Geriatric psychiatry

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Geriatric Psychiatry

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Geriatric psychiatry

  1. 1. Geriatric Psychiatry Chapter 56
  2. 2. Geriatric Psychiatry • derived from the Greek words geros (old age) and iatros (physician) • deals with preventing, diagnosing, and treating psychological disorders in older adults • Old age- phase of the life cycle characterized by its own developmental issues – loss of physical agility, and mental acuity, friends and loved ones, and status and power.
  3. 3. Stressors • psychiatrists must be able to recognize the physical and mental ills of their patients • High-ranking stresses of aging include; – acute and chronic medical illnesses – the concomitant use of therapeutic drugs – the complicating drugs “drug and drug- disease interactions.” • older women are more likely to live alone than older men
  4. 4. Psychiatric Examination of the Older Patient • Because of the high prevalence of cognitive disorders in older persons; – psychiatrists must determine whether a patient understands the nature and purpose of the examination. • patient still should be seen alone even in cases of clear evidence of impairment – to elicit any suicidal thoughts or paranoid ideation, which may not be voiced in the presence of a relative
  5. 5. Psychiatric History • Benign senescent forgetfulness- age associated memory impairments of no significance. • childhood and adolescent history: – provide information about personality organization – give important clues about coping strategies and defense mechanisms used under stress
  6. 6. Mental Status Examination • offers a cross-sectional view of how a patient – Thinks – feels – behaves during the examination.
  7. 7. General Description • includes appearance, psychomotor activity, attitude toward the examiner, and speech activity. • Motor disturbances should be noted • The patient's attitude toward the examiner; cooperative, suspicious, guarded, can give clues about possible transference reactions.
  8. 8. Functional Assessment • Patients older than 65 years of age should be evaluated for their capacity to maintain independence and to perform the activities of daily life – which include toileting, preparing meals, dressing, grooming, and eating. • The degree of functional competence in their everyday behaviors is an important consideration in formulating a treatment plan for these patients.
  9. 9. Mood, Feelings, and Affect • Suicide is a leading cause of death of older persons, and an evaluation of a patient's suicidal ideation is essential. • Loneliness is the most common reason cited by older adults who consider suicide. • Feelings of loneliness, worthlessness, helplessness, and hopelessness are symptoms of depression, which carries a high risk for suicide.
  10. 10. Perceptual Disturbances • Hallucinations and illusions by older adults can be transitory phenomena resulting from decreased sensory acuity. • Because hallucinations can be caused by brain tumors and other focal pathology, a diagnostic workup may be indicated
  11. 11. Language Output • covers the aphasias, which are disorders of language output related to organic lesions of the brain. • The best described are nonfluent or Broca's aphasia, fluent or Wernicke's aphasia, and global aphasia.
  12. 12. Visuospatial Functioning • decline in visuospatial capability is normal with aging • Asking a patient to copy figures or a drawing may be helpful in assessing the function
  13. 13. Thought • Disturbances in thinking include neologisms, word salad, circumstantiality, tangentiality, loosening of associations, flight of ideas, clang associations, and blocking • loss of the ability to appreciate nuances of meaning (abstract thinking) may be an early sign of dementia
  14. 14. Other things to take note of • Sensorium and Cognition • Consciousness • Orientation • Memory • Intellectual Tasks, Information, and Intelligence • Reading and Writing • Judgment
  15. 15. Mental Disorders of Old Age • Dementing Disorders • Depressive Disorders • Schizophrenia • Delusional Disorder • Anxiety Disorders • Somatoform Disorders • Alcohol and Other Substance Use Disorder • Sleep Disorders • Suicide Risk
  16. 16. Other Conditions of Old Age • Vertigo • Syncope • Hearing Loss • Elder Abuse • Spousal Bereavement
  17. 17. Psychopharmacological Treatment of Geriatric Disorders • A pretreatment medical evaluation is essential, including an electrocardiogram (ECG). • It is especially useful to have the patient or a family member bring in all currently used medications – because multiple drug use could be contributing to the symptoms.
  18. 18. Principles of Psychopharmacological Treatment • Major goals of the pharmacological treatment of older persons are; – to improve the quality of life – maintain persons in the community – delay or avoid their placement in nursing homes. Individualization of dosage is the basic tenet of geriatric psychopharmacology.

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