How much dementia do you see in your practice?

[LLCoolK]

I'm currently a 3rd year considering psychiatry. I've always wanted to work with dementia patients, but didn't want to deal with everything else that comes with being an internist/geriatrician. I found psychiatry interesting during my rotation, but the site I was at was limited in its patient population (mostly low-functioning schizophrenics/schizoaffectives). To the general psychiatrists, how much dementia do you see?

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[st2205]

I saw a small amount in residency. Currently have a couple in my practice (2 months in) but dementia isn't necessarily the primary reason they're there.

However, you could see as much dementia as you'd like. Psychiatry would be much more suited for having a larger dementia population than IM if you're wanting to focus on the effects of the dementia, working with families, etc. It wouldn't be very ideal if you're wanting to also manage their HTN and GERD.

 

[splik]

Well you can focus on dementia (like me!) if you so wish! Not many psychiatrists want to work with this patient population. You could focus on working in geriatric psychiatry, consultation-liaison psychiatry, or neuropsychiatry if you are interested in dementia. You could work on an inpatient geropsych or neurobehavioral unit, in a day hospital program, in a memory clinic, or in nursing homes (or some combination of the above). If you are interested in research there is plenty to research and lots of unanswered questions and it is relatively well funded compared to some other diseases. If you are interested in teaching, all the cool cases come to the academic medical centers so you could be heavily involved in teaching students, residents and fellows. Neurology is another potential avenue to working with dementia patients. Most of your psychiatry residency training is not going to be in dementia though, so you should also have an interest in mood disorders, psychosis, substance use disorders and so on as well. Given that behavioral and psychological symptoms are so common in dementia (and this is mainly where psychiatrists get involve), being interested in disturbances in emotion and behavior in general would suggest psychiatry is a good fit for you.

If you want to learn more about geriatric psychiatry, the AAGP annual meeting is in Hawaii next year and they have all expenses paid travel awards for med students to attend!
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[Blitz2006]

Based on my experience in residency, any patient that has dementia is usually shuttled to neurology.

There are some psychiatrists (geriatric, neuropsychiatrists) that enjoy doing MMSEs, MOCAs, and even prescribe aricept/namenda, etc, but I think this is the minority.

So in the real world, you mainly as a psychiatrist will be dealing with dementia patients if they have agitation, "behavioral disturbance"...

 

[clausewitz2]

Based on my experience in residency, any patient that has dementia is usually shuttled to neurology.

There are some psychiatrists (geriatric, neuropsychiatrists) that enjoy doing MMSEs, MOCAs, and even prescribe aricept/namenda, etc, but I think this is the minority.

So in the real world, you mainly as a psychiatrist will be dealing with dementia patients if they have agitation, "behavioral disturbance"...

Very center dependent. We have a robust inpatient/outpatient getting infrastructure so we get rather a lot of folks with dementia, though admittedly inpatient we are getting very agitated demented people or people with dementia who have notable psychiatric symptoms in addition to cognitive impairment.

Started Ritalin recently in someone with a very classic Diogenes syndrome, they are now eating voluntarily and cleaning up after themselves without prompting. @splik I can see part of why you find it fascinating.

 

[LLCoolK]

Well you can focus on dementia (like me!) if you so wish! Not many psychiatrists want to work with this patient population. You could focus on working in geriatric psychiatry, consultation-liaison psychiatry, or neuropsychiatry if you are interested in dementia. You could work on an inpatient geropsych or neurobehavioral unit, in a day hospital program, in a memory clinic, or in nursing homes (or some combination of the above). If you are interested in research there is plenty to research and lots of unanswered questions and it is relatively well funded compared to some other diseases. If you are interested in teaching, all the cool cases come to the academic medical centers so you could be heavily involved in teaching students, residents and fellows. Neurology is another potential avenue to working with dementia patients. Most of your psychiatry residency training is not going to be in dementia though, so you should also have an interest in mood disorders, psychosis, substance use disorders and so on as well. Given that behavioral and psychological symptoms are so common in dementia (and this is mainly where psychiatrists get involve), being interested in disturbances in emotion and behavior in general would suggest psychiatry is a good fit for you.

If you want to learn more about geriatric psychiatry, the AAGP annual meeting is in Hawaii next year and they have all expenses paid travel awards for med students to attend!
AAGP Scholars Program Information for Applicants

Thanks for the response. Have you completed a fellowship in geriatric psychiatry? Is it necessary if that's a path I would like to take?

 

[Dharma]

Enough in the ED and on consults to be glad I don't see them on a daily basis.