Expert Discusses Pharmacological Interventions for Elderly

Pharmacologic intervention on the C/L service was the focus of a workshop presented today by Sandra Jacobson, M.D., author of the second edition of the Clinical Manual of Geriatric Psychopharmacology, just published by American Psychiatric Publishing.

The benzodiazepine challenge test for catatonia was reviewed in detail, along with techniques to elicit the motor signs of serotonin syndrome. In addition, the potential for underdiagnosis of serotonin syndrome according to the Hunter criteria was noted. In the discussion of akathisia, the role of anti-adrenergic drugs was explained using a model proposed by Loonen and Stahl in 2011. The point was made that anticholinergic drugs have no role in the treatment of this syndrome. For rapid control of severe akathisia, IV propranolol and benzodiazepines were recommended. For more routine treatment, oral propranolol, oral lorazepam, or clonidine was suggested.

Newly proposed treatments for akathisia hypothesized to work by 5HT2A antagonism—including trazodone and mirtazapine—were discussed. The use of tetrabenazine to treat tardive dyskinesia—including more serious and unusual syndromes such as respiratory dyskinesia—was reviewed. Also discussed was the need to establish a routine of evaluating hepatic and renal function of hospitalized C/L patients before psychotropic medication is recommended, so that dosage and schedule adjustments can be made. Methods for rapid estimation of glomerular filtration rate using the Web-based GFR (MDRD) calculator and of potential hepatic injury using Hy’s law were described.

For more information on the Clinical Manual of Geriatric Psychopharmacology, click here. APA members may purchase the book at a discount online or at the annual meeting.