In this Issue
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Message from the Editor
CAGP Meeting Summaries & Highlights
Workshop Summaries
2010 CAGP Award Recipients
Upcoming Events
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IN SHORT |
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CAGP Elections: This year
the Canadian Academy of Geriatric Psychiatry held an election to
determine who would serve on the 2010-2011 Board of Directors.
Please find below the incoming board of directors as elected on
September 22, 2010. |
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CAGP Annual Report: The
2009-2010 Annual Report containing the chair reports and
summaries for the last 12 months can now be found online or by
clicking the on the name. |
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Ontario Members: Long-Term Care Home Act - Implementation
Update #3
English |
French
Update #4
English |
French
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Opportunities for Geriatric Psychiatrists |
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Do you have a career opportunity in the field of Geriatric
Mental Health that you would like to advertise with our
members? We invite you to send your job opportunity to us
for distribution amongst members of the Canadian Academy of
Geriatric Psychiatry. Note: position must be comprised of at
least 50% of geriatric psychiatry |
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Volunteer
Opportunity |
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The CAGP has various
volunteer opportunities throughout the year. If you are
interested in getting involved or want to find more send an
email to info@cagp.ca
indicating your interest in one or more of the following
areas. Education, Communication (Websites, E-newsletter,
etc), membership, Annual Scientific meeting and /or the
Board of Directors. |
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Board of
Directors
2009 - 2010 |
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Dr. Kiran Rabheru,
President
Dr. Melissa Andrew, Vice President & Education Chair
Dr. Martha L Donnelly, Past President & Nominations
Chair
Dr. Marlene Smart, Treasurer / Secretary
Dr. Mark Rapoport, ASM Co-Chair
Dr. Rene Desautels, Sponsorship & ASM Co-Chair
Dr. Cathy Braidek, Membership Chair
Dr. Stuart Sanders, Communications Chair
Dr. Keri-Leigh Cassidy, Director
Dr. Karen Saperson, Director
Dr. Stephane Tanguay, Director
Dr. Dallas Seitz, Director
Dr. David Conn, CCSMH |
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Ask A Question
CAGP
website is being updated on a regular basis. A new feature is
the members only Discussion Forum providing members the opportunity to
ask questions of each other or those they consider experts. We
encourage all members to begin using this Discussion Forum — think of it
as a
Geriatric Psychiatry
Q&A. To view or post a question in the Discussion Forum, enter
your login information to access the Members-only section and then click
on 'Discussion Forum'.
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E-newsletter Authors &
contributors |
We would like to acknowledge the
contributions of the following individuals to this issue.
- Zahinoor Ismail, MD, FRCPC
- Stuart Sanders, MD, FRCPC
- Dallas Seitz, MD, FRCPC
- Martha Donnelly, MD, FRCPC
- Tarek Rajji, MD, FRCPC
- Patricia Lepage, MD, FRCPC
- Mark Rapoport, MD, FRCPC
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MESSAGE FROM THE EDITOR |
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Dear Member |
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As usual this fall
edition of the Newsletter provides a summary of our Annual
Scientific meeting presentations. If a particular summary
interests you then you might be interested to go to the members
page on the website as there are PDF files of the slides used in
each presentation. Next year we hope to improve on the Video
section so that for a fee you can access the entire
presentation, much as is done at the American Psychiatric
Association meetings.
As usual, please feel free to submit any information of
interest, or even interesting web links you discover that you
think may be of interest to other members, we are constantly
updating the web page and the links for members section in
particular.
Stuart Sanders, MD, FRCPC, Communications Chair
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CAGP MEETING
SUMMARIES & HIGHLIGHTS |
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CAGP 2010
Annual Scientific Meeting: From Prevention to Palliation
I was pleased to co-chair the 2010 annual
Scientific meeting of the CAGP in Toronto along with Dr. Zahinoor
Ismail, who is the director of CME for the division of Geriatric
Psychiatry at the University of Toronto. Working together with Drs. Rhaberu, Smart,
and Desautels of the CAGP board, and with Dr. Benoit Mulsant of
the University of Toronto, we were able to assemble a program to
appeal to our national group of psychiatrists as well as family
doctors and other allied health professionals with an interest
in seniors’ mental health.
The theme of this year’s program was “From Prevention to
Palliation”. The keynote address and one workshop focused on
palliative approaches to dementia. There were plenary sessions
on antipsychotics and behavioural treatments for dementia, and
the other workshops concerning a variety of topics including
treatment-resistant depression, sexuality, schizophrenia,
psychopharmacology and ethics.
Education was an important theme at this year’s workshop with a
lunchtime invited session for education leaders, and a workshop
on the progress towards subspecialization. We also for the first
time made the handout materials for all sessions available
online, free for attendees and CAGP members.
We had 189 registrants at this year’s meeting, of which 54% were
physicians, 27% other allied health professionals and 11%
residents/students. The total numbers were 52% higher than last
year.
There were 33 organizations represented at the meeting, and from
the information collected at the time of registration it is
clear that word-of-mouth and colleague recommendations were the
most successful ways of communicating the meeting. So a big
thank you to all those that helped spread the word! My
colleagues and I prepared summaries of the sessions for this
newsletter.
Mark Rapoport, MD, FRCPC
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Advanced Dementia: The Patient and Family
Experience - Dr. Susan Mitchell
Dr. Susan Mitchell, geriatrician from Harvard Medical School in
her keynote address proposed a fresh perspective on end-stage
care for persons with dementia. She described her group’s
Advanced Dementia Prognostic Tool (ADEPT), which included a
validated mortality risk score based on national data. Her group
prospectively validated the tool at the bedside in order to
determine 6 month mortality. While the risk score did predict
mortality better than hospice-based rules, the prediction was
imperfect. She recommended that palliative approaches be guided
by goals of care rather than estimated life expectancy as the
latter is difficult to predict. She then reported on an 18 month
prospective study of the clinical course of advanced dementia
known as the CASCADE study. In that study the 6 month mortality
was 47%, but interestingly, in 40% of cases, dementia was not
mentioned on the death certificates. Many burdensome symptoms
were identified, that were similar to patients with cancer –
including dyspnea, pain, pressure ulcers, and aspiration. About
41% received “burdensome” or aggressive interventions. Dr.
Mitchell emphasized that such interventions occurred less often
if the family member believed the patient had less than 6 months
to live and understood the complications of advanced dementia.
Of the caregivers, 10% reported significant depression at
baseline, and 14% were on antidepressants. The best predictor of
post loss grief was pre-loss grief, which in turn, was
significantly related to depression. It was unclear from the
research whether a high level of family visits reflected poor
care or promoted poor care. Dr. Mitchell suggested educating
about dementia as a terminal condition, and teaching families
about the decisions and symptoms they should expect. She
advocated for increasing capacity for palliative care in nursing
homes, and removing the prognosis requirement in order to access
this care.
Mark Rapoport, MD, FRCPC
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Antipsychotics
for Dementia: Has the balance finally tipped? - Dr. Nathan
Herrmann
Dr. Nathan Herrmann, Professor of Psychiatry at the University
of Toronto and former Head of the Division of Geriatric
Psychiatry, presented a session on the risk-benefit analysis of
antipsychotics. He first presented the evidence for efficacy of
antipsychotics, indicating that the benefit is modest. He then
reviewed the safety issues with antipsychotics including the
increased risk for EPS, hip fractures and impaired cognition.
Dr. Herrmann discussed the metabolic issues with antipsychotics
including weight gain and glucose dysregulation, highlighting
new data implicating the role of typical antipsychotics in
hyperglycemia to an equal and possibly greater extent than some
atypicals. Dr. Herrmann also reviewed QTc prolongation and
highlighted the role of sertindole in prolonging QTC and the
dose response of all antipsychotics and cardiac death. Dr.
Herrmann then discussed the role of antipsychotics in CVA risk
(both typicals and atypicals) and mortality (referring to the
black box warning from the FDA and Health Canada as well as the
DART-AD study). He also presented unpublished data on the risk
of mortality with antipsychotics prescribed for elderly
Parkinson’s disease. Dr. Herrmann completed his session by
referring to his CMAJ 2008 paper indicating that despite
regulatory warnings, the use of antipsychotics in dementia keeps
increasing.
Zahinoor Ismail, MD, FRCPC
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Non-pharmacological Approaches for the Treatment of Behavioral
Disturbances in Dementia - Dr. Rob Madan
Dr. Rob Madan, head of postgraduate education at the University
of Toronto’s division of geriatric psychiatry, presented the
closing plenary session on behavioural approaches to behavioural
and psychological symptoms in dementia. He outlined three models
of understanding such symptoms – the progressively lowered
stress threshold, the unmet needs model and learning theory. He
reviewed the evidence surrounding behavioural approaches, and
commented on the small sample sizes, lack of control groups, and
quasi-experimental designs. A further limitation that he
emphasized was the impracticality of some of the more elaborate
interventions in real clinical practice. His review suggested
benefits particularly from sensory modalities. He described
behavioural techniques of extinction and reinforcing positive
alternative behaviours, and encouraged the audience’s creativity
in approaching a difficult case that he described. Barriers to
adhering to such approaches were explored including staff
changes, difficulty attaining buy-in and consistency, as well as
a lack of resources and expertise.
Mark Rapoport, MD, FRCPC
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CAGP MEETING
SUMMARIES & HIGHLIGHTS |
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BPSD:
Toward a Palliative Approach - Dr. David Mamo, Dr.
Tiffany Chow, Dr. Zahinoor Ismail, Dr. Barbara Russell, Dr.
Robyn Waxman
Drs. David Mamo, Zahinoor Ismail, Tiffany Chow, Barbara Russell
and Robyn Waxman presented workshops during both sessions
entitled “BPSD: Toward a Palliative Approach.” The workshop was
intended as a forum for discussion of alternative approaches to
management of BPSD and to challenge clinicians preconceived
notions on reasons for treatment via discussion around a
specific and challenging case. Within this context many themes
were discussed: the patient vs. the person; therapeutic optimism
vs. realism vs. futility vs. nihilism; the definition of
“meaningful interaction” in dementia; what is quality of life in
dementia – both for the patient and their family; personal
directives and the patient’s most recent capable expressed
wishes and the subjective nature of these wishes; medical vs.
narrative futility; dignity vs. depersonalization; a
reassessment of burdensome interventions (like ICU admissions)
on quality of life and whether they actually improve overall
outcome; the notion that death does not always equate with harm;
full disclosure of dementia prognosis; changes in personhood and
selfhood with advancing dementia and the relevance of past
advanced directives in the context of the “new self”; and the
evolution of the concept of autonomy towards “relational
autonomy” in which a person’s family context is taken into
account.
There was rich discussion around these issues and the panel
encouraged all audience members to contact the panel with any
further ideas or comments, with an eye towards creating a
broader forum for discussion of palliative approaches in
dementia care.
Zahinoor Ismail, MD, FRCPC |
Sexuality In Dementia - Dr. Susan Ilkov-Moor, Tracey Clancy This workshop attended by 22 people was wide ranging and covered a lot
of material, from The expression of appropriate intimacy in Long Term
care to the issues of abuse, inappropriate sexual behaviours and options
for management and even looked at some of the ethical issues arising in
each of the scenario’s.
The objectives were 1/ Develop an understanding of memory loss and
“normal” sexuality 2/ Develop an approach to the assessment, management
and follow up for sexually expressed behaviours in Dementia and 3/ be
aware of the Psychosocial and medico legal aspects , as well as being
able to be a better advocate for the demented person themselves.
A number of cases were presented for discussion purposes which
illustrated a number of the common dilemmas seen. The issue of the
opportunity for sexual expression in dementia was reviewed along with an
exploration of the impact this may have on caregivers and families. An
examination of the negative stereotypes that can be commonly seen was
reviewed, along with the issues facing the couples themselves in aiming
for intimacy in a Long Term Care setting! A recognition that for a
consultant to explore these issues it must be done with respect and
sensitivity both to patients and to staff, given the multicultural
nature of staffing and the different values they bring with them, not to
mention their comfort level with the whole topic itself.
The impact of the dementia process on sexuality was explored, which lead
into the issue of commonly seen sexual behaviours by individuals in long
term care which are disturbing to staff, and how to approach them,
particularly in allowing appropriate sexuality to occur, addressing
inappropriate behaviours and the ability to distinguish the two.
A review of a best practice guideline used in Ontario, developed by
Debora Steele R.N. was presented and discussed, as well as a review of
the Neurobiology of sexuality, and diseases or lesions associated with
particular problem behaviours.
A review of the PLISSIT model (Permission, limited information,
specific suggestions and intensive therapy….an approach developed for
working with sexual problems in younger patients) as adapted to Long
Term Care and Dementia was discussed though in the writers opinion the
model does not lend itself well to this population. However a review of
non pharmacological therapies followed by pharmacological, reviewing the
risks, benefits and efficacy was detailed and helpful.
Lastly the issues of same sex relationships were touched on, again
looking at appropriate and inappropriate , along with the issues of
sexual abuse of the demented person by others in the facility or by
spouse. When, for example is the patient still able to give consent to
sexual intercourse?
This was a detailed, comprehensive presentation. If anything there was
too much to present in the time available and it was the feeling of many
in the room that a longer time should be given to this subject in the
future, or perhaps the different issues discussed could form workshops
of their own.
Stuart Sanders, MD, FRCPC |
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Update on
Psychopharmacology: Antidepressants, Anticholinergic
Medications and Cholinesterase Inhibitors - Dr. Kiran
Rabheru, Dr. Dallas Seitz, Dr. Krista Lanctot
Three topics were presented in this session on
psychopharmacology during the two workshop time slots. The first
session lead by Dr. Krista Lanctot outlined current treatments
and future developments in treatment of cognitive symptoms of
Alzheimer’s disease and related forms of dementia. Dr. Lanctot
reviewed the evidence for cholinesterase inhibitors and
memantine including important information on recent developments
such as new information on the use of these medications in
moderate to severe dementia and emerging evidence on the effects
of these medications on non-cognitive symptoms such as
functional impairment and behavioural and psychological symptoms
of dementia. A discussion of several negative studies for other
medications and future directions for Alzheimer’s therapeutics
were also presented. The second session was presented by Dr.
Seitz on anticholinergic medications. This presentation outlined
that many commonly prescribed medications possess
anticholinergic properties and that anticholinergic medications
are frequently prescribed to older adults. Adverse events
related to anticholinergic medications and the effects of
anticholinergic medications on efficacy of cholinesterase
inhibitors were presented along with strategies for reducing
anticholinergic adverse events. The final presentation in the
workshop was by Dr. Kiran Rabheru on the treatment of
depression. The presentation outlined results of the step-care
approach to antidepressant pharmacotherapy from the STAR-D
trial. He discussed practical strategies for achieving remission
of depression using this approach. Also included was a
discussion of the impact of medical co morbidity on depression
outcomes. Overall the workshop was well-received by attendees
who participated in an active discussion of issues relating to
all three presentations at the conclusion of both workshop time
slots.
Dallas Seitz, MD, FRCPC
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Treatment Resistant
Depression: An Update
An update by Dr. Benoit Mulsant: Dr. Mulsant stated that there
were three variables which related to resistance: Diagnostic
factors, patient related factors and treatment related factors.
Diagnostic factors included such complications as medical
conditions, incipient dementia, co-morbid anxiety and the
presence of psychotic features. Treatment variables included
choice of treatment dose and duration. Patient variables
included tolerance and compliance to treatment, as well as
psychosocial factors which might influence treatment. Meyers in
2002 reported only 44% of patients had received at least one
minimally adequate trial, even at an academic site. Alexopolous
in 2001 developed therapy guidelines for depression in old age.
His guidelines included, as first line, SSRI’s and venlafaxine
XR; as second line, TCA’s, mirtazapine, bupropion and MAOI’s;
and third line, psychostimulants and trazodone.
If there was no response to an SSRI, Alexopolous suggested
switching to venlafaxine XR, bupropion XR or nortriptyline.
White in 2005 followed percentages of responses over multiple
augmentations and noted there were a lot of drop outs within the
study of patients, so the numbers were quite small by the third
augmentation. He also noted that augmentation had a better
tolerability and safety profile than switching.
Since 2001 three new antidepressants have come on board,
escitalopram, desvenlafaxine and duloxetine. Also monotherapy
with quetiapine or augmentation with quetiapine or aripiprazol
have been added to treatment regimes.
Brain Stimulation Therapy for Late Life Depression by Dr. Daniel
Blumberger: Bilateral rTMS may be effective for older adults. A
small randomized controlled trial showed improvements in
vascular depression. With rTMS greater treatment resistance was
associated with non-remission. rTMS is not covered however by
any health care plans in Canada.
With ECT improved remission and less cognitive side effects
occurs with nortriptyline/ECT versus placebo/ECT. Right
unilateral ECT has similar efficacy to bilateral and less
cognitive side effects.
Martha Donnelly, MD, FRCPC
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The Geriatric Psychiatry
6 month Resident Rotation – a cross-Canada show, tell & ask
- Chaired by Dr. Martha Donnelly
Dr. Gosselin from UBC described her new one-week course on ECT,
including both didactic and hands-on sessions. It is in the
first week of the six-month of geriatric rotation and is
mandatory for all. It will be repeated two times a year and on
its first run was highly rated.
Dr. Donnelly described the didactic Thursday lecture series for
the R-3’s. There are seventeen over the year. R3 at UBC is
comprised of six-months of geriatric and six-months of child so
the core curriculum is interdigitated between child and
geriatrics. Dr. Michael Wilkins-Ho has created a WIKI page for
residents and faculty with orientation patient packages, reading
lists and power points from the core lecture series. Residents
at UBC will do their geriatrics in several different places,
including two distinct rotations in Vancouver, one in Richmond,
one in New Westminster, one in White Rock, one in Victoria and
one in Prince George.
Dr. Shea from Ottawa defined the Ottawa Core Lecture Series,
which included Systems of Care for the Elderly, CAN-MEDS Roles,
Delirium, Dementia, Mood Disorders in the Elderly and ECT,
Psychopharmacology for the Elderly, Anxiety, Sleep Disorders,
Substance Use, Psychotic Illnesses, Legal Issues and a
Case-Based Integrative Lecture. Their six-month rotation started
in 2007 and the competencies were embedded in the CAN-MEDS
framework. They have two three-month rotations, Inpatient versus
Day Hospital, Outpatient or Outreach, or a six-month integrated
rotation. Evaluation opportunities include logs, an OSCE bank,
direct observation, collaboration with referring physicians,
presentation at geriatric multidisciplinary rounds and
supervision of medical students. Feedback so far has been
positive. The supervisors now this year are adjusting to junior
resident knowledge levels.
Martha Donnelly, MD, FRCPC
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Cognitive Behavioral Social
Skills Training in Older Individuals with Schizophrenia - Dr.
Tarek Rajji
In this workshop we discussed the increasing number of older
patients with schizophrenia. The prevalence of schizophrenia in
late life is around 1% and by 2025, 20% of patients with
schizophrenia will be 65 or older. We also talked about the
burden of schizophrenia, especially in late life. Schizophrenia
is one of the most debilitating and expensive mental disorders.
Its burden is due to a large extent to the associated deficits
in cognition and function. As patients with schizophrenia grow
older, these deficits are likely to have a greater impact at a
personal and public health level. Pharmacotherapy has been shown
to have a minimal effect on improving cognition or function. We
then discussed Cognitive Behavioural Social Skills Training (CBSST).
CBSST is a novel manualized psychosocial intervention that aims
at improving instrumental and social function. CBSST is a
personalized intervention that enables patients to achieve their
own specific goals in context of post-acute continuing care.
CBSST incorporates cognitive techniques, and training on social
skills such as problem solving, and verbal and non-verbal
communication. Among mid to late-life patients with
schizophrenia CBSST has been shown to increase social function
even at one year after the end of treatment. To date, there are
no published reports assessing the efficacy of CBSST in patients
with late-life schizophrenia. Thus, we presented the design of
project in which we are studying the efficacy of CBSST in
patients with late-life schizophrenia, age 60 years or older, in
improving their instrumental and social function. We are using
novel performance-based measures of instrumental function and
innovative tools to assess social cognition and function. We are
also studying the moderating effects of patients’ cognitive
characteristics and on their response to CBSST. Finally, we
discussed individual case examples of few participants who seem
to have benefited from CBSST at, for example, improving
interpersonal relationships and better managing their finances.
The group discussion was mostly focused on the fact that
participants appreciate that CBSST addresses issues not directly
related to the illness per se, but that are common to older
individuals with or without severe mental illness. We also
discussed the fact that CBSST could be readily administered by
front-line staff which makes it accessible to a larger
population of older patients with schizophrenia.
Tarek Rajji, MD, FRCPC
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Practicing
Ethical Fitness in Geriatric Outreach in Northwestern
Ontario: Challenging Cases and Unique Issues - Dr. Patricia
Lepage
The purpose of this workshop was to illustrate that practicing
ethical fitness in Geriatric Outreach requires a deeper
understanding of the family’s style of engagement to be fully
successful in the delivery of elder care. We have identified
three main styles of relating to their elder. Furthermore,
practicing ethical fitness clearly aids in the identification of
barriers to comprehensive and reliable care within the formal
care systems that are often rarely well integrated and generally
difficult to navigate. We used four cases to study the impact of
differing family dynamics and styles of engagement especially
around the issue of protection for the very vulnerable. The
impact of overly engaged family caregivers is a difficult
problem both for the caregiver in terms of stress but
potentially for the elderly parent as well when a therapeutic
alliance cannot be established with the outreach team. The
development of a Vulnerable Persons List may be a useful
community/social strategy to protect elderly individuals with
disengaged or non-existent families as seen in many Northern
Ontario bush-workers who came to Canada as immigrants after WW11
and neither married nor had families. Attendees to the workshop
described a clear resonance with each individual case presented
and their own angst in dealing with everyday ethical issues at
the frontline in Outreach. Although bush-workers were unique in
NWO, an attendee from Alberta felt a similar phenomenon existed
among cattle workers in his province. Although we all expressed
difficulty accepting one family’s solution to use an adult size
crib to keep their dementing parent safe, it was not ethically
acceptable to resort to locking an elderly dementing parent in a
bathroom while their adult children went to work. There was a
consensus that the forum provided the attendees with an
opportunity to process these cases as well as their own and
hopefully greater provision for more formal opportunities to
develop ease with the concept of practicing ethical fitness. The
additional perspective has a role in the development of
comprehensive geriatric care.
Patricia Lepage, MD, FRCPC
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Final
Comments From Your Committee Chair
As you can see, this year’s conference covered a broad array of
topics, from Dr. Mitchell’s paradigm-shift of treatment of
symptoms in severe dementia, to advances in psychotherapy and
pharmacotherapy for a variety of illnesses in geriatric
psychiatry, and also included exploration of important
behavioral approaches and ethical dillemas. The conference was
well-attended and well-received, and we’ll look forward to
another stimulating conference next year in Vancouver.
Mark Rapoport, MD, FRCPC
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Accessing the 2010
Presentations Online
In order to reduce wastage and save, the planning committee
decided to forgo printing the presentations for the 2010 Annual
Scientific Meeting: From Prevention to Palliation. Instead
presentations were posted in a secure section of www.cagp.ca for
all registered participants to access prior to the meeting. Now
that the meeting has concluded the presentations are still
available to members and non-member participants and
instructions on accessing them can be found below. It is our
hope that we can continue to use technology to our advantage
through this type of initiative and welcome your feedback so we
can better serve your needs.
CAGP Members: You can access to the conference Resources by
clicking here. NOTE: It will ask you to log in using your email
address and password.
Non-CAGP Members (only available until December 31, 2010):
Please follow the following steps.
Step 1: Acquire your password.
- Click
here to start resetting your password.
- Enter the same email
address you used to register for the conference and follow
the instruction sent to your email.
Step 2: Access Conference
Resources
- You can access to the
conference Resources by clicking
here.
NOTE: It will ask you to log in using your email address and
password.
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CONGRATULATIONS |
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Outstanding
Contributions to Geriatric Psychiatry Award
2010 Recipient:
Dr. Nathan Herrmann (ON)
Dr. Nathan Herrmann is without question the leading opinion
leader on the psychopharmacology of dementia in Canada. He has
published over 165 peer-reviewed papers in high impact journals
related primarily to the pharmacology of dementia in addition to
other areas of geriatric psychiatry, and has mentored many
leading geriatric psychiatrists in Canada. He is highly sought
after in questions of drug management of dementia including
risks and benefits, and as a speaker for scientific meetings
such as the Canadian Academy of Geriatric Psychiatry Annual
Scientific Meeting, the Canadian Congress of Neurological
Sciences, the Canadian Psychiatric Association, the
International Psychogeriatric Association Congress, and the
Canadian Geriatrics Society, just to name a few.
His influence on clinical practice in Canada has included his
involvement in the Canadian Consensus Conferences on Dementia
which provided guidelines for the treatment of dementias and he
has also provided guidance and direction to the planning of
Royal College subspecialty certification for geriatric
psychiatry in Canada over the years.
Dr. Herrmann has provided leadership and vision for the field of
Geriatric Psychiatry in Canada and beyond. He has been a
powerful advocate for the appropriate use of pharmocotherapy in
dementia and has significantly influenced health care policy for
older adults through his research, scholarly activities and
publications. It is for these reasons that he has been chosen as
the 2010 recipient of the CAGP Award for Outstanding
Contributions to Geriatric Psychiatry.
CAGP Fellowship Award
2010 Recipient:
Dr. Tegan Sacevich (MB)
CAGP Resident Awards
2010 Recipients:
Dr. Sara Brunelle (QC)
Dr. Andrea Iaboni (ON)
Dr. Genevieve Létourneau (QC)
Poster Competition
2010 Winners: Soham Rej, MD, Karl Looper MD, M.Sc., and
Marilyn Segal, MD
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Do Antidepressants Lower the Prevalence of
Lithium-Associated Hypernatremia and Symptomatic
Polyuria in the Elderly?
Abstract:
Do Antidepressants Lower the Prevalence of
Lithium-Associated Hypernatremia and Symptomatic
Polyuria in the Elderly?
Clinically significant measures of lithium-induced
nephrogenic diabetes insipidus, such as
hypernatremia and symptomatic polyuria have not been
well studied. This is especially relevant in the
elderly, who may become symptomatic and require
hospitalization with relatively small elevations in
sodium levels as compared to the younger adult
population. Antidepressant use has been associated
with hyponatremia, which may balance sodium levels
in patients on lithium, although this protective
effect against lithium-associated hypernatremia has
not been investigated.
A retrospective study in geriatric psychiatry
outpatients of three tertiary-care hospitals was
performed. Patients with a history of lithium use
alone were compared to those with a history of
concurrent lithium and antidepressant use, for
prevalence rates of persistent hypernatremia (≥
147mmol/L for ≥ 6 months), marked hypernatremia (≥
149mmol/L), or documented complaints of symptomatic
polyurea.
The prevalence of hypernatremia or symptomatic
polyuria was less in patients who had concurrent use
of lithium and antidepressants as compared to
lithium alone 2/35 (5.7%) vs. 7/20 (35%), OR 0.11,
p=0.008. Our results suggest that antidepressants
may have a protective effect against
lithium-associated hypernatremia and symptomatic
polyurea in the elderly. |
The winning entry was
one of eleven posters presented onsite at the 2010 Annual
Scientific Meeting in Toronto. Congratulations again to Dr. Rej,
Dr. Looper and Dr. Segal for their outstanding entry.
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