The population in the United States is aging rapidly. Geriatric patients pose a challenge to health care providers that is unique from their younger counterparts. The elderly are faced with a plethora of chronic medical illnesses, neurodegenerative disorders, as well as psychiatric conditions and symptoms that complicate their management. In addition, geriatric psychiatric conditions, such as depression, chronic psychiatric illness, and cognitive disorders are commonly seen in primary care practices. Most physicians and health care providers need to be well prepared to treat these complex patients in later life. General and geriatric psychiatrists in particular must be well versed in the pharmacological management of the psychiatrically impaired elderly. Sandra A. Jacobson's Clinical Manual of Geriatric Psychopharmacology, in its second edition, serves as both an outstanding reference book as well as a complete yet concise practical guide to the complex issues in geriatric psychopharmacology for providers who treat geriatric patients.
In the first chapter, the manual gives a broad yet extremely useful overview of the general concepts and prescribing practices in psychopharmacology. Although discussions of general patients are included, the author also specifies those geriatric guidelines and prescribing recommendations that clearly differ in this population. Both general pharmacokinetic and pharmacodynamic issues in psychopharmacology are covered from a primary clinical perspective with, again, an added emphasis on geriatrics differences. Drug-drug interactions, protein binding, metabolism, as well as clearance in both the kidney and the liver are described. Medical considerations and instructions for drug prescribing practices are included and are particularly relevant for those medically compromised older patients seen in clinical practices. A fairly comprehensive list of medications to be avoided in select geriatric patient populations due to potential complications is also presented. This table clearly delineates the rationale why they should be avoided, as well as the strength of that recommendation.
Further chapters are broken down into the major psychotropic medication groups: antipsychotics, antidepressants, mood stabilizers, and anxiolytics/sedative hypnotics. Commonly used agents are listed in each chapter along with their available formulations and doses available on the market. It is not a comprehensive list of all psychiatric medications available today, but it does include those agents that are by far most commonly prescribed in the geriatric population. Again, specific pharmacodynamics and pharmacokinetic principles such as metabolism, drug interactions, and clearance are listed. Diagnostic and symptom indications as well as the recommended length of use for each drug are also listed. Common and less common side effects are discussed at length. Each drug listed has a brief summary of dosage recommendations, doses available, and other details as provided at the end of each chapter.
The manual continues by including several chapters that discuss the treatment of conditions commonly seen in geriatric individuals that require psychopharmacologic intervention. Chapters that detail the treatment of movement disorders, substance related-disorders, as well as pain management have particular value for the clinician treating patients in late-life. Each chapter again gives an easily digestible summary for each specific medication at the end of each chapter. Particularly well-written is a comprehensive yet practical chapter dedicated to those medications currently available to treat the major neurocognitive disorders due to neurodegenerative disorders such as Alzheimer's and Parkinson's disease. It addresses not only cognitive enhancing treatment but also the role of these drugs in managing agitation and other behavioral symptoms of these dementing illnesses.
Throughout the text, there are highlighted boxes that share brief, clinically relevant facts that will aid the clinician in formulating their treatment plans. All chapters can be used as a quick reference for specific drugs use or clinically important questions. Alternatively, the book could also be a practical read, which will further educate any clinician on the topic of geriatric psychopharmacology. The text fully conforms to the more recent Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, diagnostic criteria. The terminology, medications, and reference as written are clear and up-to-date.
In summary, Sandra A. Jacobson's Clinical Manual of Geriatric Psychopharmacology, in its second edition, is a useful reference guide to any physician or health care provider treating geriatric psychiatric disorders. It is also concisely written, with plenty of clinically relevant material, and it can be read on its own to expand one's knowledge base. Only a minority of physicians and health care providers receive specialty training in geriatrics. This book clearly can serve as one tool toward their essential education in geriatric health care.
Elizabeth A. Crocco, MD
Chief, Geriatric Psychiatry
Associate Clinical Professor
Department of Psychiatry
and Behavioral Sciences
Miller School of Medicine
University of Miami
The author declares no conflict of interest.