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Excerpt
Psychotropic Drugs and the Elderly, a volume in the Fast Facts Series, provides a comprehensive review of psychotropic drugs, with a special focus on research on their use, risks, and benefits in the elderly and clinical skills needed to prescribe appropriately and safely for this population. Relevant assessments, treatment modalities, and alternative medicines are also discussed.
Content and organization. The introduction describes the book's structure and goals and age-related challenges in prescribing. The book has sections on antidepressants, antipsychotics, anxiolytics, mood stabilizers, and cognitive enhancers. Each section starts with an overview of all clinical conditions treated with drugs in that group, including symptoms, causes, epidemiology, and management. The members of the drug group are listed with brand and generic names, starting, maximum, and maintenance doses, indications, effectiveness and limitations, different classes within the group, variations in potency, and availability in various forms. Information on pretreatment evaluations, side effects, and relevant non-pharmacologic interventions is included. This overview is followed by detailed profiles of each drug that include brand and generic name, manufacturer, chemical and therapeutic class, FDA/off-label indications, pharmacology, mechanism of action, dosing, combination therapy, side effects, routine/special monitoring, drug interactions, effects on lab tests, specific precautions and contraindications, overdose symptoms, toxicity, suicide, caregiver notes, clinical tips, and, where indicated, non pharmaceutical interventions.
The author uses extensive tables and lists to clarify the complex issues involved in prescribing psychotropic drugs for elderly patients, which will be invaluable for educators in the field. Also included is information on each organ system (its potential state of decline and variation with aging) and transmitter system and on enzyme and isoenzyme activity. Cultural and gender differences and differences related to subgroups of patients are noted whenever research has shown variations.
Strengths and deficiencies. The strength of this book lies in its organization, consistency, and comprehensive presentation of well researched and well selected material. In its genre, the book has no deficiencies
Recommended readership. Much thought and organizational expertise went into the writing of this book. Using modern computer technology and a sizable team of competent research assistants, Dr. Sadavoy has masterminded a user-friendly and expertly and extensively referenced (84 pages of small print) guide for clinicians. This book will be of use to residents, geriatric psychiatrists, geriatricians, geriatric and geriatric psychiatry nurse practitioners, and the many primary care physicians and medical specialists who are more and more often called on to provide care for elderly patients. The author provides consistent alerts to areas where research on elderly patients is lacking and detailed information on databases and other sources that were searched (1980-2003), making this book a rich resource for the scientific community, including libraries.
Overall rating. The author displays keen awareness of the importance of peer-reviewed evidence, expert opinion, and clinical observation for evidence-based practice. The book will also be helpful for clinicians treating patients still taking medications prescribed for them when they were younger, some of which may now be contraindicated, while newer medications are available for these indications. With new drugs rapidly arriving on the scene, future editions will be needed to keep the information up to date. Psychotropic Drugs and the Elderly: Fast Facts is far more portable than the Physicians' Desk Reference and avoids marketing-sponsored research. Whether it will hold up against a handheld digital version is for the next generation to tell. I rate it excellent in accomplishing the laudatory goals the author set.
