American Journal of Geriatric Psychiatry最新文献

{"title":"12. INTEGRATING BEHAVIORAL HEALTH INTO A GERIATRIC CLINIC","authors":"Ann Pearman ,&nbsp;Mollie Goldfinger","doi":"10.1016/j.jagp.2025.04.015","DOIUrl":"10.1016/j.jagp.2025.04.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Integrating behavioral health into medical settings, such as primary care clinics, has been shown to have a positive impact on the well-being and health of patients. Increased access to mental health services as well as increased identification of psychiatric issues is an important goal for all patients but may be of particular importance for geriatric patients who often have multiple chronic conditions along with an increased risk of neurocognitive disorders.</div><div>This paper is intended to describe the process of starting an geriatric behavioral health service line into geriatric and internal medicine clinics at a large urban hospital that serves a primarily underserved population of patients.</div></div><div><h3>Methods</h3><div>Using Slicer/Dicer to extract data from the health record system (EPIC), this presentation will describe the geropsychology practice from 2022 to end of year 2024. Data included in the presentation will highlight referral pathways, diagnoses, and treatment plans.</div></div><div><h3>Results</h3><div>There have been over 2600 referrals to the Geropsychology Service since its inception. Approximately 70% of the referrals were for counseling and 30% for assessments for neurocognitive disorders. Diagnoses include depression (25%), anxiety (19%), memory/cognitive concerns (18%) and other, including grief, bipolar disorder, and adjustment issues (28%).</div></div><div><h3>Conclusions</h3><div>The data shows both the success of the new practice as well as highlighting the need for additional integrated mental health care in this population. We discuss the process of starting a geropsychology practice in a geriatric medicine setting as well as a geropsychiatry setting. In addition, we describe the ongoing development of Geropsychology-specific training opportunities for psychology and medical residents and fellows.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S9"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613902","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":"38. INVESTIGATING THE EFFECTS OF PRESCRIBED MEDICATION ON COGNITION OF MEXICAN PEOPLE WITH SCHIZOPHRENIA","authors":"Veronica Hernandez ,&nbsp;Jerry McDonald ,&nbsp;Lisa Eyler ,&nbsp;Ellen Lee","doi":"10.1016/j.jagp.2025.04.040","DOIUrl":"10.1016/j.jagp.2025.04.040","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;People with schizophrenia (PwS) experience psychotic (positive and negative) symptoms and along with overall cognitive impairment. Such deficits often predict increased physical comorbidities and a greater degree of disability. While antipsychotic, anticholinergic, psychotropic, and non-psychotropic medications effectively treat symptoms in many PwS, most studies focus predominantly on non-Hispanic White individuals. This focus results in limited evidence regarding the effects of prescribed medications on cognition among Mexican PwS, who may face unique challenges such as cultural stigma and barriers to care that can impact treatment outcomes and cognitive functioning. Notably, research indicates that Latinos experience a higher prevalence of psychotic symptoms compared to non-Hispanic White individuals and are less likely to seek and receive treatment for mental health comorbidities. Efforts to improve the quality of life and health outcomes for PwS have often been ineffective, largely due to the heterogeneity in schizophrenia research. This study aimed to expand the understanding of ethnic differences in the lived experiences of PwS and to develop more tailored interventions. We analyzed medication usage based on Mexican and non-Hispanic White ethnicity and investigated the effects of prescribed antipsychotic and anticholinergic medications on cognition. Furthermore, we explored how sex and ethnicity are related to cognitive functioning in PwS. We hypothesized that 1) Mexican PwS would have higher antipsychotic dosing and anticholinergic burden than non-Hispanic White PwS; 2) Mexican PwS would be more likely than non-Hispanic White PwS to be prescribed antipsychotic, anticholinergic, psychotropic, and antidepressant medications; 3) and larger doses of antipsychotic medication and higher anticholinergic burden would be associated with worse executive functioning and processing speed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The study sample included 111 PwS ages 26 to 66 from a completed NIH-funded study that included English-speaking PwS and non-psychiatric controls of Mexican and non-Hispanic White background from the San Diego County area. We collected drug records including current medication, dosage, and type for all participants. We also asked participants about anticholinergic burden, which refers to the overall effects of taking various anticholinergic medications. Additionally, we standardized antipsychotic dosage information using the World Health Organization’s Defined Daily Dose (WHO DDD). We administered the Delis-Kaplan Executive Function System (D-KEFS) to assess domains of cognition, including speed of processing and executive functioning, the Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, and the Calgary Depression Scale. Our analyses included T-tests to analyze group and mean differences, logistic regressions to predict the likelihood of medication usage,","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S27-S28"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614142","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":"97. GLOBAL VARIATIONS IN ELECTROCONVULSIVE THERAPY USAGE: A COMPARATIVE CASE SERIES ON SCHIZOPHRENIA IN THE UNITED STATES","authors":"Serena Park ,&nbsp;Jonathan Kim ,&nbsp;Sarah Touponse ,&nbsp;Ally Mandell ,&nbsp;Jeffery Hong ,&nbsp;Andrea Crowell ,&nbsp;Adriana Hermida ,&nbsp;Brandon Kitay ,&nbsp;William McDonald ,&nbsp;Patricio Riva Posse ,&nbsp;Rachel Hershenberg","doi":"10.1016/j.jagp.2025.04.099","DOIUrl":"10.1016/j.jagp.2025.04.099","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Electroconvulsive Therapy (ECT) is an established treatment for treatment-resistant depression (TRD), and severe psychiatric conditions, including schizophrenia, schizoaffective disorder, catatonia (Kellner et al., 2012). Globally, ECT application varies significantly, particularly between depression and schizophrenia. In the United States, ECT is used for treating major depressive disorder, whereas treatment for schizophrenia is less common. Conversely, in many Asian countries, including Japan, and regions in the Middle East, ECT is more frequently administered for schizophrenia (Chanpattana et al., 2005; Chapattana et al., 2010; Younis et al., 2022). A survey of 23 Asian countries showed that 41.8% of ECT treatments were for schizophrenia compared to 32.4% for major depression (MDD)(Chanpattana et al., 2005). ECT literature from Japan reports similar trends, while in countries such as Spain and Switzerland ECT are primarily used for depression (up to 80% of treatments in reported literature) (Chanpattana et al., 2005; Vera, et al., 2016; Wilhelmy, et al., 2023). This analysis explores whether differences in ECT usage between depression and schizophrenia stem from treatment efficacy or are shaped by medical cultural differences. Despite the proven effectiveness of ECT treatment for other conditions outside of major depression or treatment-resistant depression, global usage of ECT is inconsistent with published literature as arbitrary restrictions limit access for patients with severe mental illnesses (Tor et al., 2021).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A case series including three cases of the use of electroconvulsive therapy (ECT) to treat geriatric patients with schizoaffective disorder. Patient symptomatic response and clinical improvement were assessed with the Clinical Global Impression-Improvement (CGI-I) and Clinical Global Impression-Severity (CGI-S). Stabilization of mood was assessed with the Beck Depression Inventory (BDI), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire-9 (PHQ-9).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Case 1: 30-year-old male with a longstanding diagnosis of obsessive-compulsive disorder, autism spectrum disorder, and schizoaffective disorder, depressive type, who presented with a series of paranoia episodes over the series of a year. ECT was recommended to the patient as he was a prior responder; he received 77 ECT treatments in the clinic. Marked improvement in hallucinations, delusions, and speech latency were observed after five treatments. By ECT #11, the patient showed significant remission of psychotic symptoms and notable mood stabilization with a CGI-I of 1. By ECT #77, CGI-I was 2, CGI-S was 3, BDI was 13, GAD-7 was 4, and PHQ-9 was 6.&lt;/div&gt;&lt;div&gt;Case 2: 48-year-old female with bipolar type schizoaffective disorder who presented with paranoia, delusions, anxiety, depression and mania. The patient previously received 22 ECT treatments the year b","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S71-S72"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614266","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":"1. HIGH-SENSITIVITY C-REACTIVE PROTEIN (HSCRP) EFFECTS ON COGNITION AND BRAIN HEALTH IN OLDER ADULTS","authors":"Meghan Reddy ,&nbsp;Prabha Siddarth ,&nbsp;Meachelle Lum ,&nbsp;Jonah Im ,&nbsp;Dara Ghahremani ,&nbsp;Helen Lavretsky","doi":"10.1016/j.jagp.2025.04.004","DOIUrl":"10.1016/j.jagp.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammation can affect cognition and brain health in older adults, potentially leading to cognitive decline. Furthermore, systemic inflammatory markers, such as C-reactive protein levels, have been associated with increased risk of cognitive impairment. We aimed to examine the relationship between plasma levels of high-sensitivity C-reactive protein (hsCRP), cognition, and brain regional volume in a large cross-sectional study of older adults. We primarily focused on subcortical brain structures important for learning and memory, including striatal nuclei.</div></div><div><h3>Methods</h3><div>Participants received neuropsychological testing, provided blood samples, and underwent high-resolution sMRI. Brain volumes were computed using Freesurfer (v. 7.4.1). We used general linear models to examine relationships between plasma hsCRP levels and cognition/regional volumes, with age, sex, ethnicity, study site, intra-cranial volume (for brain volumes) as covariates. Age was treated as a factor with 2 levels (LESS THAN 65 and ≥ 65 years). HsCRP level was log-transformed for analysis. Measures of cognition included short-term memory recall (using the Rey Auditory Verbal Learning Test) and two factors derived from several cognitive measures: “memory” and “fluid IQ” (e.g. executive function). Regional volumes examined included hippocampus, striatum (caudate, putamen, pallidum, accumbens), amygdala, and thalamus.</div></div><div><h3>Results</h3><div>Data from the Human Connectome Project-Aging study (N=1132; mean age: 61.8 (SD=16), range 36-102 years; 57.2% female) were analyzed. We found that hsCRP levels were negatively associated with the cognitive function, as measured by fluid IQ (p LESS THAN 0.05). We also found that hsCRP levels were negatively associated with brain volume in the following brain regions: hippocampus (p LESS THAN 0.01), acummbens (p LESS THAN 0.01), amygdala (p LESS THAN 0.01), and pallidum (p LESS THAN 0.02).</div></div><div><h3>Conclusions</h3><div>In our study population, higher plasma hsCRP level correlated with reduction in cognitive function and brain volume. Results from this large sample underscore the importance of inflammation, as measured by hsCRP, as a determinant for brain health. Further longitudinal studies are indicated to assess potential causal relationships.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S1"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614359","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":"57. BREAKING THE ILLUSION: SUCCESSFUL RESOLUTION OF CAPGRAS SYNDROME WITH RIVASTIGMINE TREATMENT IN LEWY BODY DEMENTIA","authors":"Anureet Sekhon ,&nbsp;Rameez Sultan ,&nbsp;Jonathan Sasse ,&nbsp;Silpa Balachandran ,&nbsp;Rachida Bouhenni","doi":"10.1016/j.jagp.2025.04.059","DOIUrl":"10.1016/j.jagp.2025.04.059","url":null,"abstract":"<div><h3>Introduction</h3><div>Capgras Syndrome is a rare delusional misidentification syndrome characterized by the false belief that a familiar person has been replaced by an identical imposter. While primarily associated with psychotic disorders, it can also occur in the context of neurocognitive disorders. Treatment options for Capgras Syndrome remain limited, with few reported cases of successful management. Here we report a case of complete resolution of Capgras Syndrome in a patient with Lewy Body dementia (LBD) following treatment with rivastigmine.</div></div><div><h3>Methods</h3><div>An 82-year-old male, initially presented with memory decline and poor sleep. He exhibited confusion and disorganized behavior following a cruise trip to South America in January 2020.</div><div>Neuropsychological testing revealed neurodegenerative disorder, and subsequent evaluation led to a diagnosis of LBD. The patient's symptoms included the belief that he was living in a duplicate version of his home and his wife has been replaced by an imposter, consistent with Capgras Syndrome.</div><div>Treatment with rivastigmine patch was initiated, with subsequent switch to oral formulation due to tolerance issues.</div><div>After nine months of treatment, the patient reported complete resolution of Capgras Syndrome symptoms.</div><div>Additional neuropsychological testing found improvement in attention, visuospatial, story memory, and divided attention, and declines in verbal abstraction and word list recognition, since his previous testing in 2020.</div></div><div><h3>Results</h3><div>This case highlights the importance of exploring treatment options beyond standard psychotropic medications in neurodegenerative disorders. The resolution of Capgras Syndrome with rivastigmine underscores the need for further research into cholinergic modulation in managing psychotic symptoms associated with LBD.</div></div><div><h3>Conclusions</h3><div>Our case highlights the successful treatment of Capgras Syndrome in a patient with LBD using rivastigmine. Further research is needed to elucidate the underlying mechanisms and optimize treatment strategies for this rare but debilitating condition. Cholinesterase inhibitors may offer a promising therapeutic approach for Capgras Syndrome, but additional studies are necessary to confirm their efficacy and safety profile.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S42"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614400","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":"48. TRANSITIONING BETWEEN DRUG CLASSES IN ELDERLY ADULTS: DATA FROM TWO STUDIES WITH LEMBOREXANT AND Z-DRUGS","authors":"Motohiro Ozone ,&nbsp;Maha Ahmad ,&nbsp;Margaret Moline ,&nbsp;Naohisa Uchimura ,&nbsp;Hiroshi Hiejima ,&nbsp;Kenta Murotani ,&nbsp;Takehiro Taninaga ,&nbsp;Jocelyn Y. Cheng ,&nbsp;Dinesh Kumar","doi":"10.1016/j.jagp.2025.04.050","DOIUrl":"10.1016/j.jagp.2025.04.050","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Insomnia is one of the most prevalent sleep disorders in older adults. Switching insomnia medications occurs frequently in clinical practice for a variety of reasons, including clinical response, side effects, cost, and patient preference. Few studies have evaluated the impact of transitioning between insomnia medications, especially in the elderly population for whom insomnia is disproportionally prevalent. Lemborexant (LEM) is a dual orexin receptor-antagonist approved in multiple countries, including the United States and Japan, for the treatment of adults with insomnia. Two studies (United States: E2006-A001-312, Study 312, NCT04009577; Japan: E2006-M081-401, Study 401, NCT04742699) evaluated the strategies for transitioning to LEM 5 mg (LEM5) or 10 mg (LEM10) in adults with insomnia who were dissatisfied with the efficacy and/or tolerability of their current treatment with a non-benzodiazepine sedative-hypnotic (Z-drug). This post hoc analysis evaluated the success rate of transitioning to LEM and the impact on insomnia severity in participants aged ≥65 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Both open-label studies examined prespecified dosing paradigms for participants directly transitioning from a Z-drug to LEM without down-titration of the Z drug. Study 312 consisted of a 3-week Screening Period (participants continued zolpidem tartrate [ZOL]), a 2-week Titration Period (TITR), a 12-week Extension Period (EXT; not reported here), and a 4-week Follow-up Period (not reported here). In Study 312, adults with insomnia who used ZOL intermittently (3–4 nights/week) or frequently (≥5 nights/week) were assigned to 1 of 2 cohort s. Cohort 1, intermittent ZOL users and participants with 1 week each of intermittent and frequent ZOL usage, began TITR with LEM 5. Cohort 2 consisted of frequent ZOL users who received ZOL ≥5 nights/week during the last 2 weeks of the screening period and were randomized 1:1 to LEM5 (Cohort 2A) or LEM10 (Cohort 2 B). Study 401 followed a similar design except for a 2-week Screening Period where participants continued their current Z-drug (ZOL, zopiclone, or eszopiclone). All participants in Study 401 started with LEM 5. Endpoints in this post hoc analysis included the proportion of participants who successfully transitioned to LEM at the end of TITR and change from baseline in insomnia severity (assessed by the Insomnia Severity Index [ISI]). Successful transition was defined as the proportion of participants who elected to remain on LEM in the EXT. Safety information was also collected.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 53 participants in the Full Analysis Set in Study 31 2, 21 participants were aged ≥65 years (Cohort 1, n=5; Cohort 2A, n=5; Cohort 2B, n=11). In Cohort 1, 4 of 5 (80.0%) participants successfully transitioned from ZOL to LEM. In Cohort 2A, 5 of 5 (100.0%) successfully transitioned, and in Cohort 2B, 7 of 11 (63.6%) successfully transitioned from ZOL to LEM. O","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S35-S36"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614095","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":"71. \"I THINK I HAVE ADHD”: DIFFERENTIATING LATE-ONSET ADHD FROM MCI IN OLDER ADULTS","authors":"Anne Waniger ,&nbsp;Maria Lapid","doi":"10.1016/j.jagp.2025.04.073","DOIUrl":"10.1016/j.jagp.2025.04.073","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Cognitive complaints in patients over the age of 65 are common and associated with underlying conditions such as depression, anxiety, or the early stages of a neurodegenerative disease. Patients meeting criteria for mild cognitive impairment (MCI) may also be misdiagnosed with attention deficit hyperactivity disorder (ADHD) due to overlapping symptoms such as difficulties with sustained attention, organization and memory. This overlap can complicate the differential diagnosis and may lead to inappropriate treatments. While studies have examined the increased risk of dementia in individuals with pre-existing ADHD, there is limited literature describing cases in which patients with a new late-onset ADHD diagnosis were later found to have a neurodegenerative disease as a better explanation for their symptoms. Accurate differentiation between MCI and ADHD is crucial for providing appropriate care and counseling for patients and their families.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We describe two cases of patients in their 70s who were initially diagnosed with ADHD after reporting subjective cognitive difficulties and undergoing neuropsychometric testing. Further evaluation, including neuroimaging, revealed cognitive impairment secondary to a neurodegenerative disease. We describe the clinical presentation, diagnostic workup, and the role of neuroimaging in clarifying the diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Patient #1 presented to a psychiatric clinic at age 75 with an 18-month history of word finding difficulties and depression, which had previously been in remission for several decades. Neuropsychometric testing one year prior to evaluation was normal across most domains, with relative areas of weakness with attention regulation and executive function, thought to be consistent with a diagnosis of ADHD with contributions from anxiety and depression. He was started on a new antidepressant in addition to Adderall. Repeat neuropsychometric testing did not indicate significant progression, and further testing was not pursued. One year later, he returned to his primary physician with worsening memory concerns and functional decline. He was evaluated by Neurology, who were concerned about cognitive impairment now in the moderate range. He underwent an FDG-PET, which demonstrated a pattern consistent with Alzheimer’s disease.&lt;/div&gt;&lt;div&gt;Patient #2 presented to a behavioral neurology clinic at age 77 for a second opinion regarding approximately 4 years of memory concerns. Neuropsychometric testing 6 months prior to evaluation revealed mild cognitive impairment with a mild decline in memory compared to previous testing 3.5 years earlier. He also underwent brain MRI and FDG-PET at that time, which were interpreted as normal. He was diagnosed with ADHD and started on Adderall. Subsequent neuropsychometric testing was consistent with MCI, amnestic, multi-domain. FDG-PET revealed mildly decreased FDG uptake in the left an","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S52-S53"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614098","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":"60. SYSTEMATIC REVIEW OF FLUPHENAZINE EFFICACY IN TREATMENT-RESISTANT PSYCHOSIS FOR OLDER ADULTS","authors":"Jacklyn Vargas ,&nbsp;Hossein Fattahi ,&nbsp;Kie Fuji ,&nbsp;Omar Ghosh ,&nbsp;Raisa Yagudayeva","doi":"10.1016/j.jagp.2025.04.062","DOIUrl":"10.1016/j.jagp.2025.04.062","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Treatment-resistant psychosis presents significant challenges for the older adult population (&gt; 60 years of age), who are more often vulnerable to medication side effects and with complex medical comorbidities. Fluphenazine, a high-potency typical antipsychotic, has been used to manage symptoms of psychosis for decades. However, the efficacy of fluphenazine compared to other antipsychotics remains under-researched in older adults with treatment-resistant psychosis among other first generation antipsychotics. A recent case series conducted at the University of California San Diego inpatient Geriatric Psychiatry Unit demonstrated marked clinical efficacy of fluphenazine in managing symptoms of treatment-resistant psychosis in the older adult population, guiding further interest in a larger clinical comparison of this medication to other antipsychotics. This review aims to synthesize evidence regarding the effectiveness and safety profile of fluphenazine in older adults with treatment-resistant psychosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a systematic review in accordance with Prospero guidelines. Studies were identified through searches of PubMed and the Cochrane Library, with the last search conducted on October 13, 2024. Inclusion criteria comprised randomized controlled trials (RCTs), meta-analyses, and case series that compared fluphenazine with typical or atypical antipsychotics in adults, with a particular focus on older patients with treatment-resistant psychosis. Studies had to report clinical outcomes, treatment adherence, or adverse effects. Exclusion criteria included studies that only focused on children (&lt; 18 years) with psychosis, studies with low-quality of evidence, and studies that did not report on treatment-resistant psychosis. Data were synthesized by qualitatively comparing treatment outcomes, treatment adherence, and adverse effects across studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Eight studies were included, comprising of 2 RCTs, 3 observational studies, 2 meta-analyses (7 RCTs in Study 1, and 4 RCTs in Study 2), and 1 case series. The studies collectively involved over 4621 participants, ranging from adults aged 18 to older adults with treatment-resistant schizophrenia or schizoaffective disorders. One meta-analysis, including 7 RCTs and 1,567 participants, found no significant differences in treatment response between fluphenazine and low-potency antipsychotics; however, the fluphenazine group had a higher incidence of EPS. Another meta-analysis (4 RCTs, 202 participants) comparing fluphenazine to atypical antipsychotics (risperidone, quetiapine, olanzapine) reported no significant differences in symptom improvement, but more patients on fluphenazine required additional anticholinergic medications. Of note, the two meta-analyses only included RCTs with no older adults represented among the participants. An RCT (n=38) in treatment-resistant schizophrenia showed similar","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S44-S45"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614169","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":"78. GERIATRIC PSYCHIATRY TRAINING IN RESIDENCY: ADDRESSING GAPS AND ENHANCING PREPAREDNESS (AAGP SCHOLAR PROGRAM PROJECT)","authors":"Erica Stagliano ,&nbsp;Helen Kyomen","doi":"10.1016/j.jagp.2025.04.080","DOIUrl":"10.1016/j.jagp.2025.04.080","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The field of geriatric psychiatry is increasingly recognized as essential due to the growing elderly population and the unique mental health challenges faced by this demographic. Data from the Accreditation Council for Graduate Medical Education reported a peak of 106 geriatric psychiatry fellows during the 2002–2003 academic year that decreased to just 48 during 2020–2021, equating to a 55% drop in fellowship enrollment. Thus, residents' preparedness and confidence in managing geriatric psychiatric conditions by completion of residency are more critical than ever. Research indicates that access to geriatric psychiatry faculty is a key factor influencing interest in the specialty. With such a drastic decline in specialists joining the field, how can training during residency be optimized to meet the growing demand of the aging population, who will undoubtedly come under the care of the general adult psychiatrist?&lt;/div&gt;&lt;div&gt;This project, conducted as part of the AAGP Scholars Program, aimed to evaluate residents' perspectives on their training regarding their confidence and preparedness in managing geriatric psychiatric treatment, particularly within a program without geriatric psychiatry fellowship-trained faculty on services. Based on the feedback obtained, targeted educational interventions were implemented, including the development of a geriatric psychiatry lecture series, a comprehensive curriculum, and a hands-on, longitudinal enrichment activity—a scavenger hunt—designed for residents and medical students during their geriatric psychiatry rotation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;An anonymous survey was designed to assess psychiatry residents' perceptions and preparedness in the field of geriatric psychiatry in a psychiatry residency program without geriatric psychiatry fellowship-trained faculty on services.&lt;/div&gt;&lt;div&gt;The anonymous, online survey consisted of multiple-choice and Likert-scale questions designed to evaluate the following domains:&lt;/div&gt;&lt;div&gt;-Understanding of the scope of geriatric psychiatry.&lt;/div&gt;&lt;div&gt;-Perceived importance of geriatric psychiatry training.&lt;/div&gt;&lt;div&gt;-Confidence in initiating the diagnostic workup of dementia and discussing treatment options.&lt;/div&gt;&lt;div&gt;-Preparedness to manage acute psychiatric needs of geriatric patients.&lt;/div&gt;&lt;div&gt;-Contributing factors to preparedness.&lt;/div&gt;&lt;div&gt;-Areas where additional training or education is needed/desired.&lt;/div&gt;&lt;div&gt;In response to the identified gaps in geriatric psychiatry training among residents, a targeted lecture series was developed in four parts:&lt;/div&gt;&lt;div&gt;1. Pharmacological Management of Cognitive, Emotional, and Behavioral Issues in Dementia and Delirium&lt;/div&gt;&lt;div&gt;2. Neurocognitive Screening in Psychiatry with MOCA Review and Practice&lt;/div&gt;&lt;div&gt;3. Diagnosing Neurocognitive Disorders with a Review of Imaging&lt;/div&gt;&lt;div&gt;4. Developmental Psychology and End of Life Ethics&lt;/div&gt;&lt;div&gt;Additionally, a geriatric psychiatry curriculum wa","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S57-S58"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614404","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":"35. STRUCTURAL MRI AND COGNITIVE AND NEUROPSYCHIATRIC SYMPTOMS IN POST-ACUTE SEQUELAE SARS-COV-2 INFECTION (PASC)","authors":"Jonah Im ,&nbsp;Kailin Mimaki ,&nbsp;Madeline Mai ,&nbsp;Shantanu Joshi ,&nbsp;Prabha Siddarth ,&nbsp;Isha Sai ,&nbsp;Helen Lavretsky","doi":"10.1016/j.jagp.2025.04.037","DOIUrl":"10.1016/j.jagp.2025.04.037","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Approximately 30% of COVID-19 patients exhibit symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, and 90 % of those present with neuropsychiatric symptoms. As of January 2023, there have been 660M confirmed cases of COVID-19 worldwide as per the World Health Organization (WHO). Here, we used structural magnetic resonance imaging (MRI) to examine differences in gray matter thickness and volume for the limbic (cingulate gyrus) and the dorsolateral prefrontal cortex ROIs between PASC (COVID+) and healthy controls (COVID-) as well as their correlates to cardiovascular risk and resilience measures. Given the high prevalence of neuropsychiatric symptoms in PASC patients, understanding structural brain changes is essential for anticipating long-term cognitive and cardiovascular outcomes. These findings have significant implications for geriatric health, as persistent brain alterations may contribute to accelerated cognitive aging and increased vulnerability to neurodegenerative diseases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants and Clinical Assessments: Participants for this study were recruited from the UCLA hospital and the broader Los Angeles community. They included 36 individuals (14 males and 22 females) ranging from ages 20 to 67 years. 28 of these participants received a COVID-19 diagnosis. COVID-19 tests were not conducted at the time of the study, participants self-reported their test results along with their test date in the case of COVID + groups. Additional demographic information collected included years of education, handedness, race, and native language. Inclusion criteria for PASC included self-report symptoms of brain fog, depression, fatigue, etc. and other symptoms of PASC 6 months after the onset of symptoms and receiving a COVID-positive diagnosis.&lt;/div&gt;&lt;div&gt;Neuropsychiatric, Behavioral, and Neurocognitive assessments: Measures of comorbid neuropsychiatric symptoms included the 24-item the Hamilton Depression Scale (HAMD) to quantify mood symptoms, the Hamilton Anxiety Scale (HAMA), a widely used measure of anxiety symptoms, and the Apathy Evaluation Scale (AES), a measure of the severity of apathy. Measures of medical comorbidity included the Stroke Risk Factor Prediction Chart (CVRF) of the American Heart Association for rating cerebrovascular risk factors and the Cumulative Illness Rating Scale-Geriatric (CIRS-G) used for rating the severity of chronic medical illness in several organ-systems. Resilience was determined using the Connor-Davidson Resilience scale (CDRISC), as a measure of stress coping ability. All study procedures were conducted under an approval by the UCLA IRB.&lt;/div&gt;&lt;div&gt;Images were acquired using a Siemens 3T Prisma MRI system at UCLA's Brain Mapping Center with a 32-channel phased array head coil. Acquisition protocol was identical to the Huma Connectome Project Lifespan studies for Aging and Development[5]. Structural MRIs included T1-weight","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S24-S25"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614467","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}