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Introduction Discontinuation of opioid medications may be associated with emergence of restless legs syndrome (RLS), which may complicate opioid withdrawal. However, this has not been systematically studied. We aimed to prospectively determine the frequency of the occurrence and severity of RLS symptoms in patients undergoing physician supervised opioid tapering during a 3-week interdisciplinary pain rehabilitation program. Methods Adult patients undergoing prescription opioid taper were prospectively recruited during their participation in the Mayo Pain Rehabilitation Center from 2016 to 2021. Subjects completed the Cambridge-Hopkins RLS Questionnaire 13 and International Restless Legs Syndrome Study Group Rating Scale (IRLS) at baseline, midpoint, and dismissal from the program as well as 2 weeks, 1 and 3 months after dismissal from the program. Results 101 patients participated with 61% being female taking a mean morphine equivalent dose of 46.6 ± 49.0 mg. Baseline prevalence of RLS symptoms was 29% (29/101), increasing to 32% (32/101) at midpoint of treatment and further to 35% (34/97) at dismissal from the program. Frequency of RLS symptoms peaked 2 weeks after dismissal at 38% (30/78) and steadily declined to 35% (28/80) and 31% (21/68) at 1 month and 3 months after dismissal, respectively. Thirty-five percent of patients without baseline RLS symptoms reported de novo RLS symptoms at some point during their opioid taper. RLS severity score followed a similar trend as the presence of symptoms with a baseline of 16.6 ± 10.0. RLS severity score was maximum at 19.1 ± 7.3 one month following dismissal and decreased but remained elevated above baseline at 3 months following dismissal. Conclusion Symptoms of RLS occurred in over a third of patients on chronic opioids and increased during opioid withdrawal, appearing to peak in frequency and severity 2-4 weeks after discontinuation and gradually improved 3 months after discontinuation. Over one-third of patients in our cohort developed de novo symptoms of RLS at some point during their opioid withdrawal. Physicians supervising individuals undergoing opioid withdrawal should be aware of the potential development of RLS symptoms which may hinder successful opioid withdrawal. Support (If Any)

Objective To examine changes in personality in individuals with mild cognitive impairment (MCI) or dementia as observed by family members using both new data and a meta-analysis with the published literature. Design Current and retrospective personality assessments of individuals with dementia by family informants. PubMed was searched for studies with a similar design and a forward citation tracking was conducted using Google Scholar in June 2018. Results from a new sample and from published studies were combined in a random effect meta-analysis. Setting and participants Family members of older adults with MCI or dementia. Measures The 5 major dimensions (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and facets of personality were assessed with NEO Personality Inventory questionnaires. Results The new sample (n = 50) and meta-analysis (18 samples; n = 542) found consistent shifts in personality from the premorbid to current state in patients with cognitive impairment. The largest changes (>1 standard deviation) were declines in conscientiousness (particularly for the facets of self-discipline and competence) and extraversion (decreased energy and assertiveness), as well as increases in neuroticism (increased vulnerability to stress). The new sample suggested that personality changes were larger in individuals taking cognition-enhancing medications (cholinesterase inhibitors or memantine). More recent studies and those that examined individuals with MCI found smaller effects. Conclusions and implications Consistent with the clinical criteria for the diagnosis of dementia, the new study and meta-analysis found replicable evidence for large changes in personality among individuals with dementia. Future research should examine whether there are different patterns of personality changes across etiologies of dementia to inform differential diagnosis and treatments. Prospective, repeated assessments of personality using both self- and informant-reports are essential to clarify the temporal evolution of personality change across the preclinical, prodromal, and clinical phases of dementia.

As with any new clinical endeavor, new telepsychiatry projects can be invigorating and require thoughtful deliberation prior to implementation. Furthermore, administrative issues are equally important. Applications of teleconferencing services include mental healthcare of older adults in the public sector. The first part of this chapter will examine administrative aspects and provide a guide to the successful implementation of a geriatric telepsychiatry program. In addition, a review of medical literature pertaining to geriatric public psychiatry utilizing telemedicine is included. This chapter highlights public telepsychiatry implementation at the South Carolina Department of Mental Health (SCDMH), a program utilizing technological innovation to address the growing mental healthcare needs of patients in rural emergency departments in South Carolina.

some older articles made our investigation more complete. The older studies we chose typically featured larger population sizes. Some of the older papers also captured longer time horizons and thus spoke to the changes over time in Axis II illness. One limitation of older studies was use of older DSM criteria (ie DSM III). Results: The prevalence of personality disorders in elderly compared to young adults showed a significant difference. The most striking findings are the comparatively high percentage of subjects without PD in the older group and the equally high number of severe and complex PDs among the young group. Some personality disorders appear as if they increase in prevalence with age. Rather than de novo onset in later life (not consistent with stipulation about emergence in adolescence or young adulthood) it may be survivability. Conclusions: An improved understanding of personality disorders over the lifespan is needed. Studies have shown the prevalence of personality disorders is less compared to young adults. Many difficulties should be kept in mind when diagnosing elderly with a Axis II pathology. Due to limited literature many questions arise when trying to treat these disorders. Therefore more research is needed.