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UMHS Home/Logo Consult Request Guidelines

for Referral to Geriatric Psychiatry Clinic

   
Referral to Geriatric Psychiatry Clinic
Suggested Pre-Referral Evaluation and Management Guidelines The Geriatric Psychiatry Clinic evaluates complex patients ages 65 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.

Not a candidate:
Patients requiring intensive case- management (e.g. chronic schizophrenia).
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- see geriatric link
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
Collateral informant
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.
(DICE approach- Kales HC, Gitlin LN, Lyketsos K for the Detroit Expert Panel on the Assessment and Management of Neuropsychiatric Symptoms of Dementia. Management of neuropsychiatric symptoms of dementia in clinical settings: Recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, In press.)
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).
Trazodone
Patient/Family Support
Referral to Turner Geriatric Social Work Services 734-764-2556
Group and individual Cognitive Behavioral Therapy for depression
Resource and Workshop information
Links to screening tools
See Geriatrics links for MMSE, GDS, Functional status
Patient Education/Information (includes preps)

The Geriatric Mental Health Foundation: http://www.gmhfonline.org/gmhf/consumer/index.html
Information for patients/families on
Depression
Anxiety
Alcohol/Drug  misuse
Dementia
Caregiving
Healthy Aging
Sleep

The Alzheimer’s Association
http://www.alz.org/

The Lewy body Dementia Association, Inc.
http://www.lbda.org

Appointment Timeframe

Routine Wait: 6-10 weeks
Appointment Duration:
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

Questions: Anna Tolis, LMSW 734-936-1149
Clinic Location Sites

Link to the Geriatrics Center http://www.med.umich.edu/geriatrics/index.htm

UM Geriatrics Center
East Ann Arbor Health and Geriatrics Center
4260 Plymouth Road
Ann Arbor, MI 48109

734-764-6831
UM Consulting Physician Alan Mellow, MD, PhD
Donovan Maust, MD
Helen C Kales, MD
Laura Struble, PhD, GNP-BC
Mary Blazek, MD
Susan M. Maixner, MD;
Susan Duffy, MD

Inpatient Consults: None- please contact Psychiatry Consult-Liaison team 734-936-5874

Revised on: 01/28/2014