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Geriatric psychiatry Old age psychiatry Zoltn Hidasi MD

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Geriatric psychiatry What is Geriatric? Physical, mental and social aspects Mental disorders in general Different disorders in the elderly Psychiatric therapies in the elderly

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Old age?

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Gladys Burrill 92 y Honolulu Marathon 2010. Fauja Singh 100 y Toronto Marathon 2011 (Guinness record)

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Getting older v. living longer Physical changes somatic diseases Musculosceletal Musculosceletal Cardiovascular Cardiovascular Metabolic Metabolic Endocrin Endocrin Gastrointestinal Gastrointestinal Sensory deficits Sensory deficits Brain (vascular, degenerative, etc.) Brain (vascular, degenerative, etc.)

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Getting older v. living longer Mental changes Personality Personality amplification of character traitsamplification of character traits Cognition, memory Cognition, memory mental slowingmental slowing transformed memory structuretransformed memory structure summerised experiencessummerised experiences Emotional changes Emotional changes Emotional maturityEmotional maturity

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Getting older v. living longer Social changes Retirement (financial difficulties) Retirement (financial difficulties) Decrease in social status Decrease in social status Facing somatic and mental disfunctioning Facing somatic and mental disfunctioning Somatic diseases Somatic diseases Grief (loss of spouse, brothers or sisters, friends) Grief (loss of spouse, brothers or sisters, friends) Social isolation Social isolation Moving to nursing/residential home Moving to nursing/residential home

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Mental disorders in elderly? Questions 65+ ?? Prevalence? 10-25% DSM? ICD? Child adult geriatric psychiatry? Geriatry psychiatry internal medicine? Organic old age neuro-psychiatry? GP?

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Mental disorders in general Biological, psychological, social factors (bio-psycho-social model) Internal medical, neurological, psychiatric aspects Multidimensonal approach Polimorbidity! Syndromatology (atypical) etiology Cross-sectional long term course

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Mental disorders in the elderly Dementia Other organic mental disorders Other organic mental disorders Affective disorders (depression) Delirium Delusional disorders (psychosis) Anxiety disorders Substance abuse disorders Psychiatric patients getting old

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Dementia - Syndromatology Chronic course (10% above 65 y, 16-25% above 85 y) Multiple cognitive deficits incl. memory impairment (intelligence, learning, language, orientation, perception, attention, judgement, problem solving, social functioning) No impairment of consciousness Behavioural and psychological symptoms of dementia (BPSD) Progressive - static Reversible (15%) - irreversible

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Dementia - Classification Severity Mild cognitive impairment (MCI) Mild cognitive impairment (MCI) Mild dementia Mild dementia Moderate dementia Moderate dementia Severe dementia Severe dementia Localization Cortical Cortical Subcortical Subcortical Etiology

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Dementia -Etiology Alzheimers disease (60-70%) Vascular dementia (10-20%) Neurodegenerative disorders (Pick, Lewy body dis, Parkinson, Huntington, etc.) Drugs and toxins Intracranial masses Anoxia Trauma Infections (JCD, HIV, etc) Nutrition Metabolic Pseudodementia

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Affective disorders (depression) Major depression prevalence: 10-16% (hospital, residential homes) Minor depression: 47-53 % Minor depression: 47-53 % Suicide in elderly 2-3 x average over 65 2-3 x average over 65 Major depression in 80% Major depression in 80%

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Suicidal attempts in 5 years age groups in Hungary, 2002 (Hungarostudy: Kopp et al) Suicidal attempts

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Depression in old age Dysthymic disorder, subthreshold depression Atypical syndromatology Cognitive symptoms (attention, concentration, memory problems) - pseudodementia Somatic complaints somatoform symptoms (e.g. pain), hypochondriasis negativism, inactivity, loss of energy, fatigue, insomnia psychomotor agitation (or retardation), irritability, anxiety Psychotic symptoms, paranoid symptoms Comorbid somatic disorders Increased suicidal risk

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Delusional disorders (psychoses) Late onset schizophrenia (over 40 y) Very late onset schizophreniform disorder (over 60 y) Other delusional disorders Organic delusional disorder Delusional symptoms of dementia (BPSD) Multiple etiology, multiple syndromatology (schizophreniform, persecutory, hallucinosis, coenaesthesias, etc.)

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Psychosocial factors Personality Endogenous origin Organic (CNS) background Sensory impairment Other biological factors Delusional disorder in elderly

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Anxiety disorders High prevalence Atypical symptoms Somatoform/behavioural symptoms Psychosocial stressors Comorbidity somatic somatic psychiatric psychiatric

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Substance abuse Alcohol/medication abuse Common comorbidity somatic somatic psychiatric (anxiety, depression, etc.) psychiatric (anxiety, depression, etc.)

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Psychiatric patients getting old Schizophrenia / bipolar disorder Personality disorder Neurotic disorders anxiety, somatoform, etc. anxiety, somatoform, etc. Changes in clinical picture, therapeutical response, etc. Bio-psycho-social changes Multidimensional approach

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Psychiatric therapies in the elderly Pharamcotherapy Other biological therapies (ECT) Psychotherapies social therapies Improving cognitive functioning Improving cognitive functioning Rehabilitation Rehabilitation Treating primary or associated mood-anxiety disorder Treating primary or associated mood-anxiety disorder

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Pharmacotherapy Aspects of pharmacotherapy Mental status, neurological/somatic status Mental status, neurological/somatic status Social status Social status Etiology Etiology Special aspects Polimorbidity Polimorbidity Pharmacokinetics (interactions) Pharmacokinetics (interactions) Dosage (low) Dosage (low) Side effects (cognitive, other) Side effects (cognitive, other)

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