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Practical Psychiatry in the Long-Term Care Facility


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Table of Contents

Contributors; Foreward by Ira R. Katz; Preface; Acknowledgments; Chapter 1 Mental Health Issues in Long-Term Care Facilities by David K. Conn; Chapter 2 The Mental Status Examination by Barbara Schogt, Dmytro Rewilak; Chapter 3 Alzheimer's Disease and Other Dementias by Nathan Herrmann, Robert Madan; Chapter 4 Delirium by Barbara Schogt, David Myran; Chapter 5 Mood and Anxiety Disorders by David K. Conn, Alanna Kaye; Chapter 6 The Suicidal Resident by David K. Conn, Alanna Kaye; Chapter 7 The Suspicious Resident by Barbara Schogt; Chapter 8 The Resident with Personality Disorder by Anne Robinson, Barbara Schogt; Chapter 9 Alcohol Use and Misuse by Ken Schwartz; Chapter 10 Sexuality and Sexual Behavior by Ken Schwartz, David Myran, Marcia Sokolowski; Chapter 11 Principles of Geriatric Psychopharmacology by Nathan Herrmann; Chapter 12 Optimizing the Use of Psychotropic Medications by David K. Conn; Chapter 13 Behavior Management Strategies by Dmytro Rewilak; Chapter 14 Psychotherapy for the Institutionalized Elderly by Joel Sadavoy; Chapter 15 Groups and Group Psychotherapy by Ken Schwartz; Chapter 16 Guidelines for the Assessment and Treatment of Mental Health Issues in Long-Term Care Homes by David K. Conn, Maggie Gibson; Chapter 17 Planning Mental Health Educational Programs by Susan Lieff, Ivan Silver; Chapter 18 Helping the Nursing Staff: The Role of the Psychogeriatric Nurse Consultant by Alanna Kaye, Anne Robinson; Chapter 19 Understanding and Helping the Family Etta Ginsberg-McEwan, Anne Robinson; Chapter 20 Legal and Ethical Dimensions by Michel Silberfeld; Index.

About the Author

The first edition of David Conn et alA 's handbook for staff concerning nursing home psychiatry, was published in 1992. It had 14 chapters and was good. A revised and expanded edition came out in 2001, and now we have a third, the title being slightly changed each time. Again, and to great advantage (especially in relation to the excellent case illustrations and family information sheets), the book has increased in length. There are now 20 chapters with a foreword.Surely A 'Practical Psychiatry in the Long-Term Care HomeA ' will be regarded as an essential resource in nursing homes and other aged care facilities all over the world. I have read or delved into a number of books concerning mental health problems in nursing homes and how staff can best cope with them. This beautifully presented offering is the most comprehensive, readable and useful. I agree with Ira Katz when he says in the foreword that everyone working in nursing homes and long-term facilities (including nurses, nursing aides, social workers, administrators and even non-clinical staff) should learn about mental health. As he says, A A"It is possible for nursing home residents to lead a good life, in spite of their illnesses and disabilities, if their mental health needs are metA A". Sadly, mental health needs are commonly overlooked or are addressed inadequately, which is why the International Psychogeriatric Association has formed a Task Force to foster radical improvement. This book, if used widely and appropriately, will help to catalyse change.Another group who will benefit by accessing the book will be the primary care doctors who have overall clinical responsibility for long-term care (LTC) residents. Much in these pages may be known to them only superficially at present. There is excellent discussion about behaviour management strategies, psychopharmacology, personality types, and interventions to deal with depression and other mental disorders. I think more detail on dementia (particularly fronto-temporal dementia) would have been warranted, and some of us would quibble with using the terms A 'clinical depressionA ' and A 'major depressionA ' interchangeably. There are differences between and within countries regarding alcohol use and resident involvement in decision-making in LTC facilities, yet there is little in the book that will not be useful for discussion and in education around the world.PAGE 1 of 2PAGE 2 of 2Book review by John Snowdon: (October 2007)PRACTICAL PSYCHIATRY IN THE LONG-TERM CARE HOME.A Handbook for Staff. Third edition.by David K. Conn et al.Publisher: Hogrefe & Huber, Toronto, 2007.International Psychogeriatrics 2008Reviewed by John Snowdon:There are two features that I hope will be modified for the fourth edition. Firstly, the index needs expansion. Imagine we are nursing aides and Mrs X is screaming and hitting out at people. We want help from Conn et al, but we do not find A A"screamingA A", A A"verbal outburstA A" or A A"aggressionA A" in the index. Agitation is listed under A A"Behavioural disturbances in dementiaA A". I could not find A A"PacingA A", A A"RestlessnessA A" or A A"WanderingA A", let alone A A"Simulated presenceA A".The other major omission, in my view, is a discussion of the role and importance of primary care doctors in LTC. General practitioners are the coordinators of aged care for their patients in most places. Some do it well and see themselves as contributing to team care in LTC facilities. They listen, talk and communicate with staff. Others are less good at aged care. Such a discussion would help staff to know how to shape the way attending doctors provide their input in nursing homes and elsewhere. In addition, hopefully, GPs too will read the book and be prompted to consider whether adaptation of their practice styles might be appropriate.In my view, this is more than a handbook to refer to when specific situations or problems are encountered. Given the wealth of illustrative cases, those aiming to educate staff (of various disciplines) will be able to work through the chapters in successive focussed discussion groups. Sometimes a facility-based nurse specialist will lead & coordinate this process, and in other places an A 'expertA ' will come from outside in order to lead discussions. Some of the illustrative cases will challenge beliefs and attitudes; controversy helps ensure that new ideas are retained even if not accepted as applicable.Finally, while acknowledging that newest is not necessarily best, the fact is that only one quarter of the bookA 's references & suggested readings are dated post-2000, some chapter-writers having more obviously examined the relevance of recent literature than others.Despite these caveats, I strongly recommend that all aged care facilities purchase the 2007 revision for their staff to use in education sessions and to refer to when deciding how best to deal with a problem or situation. Those who provide clinical advice (community teams and visiting GPs) and LTC administrators would also be wise to have the book readily available.


"This is a wonderful text for medical and non-medical staff working in long-term care settings. I know of no other single source manual which is so comprehensive in range, yet so easy to read and access critical information. The successful previous edition has been revised and interesting new chapters on topics such as group psychotherapy and sexuality have been added." Bruce G. Pollock, MD, PhD, FRCPC, President Elect, American Association for Geriatric Psychiatry; Professor & Head, Division of Geriatric Psychiatry, University of Toronto.""This work has evolved over a number of years. The text is clear, clinically relevant, and in many ways fulfills Ira Katz's description of the Handbook in the forward, A"as a toolkit.A" The book is very well laid out and a pleasure to read, with the text broken in many placesby A"key points,A" tables, and case illustrations...Most of the chapters in the Handbook deal with topics one would expect,...However, the topics of other chapters may surprise some readers. These include chapters on alcohol use and misuse (surelylong-term care residents have no access!) and sexuality and sexual behavior (doesn't all that stop at the door of long-term care?). These additional chapters reflect the fact that long-term care can present problems for the clinician that are unexpected-and may be overlooked if the clinician is not sensitive to finding them..."Reviewed by DAN G. BLAZER MD, PhD, JP Gibbons Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC., excerpts from a review published in Journal of Psychiatric Practice Vol. 14, No. 5, September 2008

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