Psychiatry Features

This article aims to update general hospital staff about electroconvulsive treatment.

For too long the psychological needs of older people have sat on the periphery of psychotherapeutic services, being seen by some as a luxury or a novelty, and too expensive with no productive outcome.

The diagnosis of generalised anxiety disorder in older adults can be quite a challenge to make. Many older people will not have full blown symptoms or fulfil all of the DSM-IV criteria but tend to present with physical manifestations of anxiety such as insomnia or multiple vague symptoms, which may be misinterpreted as a physical illness or as part of the ageing process rather than as a psychiatric disorder. 

Professionals in health and social care assess mental capacity for various decisions. This is described as a basic competence common to all professionals, but not all such assessments need professionals to make this judgement. There is a need for further training of all staff to competently assess mental capacity and make appropriate decisions.

There is a high risk of side effects when prescribing antidepressants in the elderly. These canbe avoided or minimised by tailoring the choice of antidepressant to the individual, by beingaware of potential drug interactions and by bearing in mind the impact of co-morbidities.Drs Ayodeji Soyinka and David Lawley explore the evidence base and main side effects ofantidepressants in common use in the elderly and how these might influence prescribing.

The number of elderly prisoners is increasing and evidence suggests that there is signifi cantunidentified psychiatric morbidity in this group. Currently, elderly prisoners who havepsychiatric needs are managed either by the generic forensic psychiatric services or genericold age psychiatry services. Drs Arghya Sarkhel, Carlo Thomas and Ajit Shah discuss theextent of the problem and how these patients can be better identifi ed.

Depression is more common in the elderly and studies suggest that twice as many womenare likely to be affected by depression than men. There is also evidence that depression canexacerbate the course or initiate the onset of serious and disabling medical conditions. In thisarticle, Professor Dora Kohen discusses depression in women and reviews the effect of somecommon co-morbidities on depression in the elderly female population.

Charles Bonnet Syndrome describes the phenomenon of hallucinations in the elderly withvisual impairment. The hallucinations are vivid, complex and well formed. They frequentlyhave no personal meaning, are recognised as being unreal by the patients and can sometimesbe voluntarily terminated by the patient. In this article, Drs Sitara Khan and Jeffrey Limdiscuss the clinical course of the syndrome.

Depression is common in the elderly general hospital patient and at any one time 100 patientswith depressive symptoms may be occupying beds in the average sized general hospital.However, depression can be often undiagnosed and untreated. In this article, Dr RogerBullock discusses why it is important to identify depression in this age group and looks at theco-morbidities associated with the illness.

Since the British Dental and Medical Society accepted the study of hypnosis into its curriculum,its usefulness in treating and facilitating treatment has become firmly established and is nowimplemented by psychiatrists, psychologists and many general practitioners. Dr Iain McIntoshexplores the benefi ts hynopsis can hold for phobic problems in the elderly and how its use canlimit the need for medication.