Geriatric Psychiatry

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.