|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:
Consider providing a medication trial when initiating consult
||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|
Suggested guidelines for medication trials (does not replace clinical evaluation and judgment)
For Behavioral Disturbances of Dementia
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)
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).|
Links to screening tools
||Referral to Turner Geriatric Social Work Services 734-764-2556|
||Group and individual Cognitive Behavioral Therapy for depression|
||Resource and Workshop information|
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
The Alzheimer’s Association
The Lewy body Dementia Association, Inc.
Routine Wait: 6-10 weeks
Initial Evaluation is 2-3 hours
Follow up visits are 25 minutes
We have little capacity to address urgent care needs.
911 should be called when patients are in acute danger of hurting themself or others.
Emergent care needs must be addressed through Psychiatric Emergency Services 734-936-5900, located B1 of University Hospital.
|How to Get Results to Consultant
UMHS Patients: Make sure all needed information is posted or scanned into MiChart
Records should be mailed or faxed well in advance of scheduled consultations. If time frame is too short, patients can hand carry outside records.
External Patients/Providers: Fax referral request form and supporting patient records. Fax: 734-647-8535.
|Clinic Contact Information
Clinic Information and Scheduling: 734-764-6831
Questions: Anna Tolis, LMSW 734-936-1149
General Psychiatry Intake/Scheduling: 1-800-525-5188 or 734-764-0231
UofM clinician provide referral through MiChart
|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
|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