American Journal of Geriatric Psychiatry最新文献

{"title":"18. LONG-TERM SAFETY AND EFFICACY OF DEUTETRABENAZINEIN PATIENTS AGED ≥ 65 YEARS WITH TARDIVE DYSKINESIA","authors":"Martha Sajatovic ,&nbsp;Pooja Gandhi ,&nbsp;Martijn Konings ,&nbsp;Steve Barash ,&nbsp;Stacy Finkbeiner","doi":"10.1016/j.jagp.2025.04.021","DOIUrl":"10.1016/j.jagp.2025.04.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Tardive dyskinesia (TD) is an involuntary, hyperkinetic movement disorder more prevalent in older patients. Deutetrabenazine is approved by the United States Food and Drug Administration for the treatment of TD based on results from two 12-week trials, ARM-TD and AIM-TD, which demonstrated significant improvements in Abnormal Involuntary Movement Scale (AIMS) score, as well as favorable safety/tolerability, versus placebo. This analysis assessed the long-term safety and efficacy of deutetrabenazine in patients with TD aged LESS THAN 65 or ≥65 years.</div></div><div><h3>Methods</h3><div>Patients who completed either ARM-TD or AIM-TD could enroll in this 3-year, single-arm, open-label extension study (NCT02198794). Change from baseline and ≥50% response rate for AIMS score, treatment success defined as “much improved” or “very much improved” on Clinical Global Impression of Change (CGIC) or Patient Global Impression of Change (PGIC), and safety were assessed at Week 145.</div></div><div><h3>Results</h3><div>Among 337 participants, 258 were aged LESS THAN 65 years and 79 were aged ≥65 years. At Week 145, 50% (130/258) of patients aged LESS THAN 65 years and 51% (40/79) of patients aged ≥65 were receiving deutetrabenazine. The mean±SE total dose at Week 145 was 40.3±0.91 and 36.8±1.85 mg/d, respectively. The mean±SE changes in the AIMS score from baseline were −6.7±0.43 and −6.2±0.77 in the LESS THAN 65 and ≥65 years cohorts, respectively (percent change: −59.3%±2.70% and −50.0%±5.33%). 71% and 54% of patients in the LESS THAN 65 and ≥65-years cohorts, respectively, achieved ≥50% AIMS response. Most patients achieved treatment success per CGIC (LESS THAN 65, 71%; ≥65, 79%) and PGIC (LESS THAN 65, 65%; ≥65, 59%). Exposure-adjusted incidence rates (incidence/patient-years) were 1.13 and 1.76 for any adverse event, 0.01 and 0.02 for akathisia, 0.06 and 0.09 for somnolence and sedation, 0.06 and 0.18 for Parkinson-like events, and 0.06 and 0.16 for depression in LESS THAN 65 and ≥65-years cohorts, respectively.</div></div><div><h3>Conclusions</h3><div>Deutetrabenazine treatment was associated with improvements in the AIMS score from baseline to Week 145 and treatment success per CGIC and PGIC scores in both age cohorts. Deutetrabenazine was well tolerated in both older and younger patients with TD.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S14"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"47. α-SYNUCLEIN SKIN BOPSY AS A DIAGNOSTIC TOOL FOR PRODROMAL DEMENTIA WITH LEWY BODIES","authors":"Zachary Cohen","doi":"10.1016/j.jagp.2025.04.049","DOIUrl":"10.1016/j.jagp.2025.04.049","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The International DLB Consortium's criteria for diagnosing probable Dementia with Lewy Bodies (DLB) require the presence of major neurocognitive disorder along with either two core clinical features or one core feature plus a supportive biomarker. Separate from these criteria, however, two prodromal forms of DLB (pDLB) have also been described: Mild Cognitive Impairment (MCI)-onset pDLB, characterized by cognitive impairment on neuropsychological testing that does not meet criteria for major neurocognitive disorder (NCD), and psychiatric-onset pDLB, characterized by new or worsening psychiatric symptoms, such as hallucinations, anxiety, or depression, which precede cognitive decline, often by several years.&lt;/div&gt;&lt;div&gt;Since cognitive decline, as well as the core features of DLB—fluctuating cognition, REM sleep behavior disorder (RBD), parkinsonian symptoms, and visual hallucinations (VH)— can be absent or milder in psychiatric-onset pDLB, patients may experience a delayed diagnosis or be misdiagnosed with a primary psychiatric disorder.&lt;/div&gt;&lt;div&gt;Psychiatric-onset pDLB also appears to exhibit a female predominance, and women are more likely to present with milder or absent parkinsonism and a lower incidence of RBD. This can render women particularly vulnerable to delayed diagnoses or misdiagnoses.&lt;/div&gt;&lt;div&gt;An accessible and reliable diagnostic biomarker is crucial for diagnosing psychiatric-onset pDLB. The detection of phosphorylated α-synuclein deposits in peripheral nerves by skin biopsy has emerged as a promising tool, demonstrating excellent accuracy for in vivo diagnosis of α-synucleinopathies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective chart review was conducted on UNC Neurology Clinic patients who underwent α -synuclein skin biopsies based on clinical suspicion for pDLB. A total of 104 patients (61 men, 43 women) aged 50-90 with suspected pDLB were analyzed. Cognitive function was assessed via Montreal Cognitive Assessment (MoCA), Mini Mental State Exam (MMSE), or comprehensive neuropsychological testing.&lt;/div&gt;&lt;div&gt;Presentations were classified as psychiatric-onset if psychiatric symptoms had emerged, or previously stable symptoms worsened, within five years prior to a cognitive decline. Presentations were classified as MCI-onset if patients had cognitive impairment not meeting criteria for major NCD. Clinical diagnosis of DLB was based on the 2017 revised consensus criteria from the International DLB Consortium.&lt;/div&gt;&lt;div&gt;3mm punch biopsies were taken from cervical spine, distal thigh, and distal leg skin sites per the Syn-One Test (CND Life Sciences, Scottsdale, AZ) protocol. Biopsies were immunostained and analyzed for phosphorylated α-synuclein by CND Life Sciences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 104 patients biopsied, 56 were positive for α-synuclein in skin. Among these 56 patients, there was a statistically significant association between female sex and psychiatric-onset pDLB (p ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S34-S35"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"73. THE IMPACT OF SELF- AND CAREGIVER-PERCEIVED ANXIETY SEVERITY ON COGNITIVE FUNCTIONING","authors":"Christopher Reeves ,&nbsp;Ruth Moring ,&nbsp;Ashley Miller ,&nbsp;Lauren Bennett","doi":"10.1016/j.jagp.2025.04.075","DOIUrl":"10.1016/j.jagp.2025.04.075","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Existing literature indicates that anxiety negatively affects memory, attention, and executive functions. High anxiety levels are linked to notable cognitive deficits, which can exacerbate daily challenges associated with cognitive impairment (Gaillard et al., 2021; Vytal et al., 2020; Hwang et al., 2023; Wang et al., 2022). Some studies report an inverse correlation between higher levels of self-reported anxiety and lower performance on cognitive test scores, while others do not find such links. However, discrepancies often exist between self-reported anxiety and caregiver reports of a patient's anxiety, with caregivers sometimes rating anxiety higher (Gulpers et al., 2022; Kaser et al., 2023; Brunet et al., 2019). These differences underscore the importance of using both self-reports and caregiver reports in neuropsychological evaluations, as they offer complementary insights into an individual's subjective experience and observable symptoms (Goodarzi et al., 2019). The study aims to explore whether higher anxiety levels, as perceived by both patients and caregivers, correlate with poorer performance on measures of attention, processing speed, and executive functioning in older adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study cohort consisted of individuals who presented to a community outpatient neuropsychology clinic with cognitive concerns and underwent comprehensive neuropsychological assessment. Participants who completed the Geriatric Anxiety Scale (GAS), had a caregiver complete the Neuropsychiatric Inventory Questionnaire (NPI-Q), and completed various neuropsychological tests of attention, executive functioning, and processing speed (Delis-Kaplan Executive Functioning System – Trails Making Test, Verbal Fluency, Color Word Interference Test, Wechsler Adult Intelligence Scale – Digit Span, Coding) were included in the final sample. Descriptive statistics, correlations, and regression analyses were completed to investigate the relationship between self-reported anxiety symptoms, caregiver assessment of anxiety symptoms, and measures of cognitive functioning.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 578 participants were included in the study. The overall sample had a mean age of 76.45 years (SD = 7.09) and an average of 15.29 years of education (SD = 2.58). The average levels of anxiety symptoms reported reflected minimal levels for both patient self-report (M = 11.52, SD = 9.03) and caregiver report (M = 0.74, SD = 1.24). A correlation analysis revealed a statistically significant relationship between the caregiver's report of anxiety symptoms and the patient's self-report of anxiety symptoms (r = .23, p LESS THAN .01) and the caregiver's report of anxiety symptoms in relation to performance on measures of auditory attention (r = -.08, p = .05) and processing speed (r = -.12, p = .03). An initial hierarchical regression analysis investigating the relationship of demographic variables, patient","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S54"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"30. ONCE -DAILY VALBENAZINE FOR TARDIVE DYSKINESIA OR HUNTINGTON’S DISEASE CHOREA IN PATIENTS WITH DYSPHAGIA","authors":"Roland Jimenez ,&nbsp;Mello Hebert ,&nbsp;Linda Rees ,&nbsp;Alexander Mar ,&nbsp;Ali Bristow ,&nbsp;Kira Aldrich ,&nbsp;Jamie Hamill ,&nbsp;Richard Moore ,&nbsp;Khody Farahmand","doi":"10.1016/j.jagp.2025.04.032","DOIUrl":"10.1016/j.jagp.2025.04.032","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Valbenazine (VBZ) is a unique once-daily medication approved for tardive dyskinesia (TD) and chorea associated with Huntington’s disease (HD). For patients with TD and HD, swallowing whole pills may be difficult due to their motor symptoms, advanced age, or other comorbid conditions. Alternative modes for medication administration are therefore needed. In vitro studies with 2 approved VBZ formulations assessed the following: suitability of crushing the contents of INGREZZA® capsules (compacted, consolidated powder plug) for mixing with soft foods or liquids and potential of delivering crushed capsule contents via gastrostomy tube (G-tube); and compatibility of INGREZZA® SPRINKLE capsules (new and recently approved VBZ granules formulation) with soft foods. A Phase 1 trial in healthy adults determined the bioequivalence between VBZ granules and the powder-plug capsule, and between fed and fasted states for VBZ granules.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The dissolution profile of VBZ crushed capsule contents (compact powder-plug formulation) was analyzed (Study 1), and VBZ recovery was evaluated when the crushed powder was mixed with soft foods and liquids (Study 2) or dispersed in water and delivered via G-tube (Study 3). VBZ recovery was also evaluated for uncrushed VBZ granules mixed with soft foods (Study 4). Acceptability was defined as VBZ recovery of 90-110% (Studies 2/3) or 95-105% (Study 4). A Phase 1 trial (Study 5) used a 3-sequence, 3-period crossover design to assess bioequivalence between the VBZ granules (taken as intact capsule or sprinkled on applesauce) and the intact VBZ powder-plug capsule (Cohort 1). A 2-sequence, 2-period crossover design was used to assess bioequivalence between fed and fasted states for VBZ granules sprinkled on applesauce (Cohort 2). Geometric mean ratios (GMRs) for Cmax and AUC of VBZ and its primary metabolite, [+]-α-dihydroxytetrabenazine ([+]-α-HTBZ), were analyzed for each test condition, with bioequivalence defined as the GMR 90% CI falling within 80-125%.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Studies 1-3 indicated rapid and complete dissolution of crushed powder-plug contents of VBZ capsules (similar to intact capsules) and acceptable VBZ recovery when the crushed contents were added to foods and liquids with a wide pH range or delivered in water via G-tube. Study 4 showed VBZ granules to be compatible with various acidic and non-acidic foods. Study 5 indicated bioequivalence between VBZ granules (intact capsule or sprinkled on applesauce) and the VBZ powder-plug capsule (Cohort 1), with a slight delay in absorption rate of VBZ granules on applesauce (VBZ Cmax) but no effect on overall absorption (VBZ and [+]-α-HTBZ AUC). Bioequivalence between fed and fasted states was demonstrated for VBZ granules (Cohort 2).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Results from in vitro studies and a Phase 1 trial indicate that with 2 approved and available formulations, VBZ offer","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S21-S22"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"53. TRAJECTORIES OF CHANGE IN SUICIDE RISK, THERAPEUTIC ALLIANCE, AND TREATMENT OUTCOMES IN PSYCHOTHERAPIES FOR LATE-LIFE DEPRESSION","authors":"Delaney Callaghan ,&nbsp;Ellie Briskin ,&nbsp;Julia Chafkin ,&nbsp;Oded Bein ,&nbsp;Lindsey Sankin ,&nbsp;Faith Gunning ,&nbsp;Nili Solomonov","doi":"10.1016/j.jagp.2025.04.055","DOIUrl":"10.1016/j.jagp.2025.04.055","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Suicide rates peak in late adulthood, with rates continuing to increase throughout the past decade. Psychotherapies for depression are effective in reducing suicide risk in late-life. The therapeutic relationship is a key predictor of reduction in suicidality during psychotherapy for adult depression. However, little is known about the association between the therapeutic relationship and late-life suicidality. This study aims to examine the relationship between the therapeutic alliance and suicidality during psychotherapy for late-life depression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In a recently completed psychotherapy trial for late-life depression, we recruited 60 older adults between the ages of 50 and 85 (mean = 63.3, SD = 7.54) with major depression (MADRS ≥ 20). Patients received 9-weeks of psychotherapy (either Engage and Connect behavioral activation therapy or Symptom Review and Psychoeducation intervention). Depression severity and suicidal ideation (SI) were measured at weeks 0, 3, 6, and 9 using the Montgomery-Asberg Depression Rating Scale. Quality of the therapeutic relationship was measured with the self-reported Working Alliance Inventory from the patient. We categorized individuals into three SI groups: 1) persistent SI (an increase or no change in ideation throughout the study); 2) remitted SI (a decrease in ideation throughout the study); and 3) absent SI (no ideation endorsed at any point during the study). Using linear mixed-effects models, we tested whether therapeutic alliance from the patient perspective differed between the three SI groups over time.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We found that throughout the study, patients with persistent and remitted suicidal ideation consistently had significantly lower therapeutic alliance scores compared to those without suicidal ideation (F[2,58] = 12.52, p &lt; .001). We also found a significant interaction, such that the difference in therapeutic alliance between the group with persistent SI and those with no SI increased over time (F[16,422] = 2.22, p &lt; .01). Alliance in both the remitted and absent SI groups increased throughout treatment (as of week 5, t’s &gt; 2, p’s &lt; .05; aside from week 7 in the remitted SI group, p = .12). In contrast, alliance decreased throughout therapy in the group with persistent SI (as of week 6, t’s &gt; 2, p’s &lt; .05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The preliminary results indicate a relationship between persistent suicidal ideation and therapeutic alliance. Patients with persistent suicidal ideation reported lower alliance scores throughout the study. In addition, those with persistent SI showed consistent difficulty developing and sustaining a strong alliance over the course of treatment. These findings could inform personalization of psychotherapy to include alliance-building interventions with this subgroup. Further, future research can examine mediators and moderators of this relationsh","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S39-S40"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"76. GLP-1 RECEPTOR AGONISTS AND ALZHEIMER'S DISEASE: ASSESSING THEIR THERAPEUTIC POTENTIAL","authors":"Tarlan Kehtari ,&nbsp;Patricia Junquera","doi":"10.1016/j.jagp.2025.04.078","DOIUrl":"10.1016/j.jagp.2025.04.078","url":null,"abstract":"<div><h3>Introduction</h3><div>Alzheimer's Disease (AD) is a progressive neurodegenerative disorder with current therapeutic approaches offering limited efficacy in modifying its course. Recent data suggest that GLP-1 receptor agonists, traditionally utilized for glycemic regulation in type 2 diabetes, may exhibit neuroprotective effects with potential implications for AD treatment. This review aims to synthesize and critically assess the impact of GLP-1 receptor agonists on AD-related outcomes, including cognitive decline, neurodegeneration, and cerebral glucose metabolism.</div></div><div><h3>Methods</h3><div>A comprehensive narrative review was conducted, integrating findings from various clinical trials examining the efficacy of GLP-1 receptor agonists in mitigating AD pathology. The review also explores the underlying mechanisms, particularly focusing on the modulation of neuroinflammation, synaptic plasticity, and brain glucose homeostasis.</div></div><div><h3>Results</h3><div>The findings demonstrate a modest but statistically significant attenuation of brain atrophy, predominantly in the hippocampal and cortical regions, which are heavily implicated in AD progression. Moreover, improvements in cerebral glucose uptake and metabolism were observed, addressing the metabolic deficits characteristic of AD.</div></div><div><h3>Conclusions</h3><div>While the current evidence is promising, heterogeneity in study design and small sample sizes limit the generalizability of these findings. Future large-scale, long-duration trials are essential to confirm the therapeutic potential of GLP-1 receptor agonists in AD and to further elucidate their neuroprotective mechanisms. Incorporating these agents into existing AD treatment protocols could represent a novel and potentially transformative approach to disease modification.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S56"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"79. INFORMATION BEGETS INTEREST: ENHANCING MEDICAL STUDENT ENGAGEMENT IN GERIATRIC PSYCHIATRY THROUGH A TARGETED EDUCATIONAL INTERVENTION","authors":"Toni Carter","doi":"10.1016/j.jagp.2025.04.081","DOIUrl":"10.1016/j.jagp.2025.04.081","url":null,"abstract":"<div><h3>Introduction</h3><div>With the rapidly aging population, ensuring equitable access to mental healthcare for older adults is a pressing human rights issue. Despite this, geriatric psychiatry remains underrepresented in medical curricula and may hinder future physicians’ ability to recognize and address the mental health needs of older adults. At the University of Florida School of Medicine, geriatric psychiatry was previously designated for self-study within the psychiatry clerkship, limiting opportunities for structured, interactive learning. To address this gap, a geriatric psychiatry lecture was developed and delivered to third-year medical students during their psychiatry clerkship</div></div><div><h3>Methods</h3><div>The geriatric psychiatry lecture is anticipated to be taught to three rotations of third-year medical students (n = 30-45) from October 2024 through initial data analysis in February 2025 and continue thereafter with appropriate revisions. The lecture combined traditional teaching with an interactive case-based approach, where students applied their knowledge to diagnose a geriatric patient with non-specific symptoms. Additionally, the session included practice questions designed to reinforce key concepts and promote active learning. After the lecture, students completed an anonymous survey assessing interest in geriatric psychiatry, previous exposure to the field of geriatric psychiatry, and perceptions of the lecture’s relevance and effectiveness. Survey responses are currently under analysis. This project was deemed IRB-exempt as it involved the evaluation of an educational intervention without collection of sensitive or identifying student data.</div></div><div><h3>Results</h3><div>While the survey data is still being collected and analyzed, it is anticipated that this interactive approach will enhance students' understanding of geriatric psychiatry and foster a greater interest in the psychiatric care of older adults. The feedback will inform improvements to the lecture and help determine the effectiveness of the interactive elements in promoting learning and engagement. Results are anticipated to be analyzed in February 2025.</div></div><div><h3>Conclusions</h3><div>This targeted educational initiative represents a key step in improving geriatric psychiatry education within the medical school curriculum at the University of Florida. By incorporating case-based learning and interactive elements, the project aims to equip future physicians with the knowledge and interest necessary to meet the psychiatric needs of an aging population. Survey results will guide further refinement of the lecture and contribute to ongoing efforts to integrate geriatrics more fully into medical education.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S58-S59"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"80. MAPPING RESIDENT COMPETENCY: NATIONAL SURVEY ON GERIATRIC MILESTONES IN MEDICATION MANAGEMENT, BEHAVIORAL HEALTH, AND PATIENT SAFETY BY THE LIGHTS-RX HARM REDUCTION PROGRAM","authors":"Monica Pelowski","doi":"10.1016/j.jagp.2025.04.082","DOIUrl":"10.1016/j.jagp.2025.04.082","url":null,"abstract":"<div><h3>Introduction</h3><div>The increasing demand for competent geriatric care necessitates a thorough assessment of resident training in key areas. With an insufficient number of geriatric psychiatrists to meet the needs of the aging population, primary care providers are expected to take on a greater role in managing the behavioral, affective, and substance use issues of older adults. However, early insights indicate that there may be opportunities to enhance training in these areas to better support their efforts. This study aims to evaluate self-perceived competency levels among first- and senior-year residents in family medicine, internal medicine, and psychiatry, focusing on medication management, cognitive and behavioral health assessment, hospital patient safety, and substance use disorder management.</div></div><div><h3>Methods</h3><div>We will conduct a nationwide survey based on the American Geriatric Society’s milestones, targeting residents across the United States. This survey is an expanded and refined version of our pilot study conducted in the Lansing area, which indicated that residents often feel their competencies in these critical areas do not meet their expectations. Additionally, the survey will incorporate questions addressing perceptions of ageism in healthcare settings, aiming to explore how these attitudes may impact the quality of care provided to older adults.</div></div><div><h3>Results</h3><div>Data collection is currently in progress, with completion anticipated by March 2025, in time for presentation at the American Association of Geriatric Psychiatry conference. Preliminary findings from the pilot study suggest significant gaps in self-perceived competencies, highlighting areas for potential curricular enhancement.</div></div><div><h3>Conclusions</h3><div>The results of this national survey will provide valuable insights into the training needs of medical residents in geriatric care, informing educational strategies aimed at improving competency and patient outcomes in this vulnerable population.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S59"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"81. CONVERSATION STARTERS, PART 2: RESIDENT EXPERIENCES WITH ADVANCE CARE PLANNING","authors":"Brian Donley ,&nbsp;Erica Garcia-Pittman","doi":"10.1016/j.jagp.2025.04.083","DOIUrl":"10.1016/j.jagp.2025.04.083","url":null,"abstract":"<div><h3>Introduction</h3><div>Advance Care Planning (ACP) is an important yet underutilized process. While taught and practiced more heavily in other specialties, psychiatry residents have little exposure to it. However, psychiatrists are well-positioned to have these complex discussions, discussing patient values, and assessing capacity. A previous poster presented in 2024 examined resident perceptions of ACP. Here, we present results from a workshop training psychiatry residents to conduct ACP discussions as part of their outpatient Geriatric Psychiatry clinic.</div></div><div><h3>Methods</h3><div>As part of an introduction to the outpatient training year and outpatient geriatric psychiatry clinic, general psychiatry residents were given a one-hour lecture on medical advance care planning. This discussed the evidence supporting advance care planning and its components, and included an experiential activity of residents completing their own Values worksheets through the National Institute on Aging. They were provided with copies of legal documents for designating a Medical Power of Attorney and an advance directive, and instructed how to direct patients to appropriate resources. Surveys were given before and after the activity to assess residents’ knowledge and comfort with aspects of ACP.</div></div><div><h3>Results</h3><div>n=9 PGY2 residents completed pre- and post- surveys of the ACP workshop. Wilcoxan signed-rank test was used as a non-parametric test due to low sample size. Residents rated significant improvement (p LESS THAN 0.05) in general knowledge about ACP and its components, filling out ACP paperwork and directing patients to further resources, improved confidence in initiating and conducting ACP discussions with their patients. There was not a significant difference between rating concerns about having enough time to discuss ACP, and that ACP should be conducted primarily by other specialties.</div><div>Prior to the workshop, residents also rated lacking knowledge and experience as barriers to engaging in ACP with their patients. Self-rated confidence regarding knowledge of ACP improved (p LESS THAN 0.5) on post-test.</div></div><div><h3>Conclusions</h3><div>In this small pilot study, psychiatry residents improved their knowledge and confidence in conducting advance care planning discussions with their patients. We will also present data regarding the actual rate of documented ACP conversations in new patient intake and patient transfer appointments mid-way (6 months) into the outpatient training year, and qualitative data regarding the residents’ experience with ACP. Future work will aim to teach residents about advance care planning specifically in people with or at high risk for neurocognitive disorders.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S59-S60"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"87. RETHINKING STRUCTURAL CONSIDERATIONS IN THE DIFFERENTIAL DIAGNOSIS OF GERIATRIC 3D: AN INDIGENOUS ELDER’S SUICIDE BY SELF-IMMOLATION IN TAIWAN","authors":"Wei-Ting Tseng ,&nbsp;Yi-Cheng Wu ,&nbsp;Liang-Jen Wang","doi":"10.1016/j.jagp.2025.04.089","DOIUrl":"10.1016/j.jagp.2025.04.089","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;This is a 71-year-old Indigenous male patient who was admitted to a medical center after self-immolation during a protest. He was hospitalized in the Burn ICU for treatment of third degree of major burns to his face and upper limbs, an inhalation injury and sepsis. Following extubation, the psychiatrist team was consulted to evaluate his suicide attempt, insomnia, and episodic agitation.&lt;/div&gt;&lt;div&gt;Upon psychiatric evaluation, the patient was alert and oriented to place, but not fully in time. He reported feeling “dysphoric” for months, with poor sleep, appetite, and a sense of hopelessness. Long-term land dispossession and a recent government demolition order targeting his tribe’s homes contributed to his distress. He revealed that he premeditated his self-immolation, purchasing gasoline two days before and leaving a note: “burn, not yet consumed.” Tracing his personal history, born in his traditional territory, he had left young due to colonial land policies, working high-risk jobs in cities. Decades later, he returned post-retirement, but his resettled community was devastated by typhoons. Despite his outgoing nature, his family observed increasing impulsivity and rumination over land issues This self-immolation act was his first time considering and attempting suicide. There’s no violence, substance or any psychiatric history for him. His has type 2 diabetes under regular medication control, otherwise he’s healthy. In later psychiatric follow-up evaluation, he expressed regretful feeling about his suicide, stating he “heard God’s voice saying this [suicide act] was wrong” and “visioned a battle between God and Satan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Tentative psychiatric diagnoses include geriatric depression, delirium, and consideration of neurodegenerative disorder, like mild behavioral impairment. His laboratory results showed hypoalbuminemia, thrombocytopenia, and anemia, which were related to his major burn injury. The psychologist attempted a neurocognitive test but could not complete it due to the language barrier, as the examination tools were not available in the patient’s native tongue.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This case brings up a challenging reflection on the health disparity in standard evaluation for suicide and differential diagnosis among marginalized populations like Mr. M, who falls into the classic geriatric \"3D\" categories: depression, delirium, and dementia (neurocognitive disorder).&lt;/div&gt;&lt;div&gt;The SADPERSONS scale, a standardized suicide risk tool, was utilized in the patient’s evaluation. Some static demographic factors were score positive such as male gender, old age, and the organization of his suicide plan. However, the interpretation of his “dysphoric and angry mood” as “depressed mood” and his vivid, unusual experiences (noted as visual and auditory hallucinations) reflected his cultural and spiritual background. These experiences may not necessarily indicate “loss of r","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S65"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}