Changes in Behavior and Personality
Corresponding to the stereotype of inevitable intellectual decline with aging are stereotypes of regressive behavior and increasing inflex-ibilily of personality traits. However, these are more a sign of psychiatric disturbance than a manifestation of aging. Consider the issue of cautiousness. Research shows that (he elderly are more cautious than younger adults about risk taking when the payoff is predictable and constant. If the size of the payoff depends on the degree of risk, however, older persons are no more cautious than younger persons.
Anxiety can resull in cautiousness, causing delays in decision making and reactions. In other words, excessive cautiousness in the elderly may signal underlying anxiety or a related clinicaldisorder. However, it is entirely appropriate for a frail or disabled older person to he more careful in general. A maladaptive overcautiousness resulting from anxiety must be distinguished from an appropriate, adaptive response to reality.
If older adults appear to be more rigid lhan younger adults, then cohort differences (ie, generational differences that stem from having grown up during different hisloric periods)—and no! age differences— are more likely involved. Research shows no( only that personalities remain stable with aging but also that behavioral and psychologic adap-tiveness continues and docs not normally give way to regression or rigidity. If certain behaviors or traits become increasingly exaggerated, maladaptive, and unmodifiable, neurosis rather than normal aging may be to blame. Treatment rather than acceptance is in order.

Changes in Cognition
A longitudinal study of cognitive capacity in a cohort of men followed from 1919 to 1961 described increments in verbal ability and total intellectual performance from age 20 to age 50. although mathematical ability declined slightly. From 50 to 60 yr of age, scores of intellect showed little change. These studies were among the first to raise serious doubts about the presumed normal decline in mental ability with aging, which had been inferred from earlier cross-sectional research.
A 12-yr longitudinal study of older men (median age, 71 yr) con-dueled by the National Institute of Mental Health examined a broad range of variables. Physical and psychiatric disease was absent or minimal; the goal was to separate the impact of aging from that of illness. As these healthy men moved from their 70s to their 80s. various intellectual functions declined while others improved. For example, quality of cognitive operations, draw-a-person exercises, and sentence completions declined, while vocabulary and picture arrangement ability improved. This suggests that older persons may have difficulty with activities requiring a quick reaction lime or a high degree of precision, although they maintain the ability to understand their situation and learn from new experiences.
Moreover, men who developed arteriosclerotic cardiovascular disease had significantly greater decrements in intellectual performance than those who remained healthy. Therefore, significant changes in intellectual performance should not be dismissed as normal consequences of aging but should be evaluated as potentially modifiable manifestations of disease (psychiatric as well as general medical). For example, both depression and hypothyroidism are treatable problems that can be covert and cause cognitive impairment.
Changes in Behavior and Personality
Corresponding to the stereotype of inevitable intellectual decline with aging are stereotypes of regressive behavior and increasing inflex-ibilily of personality traits. However, these are more a sign of psychiatric disturbance than a manifestation of aging. Consider the issue of cautiousness. Research shows that (he elderly are more cautious than younger adults about risk taking when the payoff is predictable and constant. If the size of the payoff depends on the degree of risk, however, older persons are no more cautious than younger persons.
Anxiety can resull in cautiousness, causing delays in decision making and reactions. In other words, excessive cautiousness in the elderly may signal underlying anxiety or a related clinicaldisorder. However, it is entirely appropriate for a frail or disabled older person to he more careful in general. A maladaptive overcautiousness resulting from anxiety must be distinguished from an appropriate, adaptive response to reality.
If older adults appear to be more rigid lhan younger adults, then cohort differences (ie, generational differences that stem from having grown up during different hisloric periods)—and no! age differences— are more likely involved. Research shows no( only that personalities remain stable with aging but also that behavioral and psychologic adap-tiveness continues and docs not normally give way to regression or rigidity. If certain behaviors or traits become increasingly exaggerated, maladaptive, and unmodifiable, neurosis rather than normal aging may be to blame. Treatment rather than acceptance is in order.

NORMAL CHANGES OF AGING
Changes in Cognition
A longitudinal study of cognitive capacity in a cohort of men followed from 1919 to 1961 described increments in verbal ability and total intellectual performance from age 20 to age 50. although mathematical ability declined slightly. From 50 to 60 yr of age, scores of intellect showed little change. These studies were among the first to raise serious doubts about the presumed normal decline in mental ability with aging, which had been inferred from earlier cross-sectional research.
A 12-yr longitudinal study of older men (median age, 71 yr) con-dueled by the National Institute of Mental Health examined a broad range of variables. Physical and psychiatric disease was absent or minimal; the goal was to separate the impact of aging from that of illness. As these healthy men moved from their 70s to their 80s. various intellectual functions declined while others improved. For example, quality of cognitive operations, draw-a-person exercises, and sentence completions declined, while vocabulary and picture arrangement ability improved. This suggests that older persons may have difficulty with activities requiring a quick reaction lime or a high degree of precision, although they maintain the ability to understand their situation and learn from new experiences.
Moreover, men who developed arteriosclerotic cardiovascular disease had significantly greater decrements in intellectual performance than those who remained healthy. Therefore, significant changes in intellectual performance should not be dismissed as normal consequences of aging but should be evaluated as potentially modifiable manifestations of disease (psychiatric as well as general medical). For example, both depression and hypothyroidism are treatable problems that can be covert and cause cognitive impairment.
Changes in Behavior and Personality
Corresponding to the stereotype of inevitable intellectual decline with aging are stereotypes of regressive behavior and increasing inflex-ibilily of personality traits. However, these are more a sign of psychiatric disturbance than a manifestation of aging. Consider the issue of cautiousness. Research shows that (he elderly are more cautious than younger adults about risk taking when the payoff is predictable and constant. If the size of the payoff depends on the degree of risk, however, older persons are no more cautious than younger persons.
Anxiety can resull in cautiousness, causing delays in decision making and reactions. In other words, excessive cautiousness in the elderly may signal underlying anxiety or a related clinicaldisorder. However, it is entirely appropriate for a frail or disabled older person to he more careful in general. A maladaptive overcautiousness resulting from anxiety must be distinguished from an appropriate, adaptive response to reality.
If older adults appear to be more rigid lhan younger adults, then cohort differences (ie, generational differences that stem from having grown up during different hisloric periods)—and no! age differences— are more likely involved. Research shows no( only that personalities remain stable with aging but also that behavioral and psychologic adap-tiveness continues and docs not normally give way to regression or rigidity. If certain behaviors or traits become increasingly exaggerated, maladaptive, and unmodifiable, neurosis rather than normal aging may be to blame. Treatment rather than acceptance is in order.

NORMAL CHANGES OF AGING AND PATTERNS OF PSYCHIATRIC DISEASE

Failure to differentiate disease-related psychiatric changes from manifestations of normal aging has blurred the understanding of mental funclion in healthy older adults. Many decrements in capacity or performance viewed as age related—particularly those associated with cognition and behavior—actually reflect modifiable consequences of illness.
NORMAL CHANGES OF AGING

Changes in Cognition
A longitudinal study of cognitive capacity in a cohort of men followed from 1919 to 1961 described increments in verbal ability and total intellectual performance from age 20 to age 50. although mathematical ability declined slightly. From 50 to 60 yr of age, scores of intellect showed little change. These studies were among the first to raise serious doubts about the presumed normal decline in mental ability with aging, which had been inferred from earlier cross-sectional research.
A 12-yr longitudinal study of older men (median age, 71 yr) con-dueled by the National Institute of Mental Health examined a broad range of variables. Physical and psychiatric disease was absent or minimal; the goal was to separate the impact of aging from that of illness. As these healthy men moved from their 70s to their 80s. various intellectual functions declined while others improved. For example, quality of cognitive operations, draw-a-person exercises, and sentence completions declined, while vocabulary and picture arrangement ability improved. This suggests that older persons may have difficulty with activities requiring a quick reaction lime or a high degree of precision, although they maintain the ability to understand their situation and learn from new experiences.
Moreover, men who developed arteriosclerotic cardiovascular disease had significantly greater decrements in intellectual performance than those who remained healthy. Therefore, significant changes in intellectual performance should not be dismissed as normal consequences of aging but should be evaluated as potentially modifiable manifestations of disease (psychiatric as well as general medical). For example, both depression and hypothyroidism are treatable problems that can be covert and cause cognitive impairment.
Changes in Behavior and Personality
Corresponding to the stereotype of inevitable intellectual decline with aging are stereotypes of regressive behavior and increasing inflex-ibilily of personality traits. However, these are more a sign of psychiatric disturbance than a manifestation of aging. Consider the issue of cautiousness. Research shows that (he elderly are more cautious than younger adults about risk taking when the payoff is predictable and constant. If the size of the payoff depends on the degree of risk, however, older persons are no more cautious than younger persons.
Anxiety can resull in cautiousness, causing delays in decision making and reactions. In other words, excessive cautiousness in the elderly may signal underlying anxiety or a related clinicaldisorder. However, it is entirely appropriate for a frail or disabled older person to he more careful in general. A maladaptive overcautiousness resulting from anxiety must be distinguished from an appropriate, adaptive response to reality.
If older adults appear to be more rigid lhan younger adults, then cohort differences (ie, generational differences that stem from having grown up during different hisloric periods)—and no! age differences— are more likely involved. Research shows no( only that personalities remain stable with aging but also that behavioral and psychologic adap-tiveness continues and docs not normally give way to regression or rigidity. If certain behaviors or traits become increasingly exaggerated, maladaptive, and unmodifiable, neurosis rather than normal aging may be to blame. Treatment rather than acceptance is in order.

Fear oldeath:

Research shows thai while the elderly often think about death, they fear dealh less than do other age groups. Thinking or talking about death is not the same as fearing or dreading it. Thoughts or conversations about death are naturally more common in the elderly, since they more likely have peers and relatives who have died or are dying. Dread of death is uncommon in persons who are not dying or experiencing some major loss, although reports show a normal and common dread of death in middle-aged persons, who may suddenly perceive how little time is left. At this stage, people find themselves confronting an existential awareness of their own mortality; with further aging, they adapt to this realization.
A terminal illness, an underlying depression, or other emotional conflict—not the awareness Of aging itself—predisposes certain elderly persons lo death anxiety. In these cases, confronting mortality is different; a terminal illness brings an awareness of dying that can lead to despondency. Eventually, most people come to terms with their fate and can reasonably accept their condition. Depression at any age clouds a person’s thinking and often increases thoughts about death. A noticeable and persistent uneasiness about death may signal underlying depression that could benefit from trealment. Evaluation is all the more important given the high rate of suicide in the elderly and the role of depression as a major risk factor.

Symptoms and Signs
Psychiatric symptoms that develop in later life are often dismissed as normal manifeslations of aging. Even schizophrenia-like symptoms may be dismissed as eccentricity or misdiagnosed as senility. Treatment cannot be planned if a problem is not acknowledged and identified.
Memory and intellectual difficulties: Significant changes in intellectual functioning are no longer readily dismissed, given the heightened awareness of Alzheimer’s disease. But the degree to which depression, anxiely, and other psychiatric disorders can inlerfere with cognition is still underappreciated. Pseudodementia (eg. depression or psychosis mimicking dementia) is an extreme form of such interference.
Change in sleep pattern (see also Ch. II): Complaints of diminished sleep time are often met with assurances that it is a normal part of aging. However, such a change should be viewed clinically as a group characteristic that does not apply to all individuals. Not all studies have found that total sleep lime is reduced in later life. Furthermore, the reduction is typically gradual; a change in sleep pattern should not be taken for granted, especially if it is of recent onset. An older person who reports noticeable reduction in sleep time (not just sleeping less at night because of daytime naps) should be evaluated.
Besides signaling potential medical (eg. musculoskeletal, genitourinary, cardiac) problems, changes in sleep pattern can be a hallmark of psychiatric disorders. Early morning awakening may be an important clue to an underlying depression; difficulty in falling asleep or restless sleep with frequent awakenings may signal an anxiety disorder.
Change in sexual interest or capacity (see also Chs. 68 and 69): As a group, healthy older men and women with a history of normal sexual activity and current opportunity retain an interest and capacity for sexual experience, although individuals may be exceptions. Significant changes, particularly of recent onset, call for diagnostic assessment with a focus on medical and surgical factors, drug side effects, and psychiatric causes. Medical problems and drug side effects affect the sexual function of men more than women, since these factors can interfere with erectile and ejaculatory capacity.
Common medical causes of erectile dysfunction include atherosclerosis (especially in diabetic patients), hypothyroidism, malnutrition, and Parkin_son”s disease. Among possible drug causes, alcohol consumption should be considered; alcohol in high amounts not only serves as a depressant, thereby negatively influencing sexual interest, but also can interfere with erectile and ejaculalory capacity. Depression or anxiety in both men and women can lower motivation for romantic involvement and diminish sexual satisfaction. Regardless of the cause, many sexual problems can be ameliorated or eliminated with proper intervention.
Fear oldeath: Research shows thai while the elderly often think about death, they fear dealh less than do other age groups. Thinking or talking about death is not the same as fearing or dreading it. Thoughts or conversations about death are naturally more common in the elderly, since they more likely have peers and relatives who have died or are dying. Dread of death is uncommon in persons who are not dying or experiencing some major loss, although reports show a normal and common dread of death in middle-aged persons, who may suddenly perceive how little time is left. At this stage, people find themselves confronting an existential awareness of their own mortality; with further aging, they adapt to this realization.
A terminal illness, an underlying depression, or other emotional conflict—not the awareness Of aging itself—predisposes certain elderly persons lo death anxiety. In these cases, confronting mortality is different; a terminal illness brings an awareness of dying that can lead to despondency. Eventually, most people come to terms with their fate and can reasonably accept their condition. Depression at any age clouds a person’s thinking and often increases thoughts about death. A noticeable and persistent uneasiness about death may signal underlying depression that could benefit from trealment. Evaluation is all the more important given the high rate of suicide in the elderly and the role of depression as a major risk factor.

Epidemiology
The high frequency of mental health problems in the elderly is significant; they impact mental status and emotional states and potentially influence the course of physical illness. Epidemiologic studies since the 1950s have documented a 15% to 25% prevalence of serious menial disorders in those “-”– 65 yr old. More than 25% of stale mental hospital patients in the USA (> 50% in the United Kingdom) arc s 65 yrofage.
Psychiatric problems are a primary or secondary diagnosis in 70% to 80% of nursing home residents; one sludy identified 9A!X of nursing home residents as having menial disorders, according to criteria in I he Diagnostic and Statistical Manual of Mental Disorders, Fourth Kdition (IXSM-IV). Because of improved general medical care in the community, patients admitted to nursing homes tend to be sicker, both mentally and physically, than in the past. However, mental disorders, particularly organic disorders, have always been prevalent in nursing home patients.
Organic disorders (most commonly, Alzheimer’s disease) affect about 10% of those > 65 yrold—the rate is considerably higher (at least 25%) in those s- 85 yr old. Significant symptoms of depression have been described in 15%J of community-dwelling elderly persons, and of schizophrenia, in 0.5% to 1.0%. The prevalence of alcohol abuse is difficult to determine but is considered to be high, conservatively estimated at 2% to 5%. Suicide occurs more often in elderly men than in any olher age group (see Suicide, below).
Discrepancies in the prevalence rales of depression in the elderly may be explained by noting that different classificalions of depression are often compared. Lower prevalence figures typically take into account only primary depressions, ie, those occurring without physical disorders or drug side effects. Secondary depressions accompany or result from somatic illness or adverse drug effects. The elderly are al greater risk than other age groups for secondary depressions because they have more physical illness and Ihc highest rate of drug use. For example, one study found that 24% of 406 elderly men seen for physical disorders in a primary care selling complained of clinically significant depressive symptoms; other studies report even higher frequencies of depressive symptoms in such persons. Thus, higher prevalence figures are more accurate because they include both primary and secondary depressions.
Symptoms and Signs
Psychiatric symptoms that develop in later life are often dismissed as normal manifeslations of aging. Even schizophrenia-like symptoms may be dismissed as eccentricity or misdiagnosed as senility. Treatment cannot be planned if a problem is not acknowledged and identified.
Memory and intellectual difficulties: Significant changes in intellectual functioning are no longer readily dismissed, given the heightened awareness of Alzheimer’s disease. But the degree to which depression, anxiely, and other psychiatric disorders can inlerfere with cognition is still underappreciated. Pseudodementia (eg. depression or psychosis mimicking dementia) is an extreme form of such interference.
Change in sleep pattern (see also Ch. II): Complaints of diminished sleep time are often met with assurances that it is a normal part of aging. However, such a change should be viewed clinically as a group characteristic that does not apply to all individuals. Not all studies have found that total sleep lime is reduced in later life. Furthermore, the reduction is typically gradual; a change in sleep pattern should not be taken for granted, especially if it is of recent onset. An older person who reports noticeable reduction in sleep time (not just sleeping less at night because of daytime naps) should be evaluated.
Besides signaling potential medical (eg. musculoskeletal, genitourinary, cardiac) problems, changes in sleep pattern can be a hallmark of psychiatric disorders. Early morning awakening may be an important clue to an underlying depression; difficulty in falling asleep or restless sleep with frequent awakenings may signal an anxiety disorder.
Change in sexual interest or capacity (see also Chs. 68 and 69): As a group, healthy older men and women with a history of normal sexual activity and current opportunity retain an interest and capacity for sexual experience, although individuals may be exceptions. Significant changes, particularly of recent onset, call for diagnostic assessment with a focus on medical and surgical factors, drug side effects, and psychiatric causes. Medical problems and drug side effects affect the sexual function of men more than women, since these factors can interfere with erectile and ejaculatory capacity.
Common medical causes of erectile dysfunction include atherosclerosis (especially in diabetic patients), hypothyroidism, malnutrition, and Parkin_son”s disease. Among possible drug causes, alcohol consumption should be considered; alcohol in high amounts not only serves as a depressant, thereby negatively influencing sexual interest, but also can interfere with erectile and ejaculalory capacity. Depression or anxiety in both men and women can lower motivation for romantic involvement and diminish sexual satisfaction. Regardless of the cause, many sexual problems can be ameliorated or eliminated with proper intervention.
Fear oldeath: Research shows thai while the elderly often think about death, they fear dealh less than do other age groups. Thinking or talking about death is not the same as fearing or dreading it. Thoughts or conversations about death are naturally more common in the elderly, since they more likely have peers and relatives who have died or are dying. Dread of death is uncommon in persons who are not dying or experiencing some major loss, although reports show a normal and common dread of death in middle-aged persons, who may suddenly perceive how little time is left. At this stage, people find themselves confronting an existential awareness of their own mortality; with further aging, they adapt to this realization.
A terminal illness, an underlying depression, or other emotional conflict—not the awareness Of aging itself—predisposes certain elderly persons lo death anxiety. In these cases, confronting mortality is different; a terminal illness brings an awareness of dying that can lead to despondency. Eventually, most people come to terms with their fate and can reasonably accept their condition. Depression at any age clouds a person’s thinking and often increases thoughts about death. A noticeable and persistent uneasiness about death may signal underlying depression that could benefit from trealment. Evaluation is all the more important given the high rate of suicide in the elderly and the role of depression as a major risk factor.

PATTERNS OF PSYCHIATRIC DISEASE
Epidemiology
The high frequency of mental health problems in the elderly is significant; they impact mental status and emotional states and potentially influence the course of physical illness. Epidemiologic studies since the 1950s have documented a 15% to 25% prevalence of serious menial disorders in those “-”– 65 yr old. More than 25% of stale mental hospital patients in the USA (> 50% in the United Kingdom) arc s 65 yrofage.
Psychiatric problems are a primary or secondary diagnosis in 70% to 80% of nursing home residents; one sludy identified 9A!X of nursing home residents as having menial disorders, according to criteria in I he Diagnostic and Statistical Manual of Mental Disorders, Fourth Kdition (IXSM-IV). Because of improved general medical care in the community, patients admitted to nursing homes tend to be sicker, both mentally and physically, than in the past. However, mental disorders, particularly organic disorders, have always been prevalent in nursing home patients.
Organic disorders (most commonly, Alzheimer’s disease) affect about 10% of those > 65 yrold—the rate is considerably higher (at least 25%) in those s- 85 yr old. Significant symptoms of depression have been described in 15%J of community-dwelling elderly persons, and of schizophrenia, in 0.5% to 1.0%. The prevalence of alcohol abuse is difficult to determine but is considered to be high, conservatively estimated at 2% to 5%. Suicide occurs more often in elderly men than in any olher age group (see Suicide, below).
Discrepancies in the prevalence rales of depression in the elderly may be explained by noting that different classificalions of depression are often compared. Lower prevalence figures typically take into account only primary depressions, ie, those occurring without physical disorders or drug side effects. Secondary depressions accompany or result from somatic illness or adverse drug effects. The elderly are al greater risk than other age groups for secondary depressions because they have more physical illness and Ihc highest rate of drug use. For example, one study found that 24% of 406 elderly men seen for physical disorders in a primary care selling complained of clinically significant depressive symptoms; other studies report even higher frequencies of depressive symptoms in such persons. Thus, higher prevalence figures are more accurate because they include both primary and secondary depressions.
Symptoms and Signs
Psychiatric symptoms that develop in later life are often dismissed as normal manifeslations of aging. Even schizophrenia-like symptoms may be dismissed as eccentricity or misdiagnosed as senility. Treatment cannot be planned if a problem is not acknowledged and identified.
Memory and intellectual difficulties: Significant changes in intellectual functioning are no longer readily dismissed, given the heightened awareness of Alzheimer’s disease. But the degree to which depression, anxiely, and other psychiatric disorders can inlerfere with cognition is still underappreciated. Pseudodementia (eg. depression or psychosis mimicking dementia) is an extreme form of such interference.
Change in sleep pattern (see also Ch. II): Complaints of diminished sleep time are often met with assurances that it is a normal part of aging. However, such a change should be viewed clinically as a group characteristic that does not apply to all individuals. Not all studies have found that total sleep lime is reduced in later life. Furthermore, the reduction is typically gradual; a change in sleep pattern should not be taken for granted, especially if it is of recent onset. An older person who reports noticeable reduction in sleep time (not just sleeping less at night because of daytime naps) should be evaluated.
Besides signaling potential medical (eg. musculoskeletal, genitourinary, cardiac) problems, changes in sleep pattern can be a hallmark

of psychiatric disorders. Early morning awakening may be an important clue to an underlying depression; difficulty in falling asleep or restless sleep with frequent awakenings may signal an anxiety disorder.
Change in sexual interest or capacity (see also Chs. 68 and 69): As a group, healthy older men and women with a history of normal sexual activity and current opportunity retain an interest and capacity for sexual experience, although individuals may be exceptions. Significant changes, particularly of recent onset, call for diagnostic assessment with a focus on medical and surgical factors, drug side effects, and psychiatric causes. Medical problems and drug side effects affect the sexual function of men more than women, since these factors can interfere with erectile and ejaculatory capacity.
Common medical causes of erectile dysfunction include atherosclerosis (especially in diabetic patients), hypothyroidism, malnutrition, and Parkin_son”s disease. Among possible drug causes, alcohol consumption should be considered; alcohol in high amounts not only serves as a depressant, thereby negatively influencing sexual interest, but also can interfere with erectile and ejaculalory capacity. Depression or anxiety in both men and women can lower motivation for romantic involvement and diminish sexual satisfaction. Regardless of the cause, many sexual problems can be ameliorated or eliminated with proper intervention.
Fear oldeath: Research shows thai while the elderly often think about death, they fear dealh less than do other age groups. Thinking or talking about death is not the same as fearing or dreading it. Thoughts or conversations about death are naturally more common in the elderly, since they more likely have peers and relatives who have died or are dying. Dread of death is uncommon in persons who are not dying or experiencing some major loss, although reports show a normal and common dread of death in middle-aged persons, who may suddenly perceive how little time is left. At this stage, people find themselves confronting an existential awareness of their own mortality; with further aging, they adapt to this realization.
A terminal illness, an underlying depression, or other emotional conflict—not the awareness Of aging itself—predisposes certain elderly persons lo death anxiety. In these cases, confronting mortality is different; a terminal illness brings an awareness of dying that can lead to despondency. Eventually, most people come to terms with their fate and can reasonably accept their condition. Depression at any age clouds a person’s thinking and often increases thoughts about death. A noticeable and persistent uneasiness about death may signal underlying depression that could benefit from trealment. Evaluation is all the more important given the high rate of suicide in the elderly and the role of depression as a major risk factor.

Is the problem mental or physical?

Making the correct diagnosis can be especially challenging when differentiating psychologic from physical causes. Consider GI complaints, which are subject to conflicting stereotypes. One stereotype holds that most GI complaints in the elderly are of psychogenic origin—a psychosomatic explanation. The opposing stereotype holds that if one looks hard enough, a physical basis for most GI symptoms will be found in older patients.
To evaluate these views, 300 patients older than 65 yr with GI complaints were followed comprehensively for at least I yr after their initial visit to the outpatient department of a medical center. Final diagnoses were as follows: 10%, GI malignancy; 8%, gallbladder disease; 6%, duodenal ulcer; 3%, gastric ulcer; 3%, diveniculosis of the colon; 14%, a wide variety of organic problems; and .56%, GI distress of a purely psychogenic nature. The physical problems of these last patients included irritable colon, spastic colitis, gastritis, heartburn, nausea, diarrhea, constipation, and other psychophysiologic disorders.
In short, the study revealed thai both psychogenic (56%) and physical (44%) factors play major roles in patients with GI problems. Thus, the primary care physician or psychiatrist must simultaneously perform comprehensive general medical and psychiatric examinations when evaluating GI complaints.

Absorption:

Most oral psychoactive drugs are absorbed through the intestinal mucosa. Although aging does not significantly alter absorption, other prescribed or over-the-counter drugs can interfere with how efficiently or quickly psychoactive drugs are absorbed. Consequently, more attention must be directed to the timing of psychoactive drug administration (eg, when antacids arc taken at the same time as diazepam, they may delay diazepam’s absorption and the time it takes to reach peak plasma concentration).