Suggested Pre-Referral Evaluation and Management Guidelines
The Geriatric Psychiatry Clinic evaluates complex patients ages 70 years or older. Our expertise is in psychiatric presentations complicated by multiple medical co-morbidities, medications, unstable medical conditions, and dementia. We can address cognitive issues associated with mood disorders, and behavioral problems complicating cognitive impairment.
Age is NOT the only criteria for referral.
We will treat younger patients with early onset dementia.
Patients currently being treated through Community Mental Health/CSTS.
Patients with substance abuse problems may be best treated by referral to UMATS.
Older patients without medical complexity or cognitive issues should be referred to general psychiatry.
Suggested Additional Test/Management Prior to Specialty Visit
Initial management should include a basic workup of the presenting symptoms:
Depression Screen - see Geriatrics link to GDS
Cognitive Screen - perform MMSE or MoCA http://www.mocatest.org/
Medical exam - including focal neurological deficits
Labs: CBC, Comp, TSH, B12, Vit D Folate, Sed rate, RPR, UA, HIV if indicated
Imaging - CT or MRI if indicated
Consider providing a medication trial when initiating consult
Suggested guidelines for medication trials (does not replace clinical evaluation and judgment)
For Depression/Anxiety: START LOW, GO SLOW, DON'T STOP!!!
Start at 1/4 - 1/2 of adult starting dose, titrate up in 1-2 weeks to usual adult starting dose, increase again in 6-8 weeks if not responding First line agents SSRI(depression and/or anxiety)
Escitalopram or Sertraline SNRI(good if concurrent pain)
Venlafaxine XR or Duloxetine
Bupropion SR (if low energy, little anxiety)
Mirtazapine (if poor sleep and poor appetite)
For Behavioral Disturbances of Dementia
No medications are FDA indicated. Modify Environment and use behavioral strategies first.
If medications must be used, use Low doses.
SSRI - may help decrease impulsivity
Divalproex Sodium - may help for impulsive-disinhibited behaviors.
Atypical Antipsychotics - (Quetiapine or Risperidone) for paranoia/hallucinations/delusions (black-box warning).
Referral to Turner Geriatric Social Work Services 734-764-2556
Group and individual Cognitive Behavioral Therapy for depression
Due to the high volume of requests, we will accommodate you as best we can, but delays are possible.
Initial Evaluation is 2-3 hours
Follow up visits are 25 minutes
We have little capacity to address urgent care needs.
Emergent care needs must be addressed through Psychiatric Emergency Services 734-936-5900, located B1 of University Hospital.
911 should be called when patients are in acute danger of hurting themself or others.
How to Get Results to Consultant
UMHS Patients: Make sure all needed information is posted or scanned into MiChart
External Patients/Providers: Fax referral request form and supporting patient records. Fax: 734-647-8535.
Records should be mailed or faxed well in advance of scheduled consultations. If time frame is too short, patients can hand carry outside records.
Clinic Contact Information
Clinic Information and Scheduling: 734-764-6831 General Psychiatry Intake/Scheduling: 1-800-525-5188 or 734-764-0231
UofM clinician provide referral through MiChart