● Major depression o Depressed mood + SIGECAPS (4 of 8) o SIGECAPS: sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide ● Bipolar depression (use mood stabilizers/antipsychotics)

Suicidal thoughts in older adults (OAs) require immediate attention because of the high rate of death by suicide in OAs. ● OAs account for 19% of suicide deaths in the US, despite being only 15% of the population. Be especially careful with elderly white men with suicidal thoughts, as their rate of death by suicide is 4x higher than the rest of the population.

ECT is one of the most effective treatments in psychiatry, and it’s important to keep it in mind for a variety of inpatients—especially those with treatment resistant depression and psychotic depression.

Health Care Proxy (HCP) and Power of Attorney (POA) are types of advance directives, which are legal documents allowing individuals to designate someone else to make decisions on their behalf, particularly when they are incapacitated. Unlike conservatorships or guardianships, which are court-assigned, advance directives like HCP and POA allow the individual to proactively choose a representative.

Providing patients with resources as they transition from inpatient psychiatric units to outpatient care is vital for their continued support and recovery. Here are several valuable national resources:

● Late-life depression (LLD) impacts about 2-5% of older adults (OAs) in the community (Steffens DC et al, Arch Gen Psychiatry 2000;57(6):601-7). ● However, in medical and skilled nursing settings, it occurs in up to 25%. So, always screen patients for it in these locations. ● The diagnosis is often missed because it’s seen as an “understandable reaction to getting-old” or it’s misdiagnosed as anxiety. ● Depressive symptoms in OAs, which don’t full criteria for MDD, can result in similar disability as full depressive episodes and may still warrant treatment.

● Suicidal thoughts in older adults (OAs) require immediate attention because of the high rate of death by suicide in OAs. ● OAs account for 19% of suicide deaths in the US, despite being only 15% of the population. Be especially careful with elderly white men with suicidal thoughts, as their rate of death by suicide is 4x higher than the rest of the population.

When a patient threatens to kill someone, immediate action is necessary: 1. Evaluate the patient's intent, capability, and history of violence or aggression. Consider the specificity of the threat, including details about the potential victim and the plan. 2. Ensure the safety of the patient, staff, and others by implementing appropriate security measures within the unit.

Providing patients with resources as they transition from inpatient psychiatric units to outpatient care is vital for their continued support and recovery. Here are several valuable national resources:

ECT is one of the most effective treatments in psychiatry, and it’s important to keep it in mind for a variety of inpatients—especially those with treatment resistant depression and psychotic depression. In this fact sheet, we are assuming that you are not the one actually doing the ECT treatment, but rather that you will be referring your patient to an ECT program either in your hospital or for transport elsewhere. Thus, our focus will be on how you will discuss ECT with your patient, how you will coordinate with the ECT consultant, and how you will manage your inpatient in between ECT treatments.