Geriatric Psychiatrist

Description of Specialty

A geriatric psychiatrist is a medical doctor (MD) with special training in the evaluation, diagnosis, and treatment of mental health issues that may occur in older adults. These disorders include, but are not limited to, dementia, depression, bipolar disorder, anxiety and later-life schizophrenia. Common comorbid medical conditions include chronic pain, Parkinson’s disease, heart disease, diabetes, and stroke. A geriatric psychiatrist is often called upon to try to discern what symptoms are due to medical/neurological vs. psychiatric conditions and to integrate care with other health professionals including other physicians and allied health professionals.

Older adults have special physical, emotional and social needs. Taking these into consideration, the geriatric psychiatrist takes a comprehensive approach to diagnosis and treatment, including obtaining extensive past and current history, reviewing recent medical/neurologic and medication history, listening and responding to the concerns of the older adult, and working in collaboration with families and with other health care professionals to develop effective approaches to treatment. Thorough assessments of underlying medical/neurological causes of symptoms are a key part of the evaluation. Integrated into the comprehensive treatment plan are management of co-existing medical illnesses, medications, family issues, social concerns and environmental issues. As medical doctors (MDs) geriatric psychiatrists have extensive psychopharmacology training, and can review, discontinue, change or prescribe medications as clinically indicated. Additionally, geriatric psychiatrists can order laboratory and radiology tests to evaluate for medical/neurological causes of symptoms. Evidence-based psychopharmacologic (psychiatric medications) and psychosocial treatment (therapy) modalities are employed into treatment plans as indicated.

Educational Requirements

Geriatric psychiatrists are medical doctors (MDs) who have completed medical school (four years), a four-year residency (including training in internal medicine and neurology) in general psychiatry followed by one or more years of fellowship subspecializing in geriatric psychiatry.

Specialty Credentials Related to Geriatrics

Geriatric psychiatrists are certified in both general adult psychiatry as well as having additional certification in geriatric psychiatry (

Scope of Services in Long Term Care Settings

  1. Education/Leadership: Geriatric psychiatrists can help train nursing home staff to adequately and fully describe psychiatric symptoms, to regularly assess for underlying medical causes of psychiatric symptoms as well as to integrate medical and psychiatric treatment plans including pharmacologic and non-pharmacologic approaches.

  2. Assessment: Geriatric psychiatrists are experts in comprehensive biopsychosocial assessment and management. Because of their medical and psychiatric training, they are uniquely able to integrate the care that older patients receive—dealing with the “whole” person and crossing the often difficult divide between mind and body. Assessment includes comprehensive history and review of systems, reviews of physical and neurological assessments, laboratory studies to rule out underlying cause of psychiatric symptoms (e.g. anemia, thyroid disease), cognitive screening and (if indicated) referrals for neuropsychiatric testing, and neuroimaging as needed. Geriatric psychiatrists are accustomed to working within the multidisciplinary medical team including collaborating with nurses and social workers to best inform care decisions.

  3. Clinical Decision Making: By virtue of their training that integrates the medical, neurological and psychiatric, the geriatric psychiatrist is well-positioned to direct primary care doctors in complex situations involving medical and mental illness as well as to provide leadership to other members of the care team in the management of a variety of later-life mental health issues including behavioral and psychological symptoms of dementia (BPSD).

  4. Managing Behavioral and Psychiatric Symptoms of Dementia: Gold-standard management of BPSD involves a thorough search for underlying causes. For example, “agitation” in a patient with dementia might be caused by: pain or physical illness, constipation, dehydration, delirium, medication side effects, depression, anxiety, perceived threats, changes in routine, lack of structure, unmet personal needs, caregiver-patient mismatch, or over-/under-stimulation in the environment. The geriatric psychiatrist thinks “algorithmically” integrating the biopsychosocial into the search for underlying causes. Treatment of underlying medical causes and non-pharmacologic approaches are used first-line. If psychotropic medications are needed for safety/risk or for cases of psychosis, depression or aggression, they are used within the context of a risk: benefit ratio and at the lowest possible dose. In sum, geriatric psychiatrists are uniquely able to integrate the medical, psychiatric and social care of the patient with dementia.

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