In this Issue
 
Message from the Editor

CAGP Meeting Summaries & Highlights

Workshop Summaries

2010 CAGP Award Recipients

Upcoming Events
 

 

IN SHORT

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.
 
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.
 
Ontario Members: Long-Term Care Home Act - Implementation

Update #3   English | French
Update #4   English | French
 

 

Opportunities for Geriatric Psychiatrists

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
 

Volunteer Opportunity

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.
 

Board of Directors
2009 - 2010

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

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'.


 
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

 

 

October 2010 Newsletter

MESSAGE FROM THE EDITOR

Dear Member

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
 

CAGP MEETING SUMMARIES & HIGHLIGHTS


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
 

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
 

 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
 

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
 

CAGP MEETING SUMMARIES & HIGHLIGHTS

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

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
 

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
 

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
 

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
 

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
 

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
 

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.

CONGRATULATIONS

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

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.
 

Upcoming Events

 

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