Antipsychotics have demonstrated modest efficacy in treating psychosis, aggression and agitation in individuals with dementia. Their use in individuals with dementia is often limited by their adverse effect profile. The use of antipsychotics should be reserved for severe symptoms that have failed to respond adequately to nonpharmacological management strategies.

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Anti-N-methyl D-aspartate (NMDA) receptor (anti-NMDAR) encephalitis is among one of the most common autoimmune encephalitides. However, variations in clinical presentation and nonsequential multiphasic course often lead to delays in diagnosis. The mild encephalitis (ME) hypothesis suggests a pathogenetic mechanism of low-level neuroinflammation sharing symptom overlap between anti-NMDAR encephalitis and other psychiatric disorders including schizophrenia. Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders or substance-induced psychosis. Although initially described in association with ovarian teratomas in women, anti-NMDAR encephalitis has been reported in individuals without paraneoplastic association, as well as in males. It can affect all age groups but is usually lower in prevalence in individuals greater than 50 years old, and it affects females more than males. Clinical evaluation is supported by laboratory workup, which includes cerebrospinal fluid (CSF) assays. The latter often reveals lymphocytic pleocytosis or oligoclonal bands with normal to elevated CSF protein. CSF testing for anti-NMDAR antibodies facilitates diagnostic confirmation. Serum anti-NMDAR antibody assays are not as sensitive as CSF assays. Management includes symptomatic treatment and immunotherapy.

This paper provides an overview of biopsychosocial components of sexuality in older adults, sexual expression in older LGBTQ and cognitively impaired adults, and inappropriate sexual behaviors (ISB) in dementia. Recent findings:Sexual expression of older adults is influenced by diverse psychosocial and biologic determinants including ageist beliefs. Although the prevalence of sexual dysfunction increases with age, studies of sexual satisfaction reveal that only a minority experience significant distress. Stigma against sexual expression in LGBTQ older adults may cause concealment of sexual orientation from family or care providers due to fears of rejection. Cognitive impairment affects frequency of and satisfaction with sexual activity, as well as capacity to consent. Staff biases about sexuality can negatively impact sexual expression in healthcare settings. Dementia-related inappropriate sexual behaviors (ISB) are common and distressing. Recent research has focused on early identification and prevention of ISB, in addition to management through non-pharmacologic and pharmacologic approaches.

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Older adults represent the fastest growing demographic of the United States population. However, the elderly are insuffi ciently represented in studies examining the mental health impact of natural and man-made disasters. Social, cultural, and economic variables infl uence disaster-related mental health sequelae with a higher risk for morbidity and mortality among older adults due to physiologic factors, associated cognitive underpinnings, and chronic disease burden. Post-disaster mental health symptoms in elderly include sleep disturbance, irritability, acute stress reactions, depression, generalized anxiety disorder (GAD), substance use, and post-traumatic stress disorder (PTSD). Keywords Disaster exposure in older adults • Mental health • Behavioral changes • PTSD • Major depression • Generalized anxiety disorder IntroductionOlder adults represent the fastest growing demographic of the United States population. By the year 2025, the US Census Bureau projections indicate individuals aged 65 and above will comprise over 18 % of the USA population, with this

The assessment of the elderly defendant presents a specific set of challenges in the forensic psychiatric evaluation process. In this special population, a neurocognitive disorder or the presence of cognitive, psychiatric, and behavioral symptoms can impair a defendant’s understanding of the legal system or their ability to work effectively with an attorney in the preparation of a defense. Therefore, assessments of capacity to stand trial may require special attention to the mental health conditions and symptoms more commonly seen in elderly persons, and the evaluation process may require modification to accurately assess this population and to rule out malingering. Unique challenges are also encountered in the evaluation of elderly defendants for criminal responsibility and in presentencing evaluations. This chapter provides an overview of these challenges and strategies to promote accurate evaluation of the elderly defendant.

The aim of this review was to identify published randomized control trials (RCTs) that evaluated the efficacy and tolerability of suvorexant for the treatment of insomnia among older adults (≥65 years). A literature search was conducted of PubMed, MEDLINE, EMBASE, PsycINFO and Cochrane collaboration databases for RCTs in any language evaluating suvorexant for the treatment of insomnia in older adults. Additionally, references of full-text articles that were included in this review were searched for further studies. Data from three RCTs of suvorexant were included in this review. All the three studies fulfilled the criteria for being of good quality based on the items listed by the Center for Evidence Based Medicine (CEBM) for the assessment of RCTs. None of the three studies were conducted exclusively among older adults. However, they also included older individuals diagnosed with primary insomnia. These studies included a total of 1298 participants aged ≥65 years in age. Trial durations ranged from 3 months to 1 year. Available data from these studies indicate that suvorexant improves multiple subjective and polysomnographic sleep parameters for sleep onset and maintenance among older individuals with a diagnosis of primary insomnia and is generally well tolerated. Current evidence, although limited, indicates that suvorexant benefits older adults with primary insomnia and is generally well tolerated.