Question:
How do mood and anxiety disorders increase the risks of dementia?
Answered by: Dr. Philip Muskin
It is not clear why mood and anxiety disorders predict dementia. One strong possibility is that an underlying biological mechanism connects the disorders. Depression, for some people, may be an early sign of dementia.
Anxiety may be the result of cognitive impairments that are very mild at first. That is to say, the subtle biological changes that result in the depressive or anxiety disorders, eventually disrupt the function of the brain and result in dementia.
For most of the dementias, the vast majority of which are Alzheimer Dementia, symptoms appear many years after the biological processes have begun. It is possible that the disorders are related by chance, i.e., that the genes responsible for the disorders happen to sit relatively close to each other on chromosomes.
Thus people who have depression or anxiety, which will show up earlier in life than does dementia, are also likely to get dementia.
To access more "Ask the Experts" answers, or to ask a question, please click here.
Philip Muskin, M.D.
Chief: Consultation-Liaison Psychiatry
Dr. Muskin’s research and publications include mood disorders and AIDS, the psychodynamics of the failure of empathy towards patients with AIDS, panic disorder, treatment of anxiety and depression in medically ill patients, maladaptive denial of physical illness, personality disorders in the primary care setting, the role of religiosity in patients’ decisions regarding do-not-resuscitate status, the psychodynamics of physician-assisted suicide, and the impact of intercessory prayer on medical outcomes.
Friday, January 14, 2011
PIRC - The Psychiatric Institute Residents’ Clinic
Psychiatrists in training at New York State Psychiatric Institute (PI) are in the enviable position of working with experts at the top of the field, including experts who conduct research with patients in a wide variety of diagnostic categories, affording residents the opportunity to work with a broad range of patients. One way in which they are able to take advantage of the Department of Psychiatry’s outstanding faculty is through their work at the Psychiatric Institute Residents’ Clinic (PIRC), a service that provides teaching opportunities in psychopharmacology and various psychotherapies for residents in their 2nd, 3rd or 4th year of training.
The treatment of outpatients has of course been an integral part of the residency training program for many years, and for the past four years this part of the residents training took place at Columbia University Medical Center. On July 1st, the Clinic moved to PI, where it provides free services not only to patients who have completed research studies at the Institute, but individuals referred by staff at the Medical Center’s outpatient service line, 212-305-6001, and direct referrals from Columbia-affiliated physicians all over the Medical Center.
Dr. Eileen Kavanagh, a graduate of the residency program and director of PIRC, has been collaborating with research coordinators and principal investigators to facilitate referrals from the research clinics for follow up care with residents. For researchers like John Markowitz, MD, this is good news: “As a clinical researcher, I know the difficulty we face in referring patients who have not responded or only partially responded to study treatments and follow-up treatments, and it is wonderful to have a clinic of talented young psychiatrists to refer to.”
One major change has been that Dr. Kavanagh has combined various sub-clinics under one umbrella “with one electronic medical record, one person overseeing [residents’] caseloads and the diversity of the caseload.” As providing valuable learning opportunities is at the crux of the Clinic’s mission, cases will be screened carefully by Dr. Kavanagh to ensure a rich and diverse caseload. In this endeavor, Dr. Kavanagh will work closely with Drs. Maria Oquendo, Deborah Cabaniss and Melissa Arbuckle to fulfill residents training needs.
“We will track the clinical work both case-by-case and resident-caseload by resident-caseload,” said Dr. Kavanagh. “It is clearly a great learning opportunity to have a resident see a patient who needs a medication that they don’t normally prescribe. At the same time, if the residents all have a certain type of patient in their case load, at some point in the year we might stop taking such cases.”
Since the Clinic began operating at PI, Dr. Kavanagh notes, psychotherapy is in great demand as a treatment. Right now, however, she would like more “true psychopharmacology cases.” These cases involve “patients already in stable therapy with an outside provider” – which will introduce residents to working with clients who have multiple providers (i.e., those patients in a split treatment) – or cases that only require medication management once a month if not more frequently. There is also value in working with stable cases, added Dr. Kavanagh, where residents, for example, may explore the longterm effects of lithium in a patient who has been stable on the same medication for 20 years. “This type of case is very interesting for the trainee.”
Researchers who would like to refer subjects to PIRC should complete an internal referral form which Dr. Kavanagh can provide. Write to her at ek2155@columbia.edu or kavanagh@pi.cpmc. columbia.edu. Other patients, including employees, should contact the Medical Center’s outpatient referral line at (212) 305-6001. Columbia-affiliated clinicians who want to refer a patient can contact Dr. Kavanagh directly via e-mail or by calling 212-543-5549.
The treatment of outpatients has of course been an integral part of the residency training program for many years, and for the past four years this part of the residents training took place at Columbia University Medical Center. On July 1st, the Clinic moved to PI, where it provides free services not only to patients who have completed research studies at the Institute, but individuals referred by staff at the Medical Center’s outpatient service line, 212-305-6001, and direct referrals from Columbia-affiliated physicians all over the Medical Center.
Dr. Eileen Kavanagh, a graduate of the residency program and director of PIRC, has been collaborating with research coordinators and principal investigators to facilitate referrals from the research clinics for follow up care with residents. For researchers like John Markowitz, MD, this is good news: “As a clinical researcher, I know the difficulty we face in referring patients who have not responded or only partially responded to study treatments and follow-up treatments, and it is wonderful to have a clinic of talented young psychiatrists to refer to.”
One major change has been that Dr. Kavanagh has combined various sub-clinics under one umbrella “with one electronic medical record, one person overseeing [residents’] caseloads and the diversity of the caseload.” As providing valuable learning opportunities is at the crux of the Clinic’s mission, cases will be screened carefully by Dr. Kavanagh to ensure a rich and diverse caseload. In this endeavor, Dr. Kavanagh will work closely with Drs. Maria Oquendo, Deborah Cabaniss and Melissa Arbuckle to fulfill residents training needs.
“We will track the clinical work both case-by-case and resident-caseload by resident-caseload,” said Dr. Kavanagh. “It is clearly a great learning opportunity to have a resident see a patient who needs a medication that they don’t normally prescribe. At the same time, if the residents all have a certain type of patient in their case load, at some point in the year we might stop taking such cases.”
Since the Clinic began operating at PI, Dr. Kavanagh notes, psychotherapy is in great demand as a treatment. Right now, however, she would like more “true psychopharmacology cases.” These cases involve “patients already in stable therapy with an outside provider” – which will introduce residents to working with clients who have multiple providers (i.e., those patients in a split treatment) – or cases that only require medication management once a month if not more frequently. There is also value in working with stable cases, added Dr. Kavanagh, where residents, for example, may explore the longterm effects of lithium in a patient who has been stable on the same medication for 20 years. “This type of case is very interesting for the trainee.”
Researchers who would like to refer subjects to PIRC should complete an internal referral form which Dr. Kavanagh can provide. Write to her at ek2155@columbia.edu or kavanagh@pi.cpmc. columbia.edu. Other patients, including employees, should contact the Medical Center’s outpatient referral line at (212) 305-6001. Columbia-affiliated clinicians who want to refer a patient can contact Dr. Kavanagh directly via e-mail or by calling 212-543-5549.
Hospitalist Improves Psychiatric Care at NewYork-Presbyterian
This April, NewYork-Presbyterian Hospital created one of the nation’s first Hospitalist positions dedicated to providing mental health care for inpatients admitted for medical and surgical conditions. Since then, Dr. Anne Skomorowsky has used the position to provide a more consistent approach to psychiatric care for individual patients, while also raising awareness among attending physicians, residents, and physician’s assistants about the mental health needs of the populations they serve.
“We are developing a different model of psychiatric care,” noted Dr. Skomorowsky. “Every morning, I join hospital physicians on their rounds and am able to assess patients for psychiatric disorders and acute behavioralproblems.” This extra layer of attention enables mental health care needs to be factored into patient care earlier, often before symptoms have manifested in ways that interfere with effective treatment. Previously, hospital physicians were only able to call for psychiatric assessments once mental health issues had already grown problematic.
Dr. Skomorowsky described one recent example in which a woman was being repeatedly admitted to the hospital for asthma exacerbations. Through Dr. Skomorowsky’s intervention, it was determined that the patient was also experiencing hyperventilation due to a panic disorder, a diagnosis which enabled significant improvements in her overall medical care. In another case, an elderly woman was experiencing psychotic delusions which made it difficult to determine whether she was being abused by the relative with whom she lived. Through participation in a family meeting, Dr. Skomorowsky was able to help craft a treatment plan for the patient.
The position is officially titled the “Barbara Jonas Psychiatric Hospitalist” for longtime mental health advocate and former psychotherapist Barbara Jonas, who with her husband Donald gave $500,000 to honor NewYork-Presbyterian Hospital President and CEO Herbert Pardes’ longtime commitment to addressing mental health and behavioral issues. Dr. Skomorowsky, the first incumbent in the position, is a psychiatrist with specialized training in working with hospital patients. She has been with the hospital since 2004, and from 1997 to 1999, and from 1998-2008 served as a psychiatrist at St. Luke’s-Roosevelt Hospital.
“We are developing a different model of psychiatric care,” noted Dr. Skomorowsky. “Every morning, I join hospital physicians on their rounds and am able to assess patients for psychiatric disorders and acute behavioralproblems.” This extra layer of attention enables mental health care needs to be factored into patient care earlier, often before symptoms have manifested in ways that interfere with effective treatment. Previously, hospital physicians were only able to call for psychiatric assessments once mental health issues had already grown problematic.
Dr. Skomorowsky described one recent example in which a woman was being repeatedly admitted to the hospital for asthma exacerbations. Through Dr. Skomorowsky’s intervention, it was determined that the patient was also experiencing hyperventilation due to a panic disorder, a diagnosis which enabled significant improvements in her overall medical care. In another case, an elderly woman was experiencing psychotic delusions which made it difficult to determine whether she was being abused by the relative with whom she lived. Through participation in a family meeting, Dr. Skomorowsky was able to help craft a treatment plan for the patient.
The position is officially titled the “Barbara Jonas Psychiatric Hospitalist” for longtime mental health advocate and former psychotherapist Barbara Jonas, who with her husband Donald gave $500,000 to honor NewYork-Presbyterian Hospital President and CEO Herbert Pardes’ longtime commitment to addressing mental health and behavioral issues. Dr. Skomorowsky, the first incumbent in the position, is a psychiatrist with specialized training in working with hospital patients. She has been with the hospital since 2004, and from 1997 to 1999, and from 1998-2008 served as a psychiatrist at St. Luke’s-Roosevelt Hospital.
Subscribe to:
Posts (Atom)