Philip Wilkinson

Problem-solving therapy in the treatment of unexplained physical symptoms in primary care: A preliminary study

We describe a pilot study of a simple psychological treatment based on reattribution techniques and problem-solving. The treatment was administered to a consecutive series of patients (N = 11) presenting in primary care with unexplained physical symptoms. The findings suggest that the treatment is both feasible and acceptable. Finally we suggest selection criteria for those patients who may benefit from the treatment. This needs further evaluation in a randomized, controlled trial.

A pilot randomised controlled trial of a brief cognitive behavioural group intervention to reduce recurrence rates in late life depression

To standardise the delivery of a brief group cognitive behaviour therapy intervention (CBT‐G). To apply the intervention in a research setting and to estimate its effect on recurrence rates in recently depressed older adults, in preparation for a definitive study.

Older patients referred to a consultation-liaison psychiatry clinic

Little is known about the psychiatric disorders which are associated with somatic presentations of psychological distress in older people.

Referrals to a liaison psychiatry out-patient clinic in a UK general hospital: a report on 900 cases.

Objective: To describe the demographic and clinical characteristics of consecutive referrals to an out‐patient liaison psychiatry clinic in a large university hospital in the UK.

Cognitive behavioural therapy with older people

Cognitive behavioural therapy (CBT) is a structured, brief psychological treatment approach with a wide range of applications, including the treatment of psychological disorders that accompany physical illness. Over recent years there has been an expansion in the use of CBT with older people. Knowledge of CBT helps doctors to understand the mechanisms of psychological disorders and to make appropriate referrals for treatment. The objectives of this narrative review are to describe the principles of CBT, to summarise its indications and evidence base in the treatment of older people, to outline the special considerations that apply in the treatment of older people, and to list novel developments.

Cognitive behavioural therapy with older adults: enthusiasm without the evidence?

Cognitive behavioural interventions specifically for older people have been described and researched for the last 30 years. However, despite a robust evidence base to support the use of CBT in the treatment of mental disorders in younger adults, trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated. The priorities, if this is to happen, are to develop standardized, reproducible CBT interventions and to evaluate these in large trials alongside medication or as part of case-management interventions.

Psychological treatments in the management of severe late-life depression: at least as important as ECT

Regrettably, psychological treatments are often overlooked in the management of severe late-life depression while ECT is favored, even though it is more likely to be harmful and its evidence base is slim. This is of little surprise given that psychiatrists are often guilty of overlooking potentially beneficial psychosocial interventions preferring more familiar biological treatments. This position is unacceptable: depressed older adults deserve access to a whole range or interventions in order to maximize benefits and choice.

Pharmacological Management of Anxiety and Depression in Older People

Depressive and anxiety disorders are commonly encountered in older patients in primary care. They may present with psychological or physical symptoms or a combination and may impact on the course and management of coexisting physical disorders. Depression and anxiety often coexist; up to a quarter of older people with anxiety disorders also meet criteria for major depression and the presence of anxiety in depressed patients is associated with a greater risk of relapse. Not surprisingly, therefore, their causes and treatments also overlap. Most anxiety disorders are diagnosed by the age of 40, but a few people will develop them after 65 years; generalised anxiety and social phobia appear to be the more common disorders in older people. They typically run a cyclical course and are unlikely to remit completely, even with long-term treatment. Around two thirds of people with Alzheimer’s disease experience anxiety symptoms and 5–6 % have diagnosable generalised anxiety disorder so it is important to assess for cognitive impairment when deciding on management. Risk factors for anxiety in older people include female gender, multiple physical conditions, residing in a care home, and physical disability. Anxiety is specifically linked to thyroid problems, respiratory and gastrointestinal disorders, and arthritis; anxiety disorders may also precede the onset of physical illness and worsen quality of life and disability.

Nurturing syndrome in an elderly woman without dementia.

another drug being prescribed to treat the adverse effect. In the current case, the man and his physician misinterpreted the adverse gastrointestinal effects of the cholinesterase inhibitor as a new medical condition, leading to self-medicating with an additional OTC drug at toxic doses. Cholinesterase inhibitors are associated with adverse gastrointestinal events, most commonly abdominal pain, nausea, anorexia, diarrhea, and weight loss. Given that many older adults with dementia are malnourished, physicians prescribing cholinesterase inhibitors need to inform them about these potential adverse events and consider the possible contributing role of cholinesterase inhibitors in new-onset gastrointestinal symptoms or weight loss. Furthermore, the possibility of an adverse drug event presenting as a prescribing cascade should always be carefully considered when evaluating an older adult, and any new symptom should be considered to be drug related until proven otherwise. The neurotoxicity of bismuth subsalicylate is often underappreciated, despite its long history of use for a variety of gastrointestinal disorders. Two distinct toxicities must be considered: salicylate toxicity and bismuth toxicity. Salicylate toxicity is detailed in the case presentation above. Bismuth neurotoxicity can provoke delirium, psychosis, ataxia, myoclonus, and seizures and is reversible over several weeks, when bismuth intake is stopped. It is hoped that this case presentation will increase recognition of the adverse effects of cholinesterase inhibitors and salicylate and bismuth neurotoxicity with OTC medications. In addition, this case highlights the potential for prescribing cascades involving OTC preparations that are sometimes missed when taking a medication history.