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 specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psych ...

dealing with the study, prevention, and treatment of

neurodegenerative A neurodegenerative disease is caused by the progressive loss of structure or function of neurons, in the process known as neurodegeneration. Such neuronal damage may ultimately involve cell death. Neurodegenerative diseases include amyotrophic ...

cognitive impairment Cognitive deficit is an inclusive term to describe any characteristic that acts as a barrier to the cognition process. The term may describe * deficits in overall intelligence (as with intellectual disabilities), * specific and restricted defici ...

, and mental disorders in people of old age.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 providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros' ...

, behavioural neurology,

neuropsychiatry Neuropsychiatry or Organic Psychiatry 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 neurop ...

neurology Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...

, 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 and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of "presenile dementia", which Kraep ...

, a

German German(s) may refer to: * Germany (of or related to) ** Germania (historical use) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizens of Germany, see also German nationality law **Ge ...

psychiatrist and neuropathologist who first identified

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

plaques and

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

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.

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 neurocognitive disorder which involves cognitive impairments beyond those expected based on an individual's age and education but which are not significant enough to interfere with instrumental activities o ...

** Alzheimer's disease **

Vascular dementia Vascular dementia (VaD) is dementia caused by problems in the supply of blood to the brain, typically a series of minor strokes, leading to worsening cognitive abilities, the decline occurring piecemeal. The term refers to a syndrome consisti ...

Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a type of dementia characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions. Memory loss is not always an early symptom. The disease worsens over time an ...

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...

* Neuropsychiatric complications from stroke, multiple sclerosis * Late-life presentations of psychiatric disorders ** Depression ***

Melancholic depression Melancholic depression, or depression with melancholic features, is a DSM-IV and DSM-5 subtype of clinical depression. Signs and symptoms Requiring at least one of the following symptoms: * Anhedonia (the inability to find pleasure in positive t ...

** Anxiety disorders **

Bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...

Schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social wit ...

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

s * Medical-Psychiatric Disorders ** Delirium **

Catatonia Catatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during ...

* Substance use disorder

Geriatric Psychiatrist

A geriatric psychiatrist is a

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

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 psychiatrists 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 hist ...

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

, laboratory investigations,

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

, 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 (french: Collège royal des médecins et chirurgiens du Canada) is a regulatory college which acts as a national, Non-profit organization, nonprofit organization established in 1929 by a speci ...

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 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 that was founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, a ...

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.) who specialize in disorders of the nervous system (neurologists) and to qu ...

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