Mohammed T. Abou-Saleh

8 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYthis Freudian view and reported psychotherapeutic success witholder patients 12 . Beginning in the mid-twentieth century, a numberof psychotherapeutic techniques were described and clinicallyevaluated for their effectiveness. Some are particularly applicableto the elderly psychiatric patient and include both behavioral andcognitive forms of psychotherapy. In Europe and North Americapsychotherapeutic approaches have been successfully used forelderly outpatients with depression and/or hypochondriasis.THE SUBSPECIALTY OF GERIATRIC PSYCHIATRYGeriatric consultants have served in the National Health Servicein the UK for many years. A geriatric consultant is not a primarycare physician and sees patients by referral, usually from generalpractitioners 13 . The geriatric consultant is likely to be hospitalbased.Psychogeriatric long-term care beds are increasing innumber and the responsibility is usually assigned to a consultantpsychiatrist specializing in the psychiatry of old age. In 1985, theRoyal College of Physicians of London conducted their firstexamination of candidates for a diploma in geriatric medicine.Although the Board of Examiners of the College includesrepresentatives from general practice and from psychogeriatrics,the future of old age psychiatry as an area of specialization in theUK remains uncertain. In 1989 the British Department of Healthrecognized psychogeriatrics as an official subspecialty.In Canada, the Royal College of Physicians and Surgeons in1981 conducted examinations for special competence in geriatricmedicine. Although geriatric psychiatry is not recognized as asubspecialty, the College has encouraged the development ofprograms in geriatric psychiatry. Since 1988 in the USA, theAmerican Board of Internal Medicine, in collaboration with theAmerican Board of Family Practice, has offered by examination acertificate of added qualifications in geriatrics. The examination isadministered to candidates from both Boards at the same time inthe same testing centers and the criteria for qualification areidentical for both Boards 14 .Geriatric psychiatry was the first subspecialty area for whichthe American Board of Psychiatry and Neurology offered anexamination for added qualifications. The first examination wasgiven in April 1991 to 661 candidates and the second year to 578candidates. Since the first examination 3435 certificates have beenissued 15 . The next examination was scheduled for the year 2000and the first re-certification in 2000 as well. All added qualificationsin geriatric psychiatry will be time-limited to 10 years. Inmost European countries an examination is not required forqualification in a medical specialty. However, Sweden is movingto the examination as a requirement.Recently there has been a rapid development of professionalorganizations concerned with geriatric psychiatry. Two of themost active are the American Association of Geriatric Psychiatryand the International Association of Geriatric Psychiatry. TheAmerican association has made available geriatric psychiatry selfassessment.For many years, it was believed that many physicians arereluctant to become involved in geriatrics. Numerous explanationshave been offered, including relatively low monetarycompensation, the lack of satisfactory treatment outcomes andlack of personal satisfaction and scientific challenge 16 . This viewhas rapidly changed and considerable interest and satisfaction isevident among medical students as well as physicians in trainingand practice. A recent study of those who completed geriatricfellowships in geriatric medicine or psychiatry and have now beenin practice for at least 3 years found that 93% were satisfied withtheir career choice, 80% felt that they had maintained professionalstatus and prestige, 71% were satisfied with their incomesand 96% found personal gratification in taking care of elderlypatients 17 .REFERENCES1. Busse FW, Blazer DG. The future of geriatric psychiatry. In BusseFW, Blazer DG, eds, Geriatric Psychiatry. Washington, DC:American Psychiatric Press, 1989, 671–95.2. Nascher IL. Geriatrics: The Diseases of Old Age and Their Treatment.Philadelphia, PA: Blakistons, 1914.3. Nascher IL. The Aging Mind. Medical Record No. 157, 1944, 662.4. Reisberg B. Preface. In Resiberg H, ed., Alzheimer’s Disease. NewYork: The Free Press (Macmillan Inc), 1983.5. Post F. The Clinical Psychiatry of Late Life. Oxford: Pergamon, 1965.6. Busse EW, Pfeiffer I. Behavior and Adaptation in Late Life. Boston,MA: Little, Brown, 1969; 2nd edn, 1977.7. Busse EW. International Association of Gerontology. In MaddoxGL, editor-in-chief, Encyclopedia of Aging. New York: Springer,1987, 359–60.8. Bergener M. International Psychogeriatric Assocation. In MaddoxGL, editor-in-chief, Encyclopedia of Aging. New York: Springer,1987, 365.9. Detre T. The future of psychiatry. Am J Psychiat 1987; 144: 621–5.10. Procter A, Doshi B, Bowen D, Murphy E. Rapid autopsy brains forbiochemical research: experience in establishing a programme. Int JGeriatr Psychiatry 1990; 5(5): 287–94.11. Freud S. On Psychotherapy. In Collected Papers, Vol 1. London:Hogarth. First published 1905; reprinted 1949.12. Abraham K. The applicability of psycho-analytic treatment topatients at an advanced age. In Abraham K, ed., Selected Papers ofPsychoanalysis. London: Hogarth, 1949.13. Brocklehurst JC. The evolution of geriatric medicine. J Am GeriatrSoc 1978; 26: 433–9.14. Certification in Geriatric Medicine. American Board of InternalMedicine and the American Board of Family Practice. Philadelphia,PA, 1999.15. Juul D. Subspecialty certification in geriatric psychiatry. Personalcommunication, 1999.16. Busse EW. Presidential address: there are decisions to be made. Am JPsychiat 1972; 129: 33–41.17. Siu AL, Beck JC. Physician satisfaction with career choices ingeriatrics. Gerontologist 1990; 30(14): 529–34.