of Health MATTHEW P. JANICKI, Ph.D., F.Iassid Department of Health and Human Services Associate Research Professor Bethesda, Maryland Department of Disability and Human Development MICHAEL KOTYLAR, Pharm.D. University of Illinois, Associate Professor of Experimental and Clinical Chicago, Illinois Pharmacology DILIP V. JESTE, M.D. College of Pharmacy, University of Minnesota Clinical Professor of Psychiatry Minneapolis, Minnesota University of California, San Diego HELEN H. KYOMEN, M.D., M.S. La Jolla, California Director of Education and Research for Geriatric Psychiatry Staff Physician, Department of Psychiatry Service North Shore Medical Center VA San Diego Healthcare System Associate Psychiatrist, McLean Hospital, San Diego, California Brigham and Women’s Hospital SALMAN KARIM, M.B.B.S., F.C.P.S., M.Sc. Harvard Medical School Honorary Lecturer in Psychiatry Belmont, Massachusetts Lancashire Care NHS Foundation Trust MELINDA S. LANTZ, M.D. University of Manchester Chief of Geriatric Psychiatry Consultant in Old Age Psychiatry, Meadowbrook Unit Beth Israel Medical Center Hope Hospital Associate Professor of Clinical Psychiatry Manchester, United Kingdom Albert Einstein College of Medicine JORDAN F. KARP, M.D. New York, New York Assistant Professor of Psychiatry, Anesthesiology, MARIA I. LAPID, M.D. and Clinical and Translational Science Assistant Professor of Psychiatry Western Psychiatric Institute and Clinic Associate Program Director, Geriatric Psychiatry Fellowship University of Pittsburgh School of Medicine Department of Psychiatry and Psychology Medical Director for Geriatric Psychiatry, UPMC Pain Mayo Clinic Medicine at Centre Commons Rochester, Minnesota University of Pittsburgh Medical Center Pittsburgh, Pennsylvania SEAN A. LAUDERDALE, Ph.D. Associate Professor of Psychology and Counseling CHARLES H. KELLNER, M.D. Pittsburg State University Professor of Psychiatry Pittsburg, Kansas Chief, Division of Geriatric Psychiatry Director, ECT Service HELEN LAVRETSKY, M.D., M.S. Mount Sinai School of Medicine Professor of Psychiatry and Biobehavioral Sciences New York, New York Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine at UCLA ANDREW KERTESZ, M.D., F.R.C.P.C Los Angeles, California Professor of Clinical Neurological Sciences University of Western Ontario MARIA D. LLORENTE, M.D. Director, Cognitive Neurology, Department of Clinical Associate Chief of Staff, Mental Health Neurological Sciences Washington DC Veterans’ Affairs Medical Center St. Joseph’s Hospital Washington, District of Columbia London, Ontario, Canada J. PIERRE LOEBEL, M.A., M.D., F.R.C.Psych. SUSAN KIM, B.A. Emeritus Clinical Professor of Psychiatry and Behavioral McLean Hospital Sciences Belmont, Massachusetts University of Washington Seattle, Washington AAggrroonniinn__FFMM..iinndddd xx 44//1155//22001111 77::2233::5533 AAMM