Raymond Pary

Attention Deficit Disorder in Adults

ADHD/ADD, once thought to occur only in children, is now recognized as continuing into adulthood in many people. In order to be labeled as such, signs and symptoms must start before age 7 and are primarily characterized by inattention, distractibility, and impulsiveness. Although the exact mechanism is unknown, a number of associated neurochemical and structural abnormalities have been observed. This disorder can negatively affect the educational, social, and occupational lives of those who suffer from its symptoms. It interferes with the ability to establish and maintain close relationships. Pharmacotherapy remains the primary mode of treatment. Stimulants such as dextroamphetamine and methylphenidate are the main drugs utilized; they are available in immediate and longer duration versions. Bupropion is another important medicinal option, and there are a variety of other miscellaneous medications to consider, including modafinil, venlafaxine, tricyclic antidepressants, and guanfacine. Psychotherapy is shown to help control impulsiveness, form more satisfactory relationships, rear children more effectively, and improve organizational and problem-solving skills.

Alcoholism in the elderly. How to spot and treat a problem the patient wants to hide.

Alcoholism is a disease that warrants a complete medical workup and vigorous intervention in all age-groups, including the elderly. Increased awareness of the problem, with early diagnosis and treatment, can reduce mortality and morbidity. Alcoholics are at risk for relapse, so physicians should be patient and positive in their approach. Especially in the elderly, obtaining a list of all prescribed and over-the-counter medications used is an important starting point. Nonessential drugs should be discontinued and use of any others closely monitored. If a withdrawal syndrome results from discontinuation of alcohol, thiamine, multivitamins, and sedatives should be prescribed as clinically indicated. Treatment of any underlying psychiatric disorder is important. Psychosocial intervention is essential in dealing with recovering elderly alcoholics to overcome loneliness and to enhance sobriety. A formal rehabilitative effort is mandatory. Long-term rehabilitation focuses on group support and may include use of disulfiram (Antabuse).

Antidepressants and the cardiac patient. Selecting an appropriate medication.

PreviewAntidepressant medications vary in terms of their cardiovascular side effects, making the decision as to the most suitable drug for a depressed cardiac patient a challenge. For example, which antidepressants are safest for the patient with conduction disease or arrhythmia? And which ones are preferred in cases of manifest orthostasis? The selection process must be highly individualized, as discussed by Drs Pary, Tobias, and Lippmann.

Psychiatric disorders in the elderly. Psychopharmacologic management.

Psychiatric management of elderly patients is a challenging task because of the many age-related physiologic changes and medical problems in this population. Thorough patient evaluation is essential to rule out somatic disorders and determine underlying causes. Somatic complaints must be taken seriously, even if a patient is receiving treatment for a psychiatric disorder. Psychotropic therapy is used mainly for controlling depression, agitation, and psychotic symptoms. If psychiatric symptoms persist or become worse, psychotropics should be discontinued to prevent possible drug toxicity (eg, anticholinergic delirium) and psychiatric consultation should be requested.

Chronic schizophrenia. Options for pharmacologic management.

Preview Perhaps one fourth of patients with schizophrenia respond only partially to standard neuroleptic therapy. Until recently, the only pharmacologic option for such patients was adjunctive treatment with other psychotropic drugs. Now two newer drugs-clozapine and risperidone-offer hope to patients with treatment-resistant schizophrenia. This article provides an up-to-date look at effective treatment of this troubling disorder.

OBSESSIVE-COMPULSIVE DISORDER : HOW TO FREE PATIENTS FROM INTRUSIVE THOUGHTS AND RITUALS

Preview Enormous amounts of time and energy may be consumed by persons with obsessive-compulsive disorder, who think distressing thoughts and then feel compelled to act on them repeatedly. How common is obsessive-compulsive disorder? What are its typical clinical presentations? The authors of this article answer these questions and discuss pharmacologic and behavior therapy.

Delirium in the elderly. A commonly misunderstood disorder.

PreviewDelirium is increasing in frequency among the elderly as the US population ages. Left untreated, delirium can cause injury and progress to coma, dementia, and even death. The authors discuss how primary care physicians can easily reverse delirium by correct diagnosis and treatment of the underlying cause.

Dementia in the elderly.

When are confusion and forgetfulness transient signs of normal aging, when are they signs of depression or a medical illness, and when are they signs of dementia? The authors describe clinical features and diagnostic studies that help establish the presence of dementia and discuss ways of coping with both remediable and less treatable types.