Geriatric psychiatry deals with preventing, diagnosing, and treating psychological disorders in older adults. Psychiatrists must recognize physical and mental illnesses in older patients and determine how medical illnesses, medications, and age-related stressors impact them. A psychiatric examination of an older patient includes evaluating their cognitive status, suicidal thoughts, functional abilities, and signs of mental disorders that commonly affect the elderly like dementia and depression. Psychopharmacological treatment of geriatric patients requires a thorough medical evaluation and individualization of dosages to improve quality of life while maintaining independence.

1. Geriatric Psychiatry
Chapter 56

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. 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. 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. 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. Mental Status Examination
• offers a cross-sectional view of how a patient
– Thinks
– feels
– behaves during the examination.

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. 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. 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. 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. 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. 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. 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. Other things to take note of
• Sensorium and Cognition
• Consciousness
• Orientation
• Memory
• Intellectual Tasks, Information, and
Intelligence
• Reading and Writing
• Judgment

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. Other Conditions of Old Age
• Vertigo
• Syncope
• Hearing Loss
• Elder Abuse
• Spousal Bereavement

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. 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.