Treatment Approach

I always advocate for a holistic & individualized treatment plan for each patient.  A holistic treatment plan includes trying to achieve some balance in life.  Components of this can include:  exercise, nutrition, psychotherapy, moderation or abstinence with substances, formal relaxation therapy, a good support system of friends & families, spirituality, self-help books, hobbies and meaningful activities, and judicious use of medications.  This can be very hard in elder patients, especially with dementia.  But we still try to address as many of these components as possible.  Because options can be limited for these patients, it's important to brainstorm ideas & think outside the box.  Residential care is often a major component of the treatment plan as some patients need more support & cannot always successfully live at home.  Behavior therapy is a major part of the treatment plan for patients with dementia.  This basically means family & professionals learning the best way to interact with these patients.  Some general methods include validation or their emotions & distraction (try to divert them to discussing positive topic if they are focused on something negative).  I always encourage families & caregivers to educate themselves about dementia and also consider a support group for such.  You can find a local support group through the Alzheimer's Association (www.alz.org).  They will welcome families of those with other types of dementia too, as there are many similar aspects to all types of dementia.  

Genetic Testing

I order pharmocogenomic (or genetic) testing through www.genesight.com.  It's one of the first of it's kind in psychiatry, and is paid for by many insurances.  

It's a very easy test that involves collecting a saliva sample.  It's covered by Medicare completely (if the patient has a Medicare Advantage plan or private insurance, it's still mostly covered with a maximum one time out of pocket $330 cost).

This test looks at the genes responsible for liver metabolism of medications as well as at some genetic markers.  This will help me make sure the body metabolizes the medications ok, and can help narrow down medication options.  

It typically gives information about the following classes of medications:  antidepressants, anxiolytics, antipsychotics, & mood stabilizers.  It also gives information about MHTFR.  This is an enzyme present in all humans that converts dietary folate (vitamin B9) into l-methylfolate.  Research shows the brain needs adequate levels of l-methylfolate for optimal brain functions.  There are prescription & over the counter versions of this supplement, and the prescription one is FDA approved for treatment of major depression.