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 [...]
Pharmacotherapy After cardiovascular drugs, psychoactive drugs are the most frequently prescribed for older patients. Psychoactive drugs include antidepressants; anxiolytics; antipsychotics (neuroleptics); hypnotics; certain muscle relaxants, anticonvulsants, and antiparkinsonian drugs; lithium (for the mania of bipolar depressive disorders); and drugs that are claimed to enhance cognitive function (primarily memory). The same dose of a psychoactive drug [...]
Psychotherapy Many question the place of psychotherapy in geriatric medicine, but its efficacy has been demonstrated in numerous older patients, especially those with reactive depression, in whom psychosocial^ induced stress is prominent. As the average life expectancy increases, lime is less likely U) be considered an obstacle to psychotherapy. A 65-yr-old may live another 20 [...]
Interactions Between Mental and Physical Health The impact of mental health on the overall course of physical health and illness is increasingly recognized. A growing body of scientific data corroborates the adverse effects of menial health problems on physical illness in later life; impaired immune function and increased prevalence of physical illness, doctor visits, and [...]
Atypical Presentations Just as infection may have an atypical presentation in the elderly <eg. without fever or elevated WBC count), psychiatric illness may be manifested in atypical forms (eg, vague physical decline and multiple somatic complaints). In later life, vague physical decline does not always indicate physiologic aging or the subtle progression of underlying physical [...]
Suicide Depression is one of the most common risk factors for suicide. Other risk factors are outlined in TABLH 94-1. While suicide rates amone those 18 to 24 yr of age increased significantly from 1970 to 19K0, the highest rates in the USA occur in those > 65 yr old (see TABLK 94-2). Moreover, since [...]
TREATMENT CONSIDERATIONS FOR PSYCHIATRIC DISEASE After differentiating illness from aging and evaluating the interplay between psychiatric and physical factors, the process of treatment planning begins. Physicians today have access to improved psyeholher-apeutic, psychopharmacologic, and social interventions. However, with chronic mental illness, as with chronic physical illness, both remissions and exacerbations can occur. Psychotherapy Many question [...]
Elderly persons may have other depressive disorders thai are not well codified in DSM-IV, Episodes of brief depression, quite common in older adults, involve moderately severe depressive symptoms that are consistent with DSM-IV criteria except for their duration (2 wk). Although the symptoms have no clear cause and resolve spontaneously, affected patients may experience these [...]
Some elderly persons have frank major depression with or without melancholia. The core symptoms of major depression include dysphoric mood phis at least four of the following symptoms: sleep disturbance (usually decreased sleep), appetite disturbance, weight loss, psychomotor retardation, suicidal ideation, poor concentration, feelings of guilt, and lack of interest in usual activities. Melancholic depression [...]
The diagnosis of depression hinges on a thorough history and physical examination. A review of presenting symptoms against the patient’s lifestyle and previous medical and psychiatric history usually permits an accurate diagnosis. The Yesavage Geriatric Depression Scale (see TABLE 95-2) and the Hamilton Depression Scale (see TABLE 95-3) are useful assessment instruments. Although depression scales [...]
