Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly.

Insomnia in the elderly is a prevalent condition that poses treatment challenges to practitioners across medical fields. There are many behavioral and other nonpharmacological therapies, 18 Food and Drug Administration-approved pharmacotherapies, and numerous off-label, over the counter and alternative treatments. Most reviews on this subject focus either on pharmacological treatments or behavioral treatments. The authors provide a combined review of available pharmacological and nonpharmacological treatments. The authors narratively reviewed each treatment from our literature search, tabled results with the highest level of available evidence on 5 major sleep outcomes and evaluated these results for clinical significance. The authors also evaluated the safety of pharmacotherapies within the context of the 2019 Beers Criteria for Potentially Inappropriate Medications in the Elderly. The authors found the most rigorous evidence supporting Cognitive Behavioral Therapy for Insomnia as a first-line treatment option, with longer lasting therapeutic effects than treatment with pharmacologic agents alone. The authors also found evidence of similar outcomes from other behavioral interventions, such as Brief Behavioral Therapy for Insomnia and relaxation training. The authors found 4 studies, 2 on relaxation training, 1 on sleep restriction, and 1 on stimulus control limited to the elderly with clinically significant results. The authors found no pharmacological studies limited to the elderly on treatments not contraindicated by Beers criteria with clinically significant results. The authors discussed the challenges of determining clinical significance in sleep studies, the lack of studies restricted to the elderly, and the role of placebo effect.

Delusional Disorder Arising From a CNS Neoplasm.

Erotomania arising from a central nervous system (CNS) neoplasm has not been previously described. Here, we present the first known case, to our knowledge, of erotomania with associated persecutory delusions arising following diagnosis and treatment of a left frontal lobe brain tumor.

Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population.

Purpose of review: Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults. Recent findings: PubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: "substance use disorder," "substance abuse," "abuse," "illicit substances," "illicit drugs," "addiction," "geriatric," "elderly," "older adults," "alcohol," "marijuana," "cannabis," "cocaine," "heroin," "opioid," and "benzodiazepine." Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population. Summary: This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.

An updated model for the first-time hospitalization of patients with borderline personality disorder: two illustrative case reports.

Patients with borderline personality disorder can be difficult to treat on psychiatric units, especially since long-stay units specializing in the treatment of patients with borderline personality disorder are now few and far between. With the shorter length of hospital stay today, clinicians must work hard to establish the diagnosis of borderline personality disorder, adjust medications, stabilize the patient, and then find the appropriate outpatient treatment plan. Future research is needed to figure out the best way to accomplish these tasks and to identify which patients with borderline personality disorder respond to which treatments.

An Unusual Case of Erotomania and Delusional Misidentification Syndrome.

Delusional misidentification syndromes and erotomania are rare entities, each with several distinct manifestations and no clearly defined treatment regimen. Here we expand upon an earlier literature review and describe the case of a 40-year-old woman with a history of bipolar I disorder who presented after an extended period of medication nonadherence with symptoms consistent with both of these conditions; she believed that the staff on the unit were in fact disguised celebrities and fictional characters, and she claimed to be married to a famous singer. The exact relationship of these symptoms (and indeed, even their basic etiologies) remains unclear; however, both delusional syndromes resolved with a combination of risperidone and lithium therapy. Although earlier literature has suggested pimozide as the most effective agent for treating delusional syndromes, given the more favorable side-effect profile of atypical versus typical antipsychotics, this case suggests a role for risperidone as a first-line treatment in such situations.

Cetirizine-associated delusions and depression in an 18-year-old woman.

INTRODUCTION: Cetirizine is a second-generation H1 histamine receptor antagonist that is commonly used for symptomatic relief of hay fever and other allergies and can be combined with pseudoephedrine hydrochloride, a decongestant. The most common adverse effects include headache, nausea, nasopharyngitis, vomiting, and coughing. OBJECTIVE: To report on an adolescent 18-year-old woman who developed delusional thinking and depression after starting treatment with cetirizine. CASE REPORT: We report on an adolescent 18-year-old woman who developed delusional thinking and depression after starting treatment with cetirizine. Once cetirizine was discontinued, the patient returned to her clinical baseline. CONCLUSIONS: Physicians need to be aware of the potential psychiatric adverse effects associated with cetirizine.