Among the most frustrating challenges for any health care professional are treating and alleviating the distress of an agitated patient with dementia—especially compelling in the midst of today’s unprecedented population explosion among adults over age 65. For the first time ever, people age 85 and older represent the fastest-growing segment of our population.

As we find ways to meet this challenge, we are also transforming how we think about aging. Instead of the pejorative term “senility,” which implies that simply to be old is to be infirm, we refer to the ABCs of geriatric psychiatry: disturbances in (A)ffect, (B)ehavior, and (C)ognition, which are not normal at any age.

This remarkable monograph offers practical direction on assessing and managing agitation in patients with dementia. Furthermore, this encouraging work shows that successful outcomes—with response rates as high as 70%—can be achieved with a systemic approach, involving both patient and caregiver, that includes cognitive, behavioral, psychodynamic, and reminiscence therapies. This concise book identifies and diagnoses the multiple types of agitation in dementia patients. It also explains how to look for and treat the underlying medical etiologies, and recommends treatment and management techniques, including:

• Definitional and theoretical conceptualizations of agitation in the elderly; the epidemiology (i.e., the possible relationships involving agitation and dementia, and the dynamic between symptoms and the care setting) and neurochemistry (i.e., the neurobiological changes of behavior involve biochemical and structural causes, not structural causes alone) of agitation
  
• Behavior assessment scales as evaluation tools; differential diagnoses (distinguishing delirium, depression, psychosis, and anxiety from the many precipitating and maintaining factors underlying agitation); clinical assessment and management of agitation in residential and other settings (extremely difficult and frustrating, often leading to staff and caregiver burnout)
  
• Nonpharmacological interventions, such as a systemic approach to psychotherapy for both patient and caregiver (with some response rates as high as 70%), bright light therapy (promising but unproven), electroconvulsive therapy (effective—with minimal and temporary side effects—for severe, treatment-intolerant, or treatment-resistant illness), and hormone replacement therapies
  
• The pathophysiology, pharmacology, and clinical data of serotonergic agents, mood stabilizers, neuroleptics, beta blockers, benzodiazepines, and other miscellaneous agents
  
• The legal and ethical issues in treating agitation in patients with dementia—finding the balance between autonomy and beneficence in the treatment of an agitated patient with dementia is difficult at best, with the challenge being to allow the patient’s participation as long and as fully as possible

This book will appeal to a wide audience of geriatric psychiatrists, primary care physicians and internists, general practitioners, nurses, social workers, psychologists, pharmacists, and mental health care workers and practitioners.

Introduction to the clinical practice series. Introduction. Agitation in the elderly: Definitional and theoretical conceptualizations. Epidemiology of agitation. Neurochemistry of agitation. Use of behavioral assessment scales for evaluating agitation in dementia. Differential diagnosis of agitation in dementia: Psychiatric conditions: delirium, depression, psychosis, and anxiety. Clinical assessment and management of agitation in residential settings. Nursing care adaptations, behavioral interventions, environmental changes, and sensory enhancement: conceptual, process, and outcome issues. Psychotherapeutic interventions. Bright light therapy. Serotonergic agents. Mood stabilizers. Neuroleptics. Beta-Blockers, benzodiazepines, and other miscellaneous agents. Electroconvulsive therapy. Hormone Therapies. Legal and ethical issues. Index

"This elegant book tells you exactly what is known about agitation in dementia. It is replete with a wealth of references at the end of every chapter. The authors are some of the leaders in the field. . . . Overall, this book gives the reader a comprehensive approach to this difficult subject. It is a useful resource book for those designing a residency curriculum in geriatric psychiatry and a helpful book for the clinician that is grappling with these difficult behaviors."—Susan K. Ball, M.D., Psychosomatics, April 2004

"This volume would be particularly appropriate for clinicians beginning their work in geriatric settings, such as postgraduate interns and residents, geriatric psychiatry fellows, and other students in mental health professional programs, as well as for more experienced clinicians seeking a succinct and readable overview of this topic."—Journal of Clinical Psychiatry, September 2004

"This is a broad, clinically useful guide that appeals to a wide range of healthcare professionals. It is an excellent addition to the library of any practitioner dealing with an elderly population."—Daniel Loiterstein, M.D., Doody's Book Reviews, June 2004

George T. Grossberg, M.D., is Professor and Director of Geriatric Psychiatry in the Department of Psychiatry and Human Behavior at St. Louis University School of Medicine in St. Louis, Missouri.

Donald P. Hay, M.D., is a Clinical Research Physician at Eli Lilly and Company in Indianapolis, Indiana, and Adjunct Clinical Associate Professor of Psychiatry in the Department of Psychiatry at Saint Louis University in St. Louis, Missouri.

Linda K. Hay, R.N., Ph.D., Medical Liaison, Eli Lilly and Company, Indianapolis, Indiana; and Adjunct Assistant Clinical Professor, Saint Louis University School of Medicine, St. Louis, Missouri.

John S. Kennedy, M.D., F.R.C.P.C., is Professor of Geriatric Psychiatry in the Department of Psychiatry at Indiana University School of Medicine, Indianapolis, Indiana.

David T. Klein, Psy.D., St. Louis Veterans Administration Medical Center; Department of Psychiatry at St. Louis University in St. Louis, Missouri.