By Dr. Mike Shery

We do psychological work all day, every day. Having been in practice for over 25 years, we are one of more experienced practitioners around. We also read everything we can find that is written about psychiatric treatment and aging. Unfortunately, much of it is just plain misses point. Where does this come from? Since psychological treatment is becoming more important in long term care, "psychotropic mythologists" have decided to “re-join” medical establishment by touting medication as answer to every problem on planet. Suggestions about medications fill nurses’ stations, news, many discussions related to resident depression; and all manner of biological theories are proposed.

In some cases, this is all related to quite helpful neuro-biological analysis. However, in most cases, it’s related to a burgeoning “scientism” which sees all human behavior and emotion as just result of neuro-chemical metabolism and nothing more. Consistent with this outlook, they attempt to "succeed” in “eliminating problem behavior" by readjusting, re-dosing, mixing, withdrawing and titrating all manner of psychoactive medications. Reflexively, their very first thoughts are about what medication strategies to try, not what problems is resident facing.

They seem to use “psychotropic-mindedness” in order to generate “fastest elimination” of “problem behavior” possible. The truth is...a knife to a resident’s throat might “work” too...or a gun pointed at head… even several six packs may make resident more mellow and enjoyable. Many things can “work.” However, suffice it to say that treatment strategies that automatically EXCLUDE strength-focused psychotherapies out-of-hand are exactly WRONG WAY to do this work. What's more, this over-reliance on medication makes difficult task of enriching a resident’s depth of experiencing and quality of life even more arduous and frustrating.

Misplaced Priorities These well-intentioned physicians and staff always get their priorities backwards. They propose ridiculously simplistic neuro-chemical strategies, while glossing over considerable emotional and interpersonal turmoil of late life that can cause severe emotional discomfort.

Strategically, initial approach to treatment should be self-evident. First, do an assessment and discern what appraisals, thoughts or observations a resident is making that cause his/her distress. Talk with family; get their observations and insights. Then develop a plan of action involving helping resident to talk things thru, highlighting strengths s/he has overlooked, teaching anxiety, pain and/or depression reduction strategies. And get it done as quickly as possible.

By Dr. Mike Shery

Cardiologists, other doctors and long term care staff might be missing big picture as one survey suggests that only a third of heart disease patients with serious symptoms of depression or anxiety get any treatment. The findings are significant because psychological problems have been linked to poorer health and higher death rates in heart disease patients. Unfortunately, long term care residents and other heart patients just aren't being screened because physicians are just focused on heart disease and don’t think about other factors that could contribute to condition.

We know that heart attack survivors suffer from psychological distress twice as much as general population and, with congestive heart failure patients, who are often residing in nursing homes, figure is twice that…Staggering! However, only about one third of heart disease patients who report symptoms are ever treated by a mental-health provider. This is appalling because research suggests that psychological problems often contribute to onset of heart disease and worsen its progression.