The impacts of schizophrenia on physical health and successful aging have been underestimated. Psychiatrists and primary care physicians need to address the overlapping medical and psychiatric aspects of the disorder while the medical care system for these patients requires a much higher degree of coordination than is currently available.

Depression is a common psychiatric disorder of the aged. This article briefly reviews the literature on the use of cognitive behavioral therapy (CBT) with the elderly, and suggests some changes in using CBT with the elderly based on the authors' clinical experiences. Recommended changes in technique and common themes when dealing with the frail elderly are described, including the use of "supportive CBT" for patients with mild cognitive impairment. The authors' experiences suggest that CBT is an effective treatment for depression and other affective disorders of the frail elderly, and is especially useful when somatic treatmentsarecontraindicatedorproduce intolerable side effects.

Depression is a major source of suffering and disability among the elderly. It may be overlooked among elders because of its co-occurrence with the aging process, grief, dementia, and medical illness. The author reviewed the field in 1994, and in this paper describes important developments of the past two decades. These include evolving concepts in diagnosis such as minor depression, vascular depression, and the depression of Alzheimer's disease. Complex inter-relationships among depression and medical diseases have been explored, especially cardiovascular and cerebrovascular disease. During this period selective serotonin reuptake inhibitors and serotonin/ norepinephrine reuptake inhibitors have largely replaced tricyclic antidepressants and monoamine oxidase inhibitors, while electroconvulsive therapy has continued to be utilized. Repetitive transcranial stimulation is in its infancy and its role in geriatric depression is being defined. Developments in psychotherapy have solidified its place in the treatment of geriatric depression, particularly cognitive behavioral therapy.bs_bs_banner Offi cial journal of the Pacifi c Rim College of Psychiatrists

Retroclival hematomas are a rare entity. They are usually associated with significant trauma, and patients frequently have focal neurological deficits, especially cranial nerve palsies. Previous case reports of epidural clival hematomas have been described almost exclusively in the pediatric population. The authors report a unique case of traumatic clival subdural hematoma, which has never been described in an adult except in the context of hemophilia. An 18-year-old man presented with continuing nausea and headaches following a seemingly trivial head injury. He was found to have a posterior fossa retroclival hematoma extending into the spinal subdural space but without any neurological deficits. He was treated conservatively, with a good outcome. The authors discuss the possible mechanisms of injury, management, and complications related to this rare condition, and they review the pertinent literature.