To read more about Dr. Yaffe's perspective with regard to what the movie got right (and wrong) with regard to Alzheimer's disease visit: http://time.com/3695430/how-accurate-are-health-films/item/still-alice/
The film Still Alice starring Julianne Moore took home an Oscar last week for best actress. It chronicles the experience of Dr. Alice Howland, an accomplished professor at Columbia University, as she is diagnosed with early Alzheimer's disease. How accurately, however, does this critically acclaimed movie portray the onset and progression of this disease? Dr. Kristine Yaffe, a psychiatrist and professor at the University of California reviewed the film and offers her perspective in this interesting article recently appearing in Time Magazine. "Scientifically, the first phase of Alice's symptoms and encounter with her consultant neurologist are very realistic and deeply moving. The movie accurately demonstrates the early word-finding challenges, occasional memory lapses and sense of becoming overwhelmed in once familiar situations."
To read more about Dr. Yaffe's perspective with regard to what the movie got right (and wrong) with regard to Alzheimer's disease visit: http://time.com/3695430/how-accurate-are-health-films/item/still-alice/
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There are a number of life transitions and changes that may occur as a person ages. These can include adult children moving out of the home, retirement, change in financial status, death of spouse, moving to assisted living, and so on. In an effort to deal with these stresses some seniors turn to gambling as a coping method. This serves as an important reminder for anyone working with seniors to inquire about problematic gambling behaviours the same way in which questions are asked around alcohol and substance use. Check out this short article for a list of straightforward questions we can all ask to determine whether an underlying gambling disorder may be present: http://globalnews.ca/news/1798353/problem-gambling-can-be-an-issue-for-seniors/ A new study has demonstrated a positive correlation between taking high doses of anticholinergic medications for prolonged periods of time and dementia risk. This class of medication includes commonly used diphenhydramine (Benadryl), tricyclic antidepressants, and oxybutynin which is often used to treat bladder incontinence. "The study ... is the first to link higher use of anticholinergic medications to increased risk of dementia. It is also the first to suggest that the dementia risk associated with these drugs may not be reversible even years after people stop taking them." As such, "health care providers should regularly review their older patients' drug regimens -- including over-the-counter medications -- to look for chances to use fewer anticholinergic medications at lower doses." To read more about this topic, visit http://www.cbsnews.com/news/common-allergy-depression-meds-may-increase-odds-of-dementia/ Put your knowledge and skills to the test with the case of an 78 year old man who presents to hospital as for the last few weeks he has been both verbally and physically aggressive toward his wife, and has been ruminating about his father who died in the war. There has also been a noticeable decline in the patient's function as he has not been bathing, eating, taking his medications, or sleeping for more than 1-2 hours a night. He experiences flight of ideas and irritability, and has been buying lottery tickets and telling his family he will become a millionaire. He also has paranoid delusions about others trying to hurt him. He has no past psychiatric history, nor any history of substance abuse, and endorses only having a depressed mood. He does however have a complex medical history for which he takes many medications for, including diabetes, hypertension, dyslipidemia, and a recent CABG. Can you come up with a diagnosis or treatment plan? "Delusional and Aggressive While Playing the Lottery" by Muhammed Rehan Puri and Suhey Franco (Current Psychiatry) As a follow-up to last week's blog post about the increasing use of antipsychotics to manage behavioural and psychological symptoms of dementia (BPSD) in long-term care facilities, this week's post highlight's one nursing home's efforts to counteract this trend. Pathstone Living, a nursing home in Mannkato, Minnesota, has successfully altered their approach to managing BPSD from pharmacological to behavioural and environmental interventions. "A few years ago, antipsychotics were used frequently at Pathstone. 'We saw these as medications that were supposed to help the patient and, of course, we gave them to them with the feeling that we were doing good', says Shelley Matthes, a registered nurse who is head of quality assurance for the nonprofit Ecumen, which runs Pathstone and about a dozen other nursing facilities in Minnesota. Our goal, says Matthes, was to reduce our antipsychotic use by 20 percent. And in the first year we reduced it by 97 percent". To read more about how this facility successfully reduced the need for antipsychotic medications, visit http://www.npr.org/blogs/health/2014/12/09/368539057/this-nursing-home-calms-troubling-behavior-without-risky-drugs. National headlines in recent years have highlighted the staggering rates in which antipsychotics are prescribed to frail elderly living in long-term care facilities for the management of challenging behaviours, such as agitation and aggression, even though these drugs are not approved for use in such circumstances and have been associated with increased risk of death in this population. The results of a new study published in JAMA this month indicate that atypical antipsychotics can further harm elderly by increasing their risk of falls and fractures. "Adults ages 65 and older who received a new prescription [for an atypical antipsychotic] had a 53% increased risk of falling and a 50% increased risk of non vertebral osteoporotic fracture. These findings call into question the widespread off-label use of atypical antipsychotic medications and support increasing evidence of safety concerns regarding their use in older adults". To read more about the research findings, visit http://www.medpagetoday.com/Neurology/GeneralNeurology/49529 Put your knowledge and skills to the test with the case of an 82 year old woman who presents to the ED as she has become agitated by new vivid visual hallucinations. The patient has become quite frightened by these visions and has started carrying a knife for protection. Delirium, dementia and medication effects are all ruled out as potential causes. Her medical history is significant for vision loss secondary to macular degeneration and diabetic retinopathy, as well as diabetes, hypothyroidism, and a herniated disc. In terms of her mental health she reports feeling anxious and experiencing a sleep disturbance due to her fears. She also reports feeling sad and worthless as she cannot hear or see as well when she was younger. Can you come up with a diagnosis or treatment plan? "Terrifying Visions" by Abdulmalek Sadehh, Veena Bhanot, and Cristian Sirbu (Current Psychiatry) John Sheehan is a 70 year old with a host of accomplishments, both professionally and personally. He has been living with Alzheimer's disease since 2013 and both he and his wife, Sharon, are determined to not let it become his identity. “The important thing to remember is that we are not our diagnosis,” says Mr. Sheehan. “We are full people with real relationships and interesting histories. In this community [Peterborough] we have the second largest population of people over 65 in Canada, so we need to be aware of this illness and learn how to treat people who suffer from dementias with respect and empathy.” To read more about John's experience with early Alzheimer's disease including the early signs that led to his diagnosis, check out: http://www.mykawartha.com/community-story/5250354-dementia-is-a-diagnosis-not-an-identity/ When asked what population is most at risk of suicide the first response is often teenagers or young adults. In reality, however, adults over the age of 65 have the highest rate of suicide in Canada according the CMHA. Evelyn Burns-Weinrib is an 80-year-old woman from Toronto who has experienced depression later in life and survived a suicide attempt 3 years ago. She has made her experience of living with mental illness public in hopes of breaking down many of the barriers and stigma associated with depression and aging that often prevent individuals from seeking professional help. "I think that this is something that should be talked about, not brushed under the carpet. I will talk about it whenever and wherever I can … When you get older, you face a lot of losses - the loss of your job due to forced retirement or it just disappears, the loss of family members and friends. You lose your physical health, have less money to live on, and you become more dependent on others. I've learned that these are all factors that can trigger depression in seniors," says Evelyn. In order to further educate older adults about depression and mental illness in later life she has also made a monetary donation to Baycrest in Toronto, Ontario, to develop a website targeted at seniors living depression. To learn more about Evelyn's story of survival and resiliency check out this media release from Baycrest and this video interview from CityNews Toronto. To access Baycrest's seniors' mental health website visit www.baycrest.org/mentalhealth It is not unexpected that loneliness is experienced by older adults. New research, however, suggests that loneliness and social isolation have a similar effect on mortality as compared with smoking. The effects of loneliness are not only physical in nature. "Seniors that experience social isolation and loneliness are more likely to suffer from stress, depression, cognitive and functional decline, morbidity and death … Lonely seniors [are] 50% more likely to die earlier than seniors who felt meaningfully connected with others, even after results were adjusted for factors such as depression, socioeconomic status and existing health conditions." A new form of communication technology called InTouch is designed to help mitigate the social isolation often experienced by seniors. "It [InTouch] uses "asynchronous messaging" – that is, platforms that don't require both parties to communicate at the same time, such as email – multimedia and whatever medium the individual recipient prefers. InTouch allows family members to send video messages to each other and have them appear on televisions, computers or tablets, so that regardless of availability, loved ones can stay in touch." To read about this innovative program check out this article. |
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Supporting and enhancing students' and health professionals' knowledge and understanding of mental health and psychiatry
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