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Chapter 31. Clinical Psychiatry in the Nursing Home

Joel E. Streim, M.D.; Ira R. Katz, M.D., Ph.D.
DOI: 10.1176/appi.books.9781585623754.398619

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Excerpt

Nursing homes provide long-term care for elderly patients with chronic illness and disability as well as rehabilitation and convalescent care for those recovering from acute illness. As documented in previous reviews (Katz et al. 2000; Streim et al. 2004), clinical studies have consistently provided evidence that the diagnosis, management, and treatment of mental disorders are important components of nursing home care. The delivery of mental health services in nursing homes continues to be shaped by several factors, including growing scientific knowledge, availability of new treatments, evolving federal regulations, public dissemination of survey data, and changes in the medical marketplace. In this chapter we review current information on the psychiatric problems that are common in the nursing home, discuss current trends affecting clinical care, and present a conceptual model for the organization of mental health services.

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Table Reference Number
Table 31–1. Randomized, controlled studies of the outcomes of psychotherapeutic interventions in elderly nursing home residents
Table Reference Number
Table 31–2. Randomized, placebo-controlled studies of the efficacy of psychotropic medications in elderly nursing home residents

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Sample questions:
1.
Epidemiological studies during the 1980s and 1990s reported prevalence rates for psychiatric disorders among nursing home residents. On the basis of psychiatric interviews of nursing home patients in randomly selected samples, investigators reported rates for psychiatric disorders in which of the following ranges?
2.
Dementia is the most common psychiatric disorder in nursing home patients. What is the second most common psychiatric disorder?
3.
A number of nonpharmacological interventions have proven to be effective in reducing agitation in nursing home patients. Which of the following has not been shown to be effective in reducing agitation?
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