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As director of psychiatry at Hebrew SeniorLife for 18 years, Dr. Metzger has witnessed a number of changes in how we manage agitation and other elements of BPSD. In this article, he outlines current thinking about such symptoms, as well as the latest techniques—both pharmacologic and non-pharmacologic—for managing them.
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There used to be this rule of thumb that you don’t need to worry about people who are worried about their memory; you need to worry about people who aren’t worried. And that might be true for people with dementia, where there is often a loss of insight. But if you want to pick up memory problems at the earlier, mild cognitive impairment stage, do an evaluation when someone is worried about memory loss.
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We’ve all seen the ads from companies such as Lumosity implying that fun, computer-based learning games will help your mind work better. Such methods are called computerized cognitive training (CCT), and past systematic reviews have had weaknesses, such as combining CCT with other interventions or including studies that were not randomized controlled trials. These researchers performed a systematic review that was more rigorous.
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Do antidepressants cause bipolar II patients to switch from depression to hypomania? It’s a controversial question, and you’ll find academic psychiatrists who will argue passionately that antidepressants are either safe or dangerous in these patients. The latest study appears to endorse the “safe” camp.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.