Sheila M. LoboPrabhu

Integration of religion into cognitive-behavioral therapy for geriatric anxiety and depression.

Religion is important to most older adults, and research generally finds a positive relationship between religion and mental health. Among psychotherapies used in the treatment of anxiety and depression in older adults, cognitive-behavioral therapy (CBT) has the strongest evidence base. Incorporation of religion into CBT may increase its acceptability and effectiveness in this population. This article reviews studies that have examined the effects of integrating religion into CBT for depression and anxiety. These studies indicate that improvement in depressive and anxiety symptoms occurs earlier in treatment when CBT incorporates religion, although effects are equivalent at follow-up. The authors present recommendations for integrating religious beliefs and behaviors into CBT based on empirical literature concerning which aspects of religion affect mental health. A case example is also included that describes the integration of religion into CBT for an older man with cognitive impairment experiencing comorbid generalized anxiety disorder and major depressive disorder. It is recommended that clinicians consider the integration of religion into psychotherapy for older adults with depression or anxiety and that studies be conducted to examine the added benefit of incorporating religion into CBT for the treatment of depression and anxiety in older adults. (Journal of Psychiatric Practice 2009;15:103–112).

Spouses of Patients with Dementia

Abstract Caregiver spouses struggle to cope with the multiple demands of caregiving and complexities of medical care. In this article, the emotional, marital, attachment, and spiritual aspects of spousal caregiving for patients with dementia are addressed. This paper explores what keeps spouses together during this devastating illness. The literature has been reviewed to identify value systems that enable spouses to continue caregiving in these challenging circumstances. Articles were targeted that focus on the psychological and spiritual meaning of the marital bond, and its disruption when a spouse develops dementia. Recommendations for the clinical management of caregiver burden emerge from a pluralistic understanding that encompasses such constructs as “quid pro quo”; commitment and family solidarity; holding on to the familiar versus “letting go”; rupture and repair of the marital bond; mastery of separation-individuation; spirituality; changes in the sexual relationship; and reaching out for emotional support. Techniques are highlighted to help couples deal with loss, and changes in communication and intimacy. A multidimensional approach by the geriatric mental health team is emphasized in order to provide optimal care to caregiver spouses.

The Aging Physician With Cognitive Impairment: Approaches to Oversight, Prevention, and Remediation

There are many important unanswered issues regarding the occurrence of cognitive impairment in physicians, such as detection of deficits, remediation efforts, policy implications for safe medical practice, and the need to safeguard quality patient care. The authors review existing literature on these complex issues and derive heuristic formulations regarding how to help manage the professional needs of the aging physician with dementia. To ensure safe standards of medical care while also protecting the needs of physicians and their families, state regulatory or licensing agencies in collaboration with state medical associations and academic medical centers should generate evaluation guidelines to assure continued high levels of functioning. The authors also raise the question of whether age should be considered as a risk factor that merits special screening for adequate functioning. Either age-related screening for cognitive impairment should be initiated or rigorous evaluation after lapses in standard of care should be the norm regardless of age. Ultimately, competence rather than mandatory retirement due to age per se should be the deciding factor regarding whether physicians should be able to continue their practice. Finally, the authors issue a call for an expert consensus panel to convene to make recommendations concerning aging physicians with cognitive impairment who are at risk for medical errors.

Severe loneliness in community-dwelling aging adults with mental illness

Successful aging involves adapting to changing needs. The 2009 U.S. Census noted that 43% of adult Americans are single and that the oldest-old population is the most rapidly growing aging segment. Geriatric, lonely, hopeless individuals are at high risk for depression and suicide. Lonely individuals fail to adapt to their circumstances; and physical and mental illness place them at risk for neglect, morbidity, and mortality. The authors discuss the role of attachment in the individual’s subjective experience of loneliness and suggest how attachment theory can be used to guide interventions to improve the individual’s self-esteem, coping, and problem-solving abilities. This article also discusses the use of multimodal therapy, including psychodynamic, interpersonal, and cognitive-behavior therapy and coping skills training, to improve the individual’s ability to adapt to the surrounding environment and to reintegrate into the community. (Journal of Psychiatric Practice 2012;18:20–28)

The after-death call to family members: A clinical perspective

In this paper, we discuss the value of an after-death telephone call made by the treating mental health clinician to family members, after the death of a geriatric patient with a psychiatric disorder. We outline the process of the after-death call including the optimal method, nature, and content. We note the psychotherapeutic value of an after-death telephone call in addressing complex emotions, and helping the family to cope with bereavement. We also discuss institutional, legal, and ethical ramifications. We conclude that an after-death call may be of sufficient benefit to be considered as a ‘best practice’ approach in the care of every patient.

The After-Death Call to Family Members: Academic Perspectives

ObjectiveThe authors discuss clinical and teaching aspects of a telephone call by the treating clinician to family members after a patient dies.MethodsA MEDLINE search was conducted for references to an after-death call made by the treating clinician to family members. A review of this literature is summarized.ResultsA clinical application of the after-death call is proposed, with emphasis on a “no regrets” approach. The authors also discuss the management of “at risk” situations, and end with teaching points.ConclusionThe after-death call is an example of “best practices” in the care of every patient, and can be used to teach residents and students of all disciplines. Primary care providers and consultation psychiatrists may find this valuable as they communicate with families in the sensitive and often traumatic context after a patient dies.

Religion: Psychiatric Aspects

This article is a revision of the previous edition article by G.T. Harding, volume 19, pp. 13096–13102,