Julia Kirkham

Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults.

Major depressive disorder (MDD) affects many older adults and is associated with poor medical and mental health outcomes. Problem Solving Therapy (PST) has emerged as a promising psychotherapy for MDD in older adults, although the efficacy of PST in this population has not been well described. We examined the effectiveness of PST for the treatment of MDD in older adults in a systematic review and meta‐analysis.

Antipsychotic Use in Dementia: Is There a Problem and Are There Solutions?

Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.

Evidence of ocular side effects of SSRIs and new warnings

ABSTRACT FROM: Chen H, Lin C, Lai S, et al. Association of selective serotonin reuptake inhibitor use and acute angle-closure glaucoma. J Clin Psychiatry 2016;77:e692–6.[OpenUrl][1] Acute angle-closure glaucoma (AACG) may cause symptoms including eye pain, changes in vision, or swelling and redness and can rapidly lead to permanent blindness if not treated.1 Medications can precipitate AACG through adrenergic or anticholinergic-mediated pupillary dilation that results in the physical obstruction of the outflow of intraocular fluid in susceptible individuals. Case reports and a previous large database study from Ontario, Canada,2 have suggested an association between new use of selective serotonin reuptake inhibitors (SSRIs) and AACG. The potential mechanism underlying this association is unclear but may be related to effects on norepinephrine or serotonin receptors in the iris and ciliary body of the eye.3 This was a case–control … [1]: {openurl}?query=rft.jtitle%253DJ%2BClin%2BPsychiatry%26rft.volume%253D77%26rft.spage%253De692%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx

Depression rating scales for detection of major depression in people with dementia

This is the protocol for a review and there is no abstract. The objectives are as follows: To identify the accuracy of depression rating scales as screening tools for detecting DpD and compare the diagnostic accuracy of different depression rating scales for detecting MDD among adults with Alzheimers disease and related forms of dementia. To examine factors that may impact on the accuracy of depression rating scales that are used to diagnose depression. We will examine the reference standard used for verification of DpD, baseline prevalence of DpD in the study population, age of the underlying study population, gender of participants, type of dementia (any-cause dementia versus Alzheimer’s disease), study setting (community or primary care setting, long-term care, tertiary care setting), and study country as potential sources of heterogeneity. We will also evaluate the effects of using different cut-points of individual depression rating scales on the diagnostic accuracy of the scales.