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POLICIES: HOW TO MAINTAIN A VIABLE PRACTICE IN GERIATRIC PSYCHIATRY
Abstracts pectations of health care providers in this country. Specific clinical examples from the presenter’s work onsite among Southwestern Native American WWII/Korean war veterans are used to clarify these concepts.
AN APPROACH TO THE EVALUATION AND MANAGEMENT OF PAIN IN THE ELDERLY. Harry J. Gould III, M.D., Ph.D.
A
cute pain serves as one of the alerting modalities that protects us from harm. When pain is intractable, however, it is detrimental to the quality of life for individuals, families, and society as a whole. With advancing age, the incidence of chronic pain increases, while treatment options become progressively more limited. Pain management can be a challenge at any stage in life because of its multifactorial nature. It is now being recognized that failures of treatment can lie with physicians, patients, and the health care system. A multidisciplinary approach to pain management optimizes the opportunities for success. The first step in successful pain management is a thorough assessment of the patient’s pain. Next, it is necessary to define and implement a comprehensive treatment plan. The final step is to provide adequate follow-up and assessment of the treatment outcome. Applying these principles while utilizing the recent advances in the understanding of the mechanisms of pain and treatment modalities promises hope for the future satisfactory management of pain and the improvement in the quality of life for a currently underrated part of our society.
TREATMENT OF PARKINSON’S DISEASE: A BRAND NEW APPROACH. Jayaraman Rao, M.D.
P
atients with Parkinson’s disease suffer from disabling bradykinesia and bradyphrenia. While the use of carbidopa-levodopa has significantly decreased the mortality and morbidity of the disease, long-term use of carbidopalevodopa has led to the development of severe motor fluctuations and cognitive dysfunctions and, in many cases, has resulted in a very complicated course of the disease. The availability of two new dopamine agonists (Pramipexole and Ropinirole) and a drug that inhibits catechol-o-methyltransferase (COMT) (Tolcapone) has greatly enhanced our ability to improve the quality of life by providing a more sustained and predictable motor response as well as global improvement of signs and symptoms of patients in mid- and late stages of Parkinson’s disease. Introduction of dopamine agonists early in the course of the disease, and a judicious combination of COMT inhibitor and carbidopalevodopa may contribute to a slowing of the progression of the disease. This update focuses on the new strategies
Am J Geriatr Psychiatry Supplement, Fall 1999
used to treat Parkinson’s disease patients in different stages of the disease.
CODING AND REIMBURSEMENT CONTROVERSIES/POLICIES: HOW TO MAINTAIN A VIABLE PRACTICE IN GERIATRIC PSYCHIATRY. Elliott Stein, M.D.; Gary Moak, M.D.
T
he attendee will learn how to approach coding issues for inpatient and outpatient psychiatric services, including psychotherapy and evaluation and management services. Through the use of vignettes, faculty walk the attendees through the coding and documentation process for specific, common services rendered by geriatric psychiatrists to patients in various settings. Written case vignettes are provided which include instructions on how to code and document.
ECT FOR PATIENTS WITH DEMENTIA AND AGITATION. David Greenspan, M.D.
P
urpose: To identify community standards for the administration of ECT to patients with agitation and dementia. Abstract: Though the primary indications for ECT are major affective disorder in cognitively intact individuals, there is growing experience in the use of ECT in older adults with more clinically ambiguous illnesses. This clinical dialogue focuses on the use of ECT with agitated patients with dementia. The author presents a synopsis of the research literature and then explores how the participants are using this intervention in this context. He then attempts to create a consensus around such issues as diagnosis (dementia with agitation, with agitated major depression, with delirium, with catatonia), indications, risk management, consent procedures, barriers to utilizing this treatment, and strategies for dealing with them, as well as areas for future research. Conclusion: We will create a consensus statement summarizing any conclusions reached in these areas for distribution back to interested participants.
Paper Abstracts—Session 1: Alzheimer’s Disease and Neuroscience Junior Investigator Award DEPRESSIVE SYMPTOMS ARE ASSOCIATED WITH COGNITIVE DECLINE IN NONDEMENTED ELDERLY WOMEN: EVIDENCE FROM A PROSPECTIVE STUDY. Kristine Yaffe, M.D.; Robert Gore, Ph.D.; Terri Blackwell, M.A.; Laura Sands, Ph.D.; Victor Reus, M.D.; Warren Browner, M.D., M.P.H. ackground: The association between depressive disorders and subsequent cognitive decline is controversial. The authors tested the hypothesis that nonde-
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AN APPROACH TO THE EVALUATION AND MANAGEMENT OF PAIN IN THE ELDERLY. Harry J. Gould III, M.D., Ph.D.
A
cute pain serves as one of the alerting modalities that protects us from harm. When pain is intractable, however, it is detrimental to the quality of life for individuals, families, and society as a whole. With advancing age, the incidence of chronic pain increases, while treatment options become progressively more limited. Pain management can be a challenge at any stage in life because of its multifactorial nature. It is now being recognized that failures of treatment can lie with physicians, patients, and the health care system. A multidisciplinary approach to pain management optimizes the opportunities for success. The first step in successful pain management is a thorough assessment of the patient’s pain. Next, it is necessary to define and implement a comprehensive treatment plan. The final step is to provide adequate follow-up and assessment of the treatment outcome. Applying these principles while utilizing the recent advances in the understanding of the mechanisms of pain and treatment modalities promises hope for the future satisfactory management of pain and the improvement in the quality of life for a currently underrated part of our society.
TREATMENT OF PARKINSON’S DISEASE: A BRAND NEW APPROACH. Jayaraman Rao, M.D.
P
atients with Parkinson’s disease suffer from disabling bradykinesia and bradyphrenia. While the use of carbidopa-levodopa has significantly decreased the mortality and morbidity of the disease, long-term use of carbidopalevodopa has led to the development of severe motor fluctuations and cognitive dysfunctions and, in many cases, has resulted in a very complicated course of the disease. The availability of two new dopamine agonists (Pramipexole and Ropinirole) and a drug that inhibits catechol-o-methyltransferase (COMT) (Tolcapone) has greatly enhanced our ability to improve the quality of life by providing a more sustained and predictable motor response as well as global improvement of signs and symptoms of patients in mid- and late stages of Parkinson’s disease. Introduction of dopamine agonists early in the course of the disease, and a judicious combination of COMT inhibitor and carbidopalevodopa may contribute to a slowing of the progression of the disease. This update focuses on the new strategies
Am J Geriatr Psychiatry Supplement, Fall 1999
used to treat Parkinson’s disease patients in different stages of the disease.
CODING AND REIMBURSEMENT CONTROVERSIES/POLICIES: HOW TO MAINTAIN A VIABLE PRACTICE IN GERIATRIC PSYCHIATRY. Elliott Stein, M.D.; Gary Moak, M.D.
T
he attendee will learn how to approach coding issues for inpatient and outpatient psychiatric services, including psychotherapy and evaluation and management services. Through the use of vignettes, faculty walk the attendees through the coding and documentation process for specific, common services rendered by geriatric psychiatrists to patients in various settings. Written case vignettes are provided which include instructions on how to code and document.
ECT FOR PATIENTS WITH DEMENTIA AND AGITATION. David Greenspan, M.D.
P
urpose: To identify community standards for the administration of ECT to patients with agitation and dementia. Abstract: Though the primary indications for ECT are major affective disorder in cognitively intact individuals, there is growing experience in the use of ECT in older adults with more clinically ambiguous illnesses. This clinical dialogue focuses on the use of ECT with agitated patients with dementia. The author presents a synopsis of the research literature and then explores how the participants are using this intervention in this context. He then attempts to create a consensus around such issues as diagnosis (dementia with agitation, with agitated major depression, with delirium, with catatonia), indications, risk management, consent procedures, barriers to utilizing this treatment, and strategies for dealing with them, as well as areas for future research. Conclusion: We will create a consensus statement summarizing any conclusions reached in these areas for distribution back to interested participants.
Paper Abstracts—Session 1: Alzheimer’s Disease and Neuroscience Junior Investigator Award DEPRESSIVE SYMPTOMS ARE ASSOCIATED WITH COGNITIVE DECLINE IN NONDEMENTED ELDERLY WOMEN: EVIDENCE FROM A PROSPECTIVE STUDY. Kristine Yaffe, M.D.; Robert Gore, Ph.D.; Terri Blackwell, M.A.; Laura Sands, Ph.D.; Victor Reus, M.D.; Warren Browner, M.D., M.P.H. ackground: The association between depressive disorders and subsequent cognitive decline is controversial. The authors tested the hypothesis that nonde-
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