Considerations and Current Trends in the Management of the Geriatric Patient on a Consultation –Liaison Service

AbstractPurpose of ReviewTo provide consultation –liaison psychiatrists with an updated resource that can assist in the treatment and management of geriatric patients.Recent FindingsThe current available literature has not shown any differences in efficacy between haloperidol and second-generation antipsychotics in patients with delirium. When considering relative advantages of forms of antipsychotic administration, there is no support for a superior safety profile of oral compared to intramuscular or intravenous administration. A recent meta-analysis of four randomized controlled trials concluded that when melatonin was administered to older age patients on medical wards, it significantly prevented the incidence of delirium when compared with the control group. While suvorexant administered nightly to elderly patients in acute care settings may lower the incidence of delirium, larger studies are needed to confirm this finding. Despite the black box warning of increased mortality risk in older patients with dementia, antipsychotics may be used with caution by the consultation –liaison (CL) psychiatrist to treat the neuropsychologic symptoms of dementia including hallucinations and psychosis in the hospital setting. While antidepressant studies have focused primarily on citalopram and escitalopram in the treatment of agitation in the setting of dementia, these two medic ations have not been adequately compared directly to other SSRIs for this condition. It is therefore not...
Source: Current Psychiatry Reports - Category: Psychiatry Source Type: research