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To see whether the percentage of older adults entering substance abuse treatment for their first time was increasing and whether there were changes in the use patterns leading to the treatment episode, particularly an increase in illicit drugs. The Treatment Episode Data Sets publicly available from the Substance Abuse Mental Health Services Administration from 1998 to 2008. Young adults age 30–54 years as a comparison group (N = 3,547,733) and those age 55 years or older (N = 258,542) with a first-time admission for a publicly funded substance abuse treatment. Demographic and substance use history variables at admission. The proportion of older adults going for substance abuse treatment for the first time is increasing relative to younger adults. The pattern of drug use is also changing, with an increasing illicit drug involvement (cocaine and heroin) in older adult admissions. We know little of these long-time users, their current medical state, cognitive abilities, and psychiatric symptoms after such a long exposure time. Previous studies on heroin and cocaine exposure focused on individuals identified much earlier in life, and the aging long-term users might represent a relatively large but unknown population.

In a study of patients with Alzheimer's disease and associated psychosis or agitation that had responded to risperidone, the risk of relapse was greater among patients randomly assigned to switch to placebo than among those who continued to receive risperidone. Symptoms of psychosis or agitation are common in Alzheimer's disease. 1 , 2 These symptoms are associated with distress on the part of the patient, an increased burden on caregivers, more rapid cognitive decline, an increased likelihood of institutionalization, and increased health care costs. 3 Nonpharmacologic behavioral treatment approaches may help, 4 – 9 but large, controlled trials are needed to confirm the effectiveness of these strategies. Among psychotropic medications, only antipsychotic agents show superiority over placebo for the treatment of psychosis and agitation–aggression in patients with dementia, although they are associated with only low-to-moderate efficacy. 10 – 12 Side effects of antipsychotic drugs include sedation, extrapyramidal . . .

Practice effects on cognitive tests have been shown to further characterize patients with amnestic mild cognitive impairment (aMCI) and may provide predictive information about cognitive change across time. We tested the hypothesis that a loss of practice effects would portend a worse prognosis in aMCI. Longitudinal, observational design following participants across 1 year. Community-based cohort. Three groups of older adults: 1) cognitively intact (n = 57), 2) aMCI with large practice effects across 1 week (MCI + PE, n = 25), and 3) aMCI with minimal practice effects across 1 week (MCI − PE, n = 26). Neuropsychological tests. After controlling for age and baseline cognitive differences, the MCI − PE group performed significantly worse than the other groups after 1 year on measures of immediate memory, delayed memory, language, and overall cognition. Although these results need to be replicated in larger samples, the loss of short-term practice effects portends a worse prognosis in patients with aMCI.

Background Depression is prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, yet rates of Veteran mental health care utilization remain modest. The current study examined: factors in electronic health records (EHR) associated with lack of treatment initiation and treatment delay; the accuracy of regression and machine learning models to predict initiation of treatment. Methods We obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis. Results 108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586–0.602; machine learning F-measure = 0.46). Conclusions Having VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.

Recent studies have tried to determine which aspects of chronic illness heighten the risk for depression, with functional impairment receiving the most attention. There is growing evidence that functional impairment accounts for most of the association between chronic illness and depression. This study examines the relative contribution of cognitive function, physical function, and chronic illness to depression 2 years later in a nationwide sample of elders aged 70 and older. This is a longitudinal community-based study of 5,289 elders completing two waves of assessment in the Asset and Health Dynamics among the Oldest Old study. Depression assessment included an abbreviated version of the CES-D and of the Composite International Diagnostic Interview (the CESD-8 and the CIDI-S). Cognitive function, physical function, and presence of chronic illness assessed at Wave 1 were examined as predictors of depression at Wave 2 while controlling for Wave 1 CESD-8 score. In a full multivariate model, most baseline cognitive function, physical function, and chronic illness variables predicted depression as measured by the CESD-8 at Wave 2. The associations were markedly weaker between baseline variables and the Wave 2 CIDI-S. The Wave 1 CESD-8 score predicted all-cause mortality by Wave 2 (Z = 3.13; p > Z = 0.002) even after controlling for key health and functioning variables. Chronic illness, physical function, and cognitive function all independently predict depressive morbidity in late-life. The CIDI-S appeared less informative about these key relationships when compared to the CESD-8. The significance of depressive symptoms was demonstrated by their independent association with all-cause mortality at 2-year follow-up.

Affective characteristics are associated with depression severity, course, and prognosis. Patients' affect captured by clinicians during sessions may provide a rich source of information that more naturally aligns with the depression course and patient-desired depression outcomes. In this paper, we propose an information extraction vocabulary used to pilot the feasibility and reliability of identifying clinician-recorded patient affective states in clinical notes from electronic health records. Affect and mood were annotated in 147 clinical notes of 109 patients by 2 independent coders across 3 pilots. Intercoder discrepancies were settled by a third coder. This reference annotation set was used to test a proof-of-concept natural language processing (NLP) system using a named entity recognition approach. Concepts were frequently addressed in templated format and free text in clinical notes. Annotated data demonstrated that affective characteristics were identified in 87.8% (129/147) of the notes, while mood was identified in 97.3% (143/147) of the notes. The intercoder reliability was consistently good across the pilots (interannotator agreement [IAA] >70%). The final NLP system showed good reliability with the final reference annotation set (mood IAA=85.8%; affect IAA=80.9%). Affect and mood can be reliably identified in clinician reports and are good targets for NLP. We discuss several next steps to expand on this proof of concept and the value of this research for depression clinical research.

The Disaster Preparedness Task Force of the American Association for Geriatric Psychiatry was formed after Hurricane Katrina devastated New Orleans to identify and address needs of the elderly after the disaster that led to excess health disability and markedly increased rates of hopelessness, suicidality, serious mental illness (reported to exceed 60% from baseline levels), and cognitive impairment. Substance Abuse and Mental Health Services Administration (SAMHSA) outlines risk groups which fail to address later effects from chronic stress and loss and disruption of social support networks. Range of interventions recommended for Preparation, Early Response, and Late Response reviewed in the report were not applied to elderly for a variety of reasons. It was evident that addressing the needs of elderly will not be made without a stronger mandate to do so from major governmental agencies (Federal Emergency Management Agency [FEMA] and SAMHSA). The recommendation to designate frail elderly and dementia patients as a particularly high-risk group and a list of specific recommendations for research and service and clinical reference list are provided.