Chapter 20 - Clinical Geropsychiatry

Summary

While most older people are mentally healthy, persons over age 65 are vulnerable to the same spectrum of psychiatric disorders as are younger people. The heart of the psychiatric evaluation is the mental status examination, the here-and-now data-gathering equivalent of the physical examination, that allows a systematic examination of the major aspects of the patient’s mental state. Mood disorders, such as depression, are the most frequently clinically diagnosed and the most treatable psychiatric disorders in older people. Depression can commonly co-occur with anxiety, and clinicians must become comfortable asking their older patients about suicidal ideation, as rates of suicide are consistently higher among the elderly than for other age groups. The psychopharmacologic treatment of mood disorders and anxiety has advanced considerably, and many effective antidepressant and anxiolytic medications are available. Whichever medication the clinician chooses, one should start at a low dose and titrate up to a therapeutic dose gradually and slowly to prevent adverse effects. Psychotherapy is also an important part of treatment. No one approach is best; rather, a pluralistic approach that emphasizes life review and focuses on specific issues of concern is most effective for older people.