Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. ...

dealing with the study, prevention, and treatment of

neurodegenerative A neurodegenerative disease is caused by the progressive loss of neurons, in the process known as neurodegeneration. Neuronal damage may also ultimately result in their death. Neurodegenerative diseases include amyotrophic lateral sclerosis, mul ...

cognitive impairment Cognitive impairment is an inclusive term to describe any characteristic that acts as a barrier to the cognition process or different areas of cognition. Cognition, also known as cognitive function, refers to the mental processes of how a person ...

, and

mental disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

in people of

old age Old age is the range of ages for people nearing and surpassing life expectancy. People who are of old age are also referred to as: old people, elderly, elders, senior citizens, seniors or older adults. Old age is not a definite biological sta ...

.Barraclough, J.; Gill, D. (1996). ''Hughes' outline of modern psychiatry''. (4th ed.) New York: John Wiley & Sons. Bowden, V.M.; Long, M.J. (1995). Geriatric psychiatry. ''Journal of the American Medical Association, 273'', 1395. Geriatric psychiatry as a subspecialty has significant overlap with the specialties of

geriatric medicine Geriatrics, or geriatric medicine, is a medical specialty focused on addressing the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' meani ...

behavioural neurology Behavioral neurology is a subspecialty of neurology that studies the impact of neurological damage and disease upon behavior, memory, and cognition, and the treatment thereof. Two fields associated with behavioral neurology are neuropsychiatry an ...

neuropsychiatry Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neuropsychiatry, the mind i ...

neurology Neurology (from , "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine) , medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous syst ...

, and general psychiatry. Geriatric psychiatry has become an official subspecialty of

with a defined curriculum of study and core competencies.

History

Origins

The origins of geriatric psychiatry began with

Alois Alzheimer Alois Alzheimer ( , , ; 14 June 1864 – 19 December 1915) was a German psychiatrist, neuropathologist and colleague of Emil Kraepelin. He is credited with identifying the first published case of "presenile dementia", which Kraepelin later ide ...

, a

German German(s) may refer to: * Germany, the country of the Germans and German things **Germania (Roman era) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizenship in Germany, see also Ge ...

psychiatrist A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...

and

neuropathologist Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of anatomic pathology, but work closely with the cli ...

who first identified

amyloid Amyloids are aggregates of proteins characterised by a fibrillar morphology of typically 7–13 nm in diameter, a β-sheet secondary structure (known as cross-β) and ability to be stained by particular dyes, such as Congo red. In the human ...

plaques and

neurofibrillary tangles Neurofibrillary tangles (NFTs) are intracellular aggregates of hyperphosphorylated tau protein that are most commonly known as a primary Biomarker (medicine), biomarker of Alzheimer's disease. Their presence is also found in numerous other disea ...

in a fifty-year-old woman he called Auguste D. These plaques and tangles were later identified as being responsible for her behavioural symptoms, short-term memory loss, and psychiatric symptoms. These brain anomalies would become identifiers of what later became known as

Alzheimer's disease Alzheimer's disease (AD) is a neurodegenerative disease and the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems wit ...

Subspecialty

The subspecialty of geriatric psychiatry originated in the United Kingdom in the 1950s.

Naming

The ''geropsychiatric unit'', the term for a hospital-based geriatric psychiatry program, was first introduced in 1984 by Norman White MD, when he opened New England's first specialized program at a community hospital in Rochester, New Hampshire. White is a pioneer in geriatric psychiatry, being among the first psychiatrists nationally to achieve board certification in the field. The prefix ''psycho-'' had been proposed for the geriatric program, but White, knowing New Englanders' aversion to anything ''psycho-'' lobbied successfully for the name ''geropsychiatric'' rather than ''psychogeriatrics''.

Diseases

Diseases and disorders diagnosed or managed by geriatric psychiatrists include: * Dementia **

Mild cognitive impairment Mild cognitive impairment (MCI) is a diagnosis that reflects an intermediate stage of cognitive impairment that is often, but not always, a transitional phase from cognitive changes in normal aging to those typically found in dementia, especially ...

Vascular dementia Vascular dementia is dementia caused by a series of strokes. Restricted blood flow due to strokes reduces oxygen and glucose delivery to the brain, causing cell injury and neurological deficits in the affected region. Subtypes of vascular dement ...

Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a type of dementia characterized by changes in sleep, behavior change (individual), behavior, cognition, movement, and dysautonomia, regulation of automatic bodily functions. Unlike some other dementias, mem ...

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...

* Neuropsychiatric complications from

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

* Late-life presentations of psychiatric disorders ** Depression ***

Melancholic depression Melancholia or melancholy (from ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complain ...

Anxiety disorder Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...

s **

Bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...

Schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...

Personality disorder Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture. ...

s * Medical-Psychiatric Disorders **

Delirium Delirium (formerly acute confusional state, an ambiguous term that is now discouraged) is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or ...

Catatonia Catatonia is a complex syndrome most commonly seen in people with underlying mood disorders, such as major depressive disorder, or psychotic disorders, such as schizophrenia. People with catatonia exhibit abnormal movement and behaviors, wh ...

Substance use disorder Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include ''substance use problems'' and ''problematic drug or alcohol use''. Along with substance-ind ...

Geriatric psychiatrist

A geriatric psychiatrist is a

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

who specializes in the field of medical sub-specialty called geriatric psychiatrist. A geriatric psychiatrist holds a board certification after specialized training after attaining a medical degree, residency, and an additional geriatric psychiatry fellowship training program. The requirements may vary by countries. Geriatric psychiatrist are also

s who are qualified in the general diagnosis and treatment of psychiatric disorders. Some geriatric psychiatrists also conduct research to determine the cause and better treatments for neurodegenerative disorders and late-life mental health disorders. Geriatric psychiatrists may perform

neurological examination A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical his ...

mental status examination The mental status examination (MSE) is an important part of the clinical Psychiatric assessment, assessment process in Neurology, neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological ...

, laboratory investigations,

neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the neuroanatomy, structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive ...

, cognitive assessments to investigate the causes of psychiatric or neurologic symptoms in old age.

Training

International

The International Psychogeriatric Association is an international community of scientists and healthcare geriatric professionals working for mental health in aging. ''International Psychogeriatrics'' is the official journal of the International Psychogeriatric Association.

Canada

The

Royal College of Physicians and Surgeons of Canada The Royal College of Physicians and Surgeons of Canada () is a regulatory college which acts as a national, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada. The ...

is responsible for training and certifying geriatric psychiatrists in Canada. Geriatric psychiatry requires an additional year of subspecialty fellowship training in addition to general psychiatry training.

United Kingdom

The

Royal College of Psychiatrists The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom, and is responsible for representing psychiatrists, for psychiatric research and for providing public information about mental healt ...

is responsible for training and certifying psychiatrists in the United Kingdom. Within the Royal College of Psychiatrists, the Faculty of Old Age Psychiatry is responsible for training in Old Age Psychiatry. Doctors who have membership of the Royal College of Psychiatrists can undertake a three or four-year training programme to become a specialist in Old Age Psychiatry. There is currently a shortage of old age psychiatrists in the United Kingdom.

United States

The American Association for Geriatric Psychiatry (AAGP) is the national organization representing health care providers specializing in late life mental disorders. ''The American Journal of Geriatric Psychiatry'' is the official journal of the AAGP. The

American Board of Psychiatry and Neurology The American Board of Psychiatry and Neurology, Inc. (ABPN) is a not-for-profit corporation founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, and the t ...

and the

American Osteopathic Board of Neurology and Psychiatry The American Osteopathic Board of Neurology and Psychiatry (AOBNP) is an organization that provides board certification to qualified Doctors of Osteopathic Medicine (D.O.) and non-osteopathic (MD and equivalent) physicians who specialize in diso ...

both issue a board certification in geriatric psychiatry. After a 4-year residency in psychiatry, a psychiatrist can complete a one-year fellowship in geriatric psychiatry. Many fellowships in geriatric psychiatry exist.

References

External links

* {{Authority control Geriatrics