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Geriatric Geriatric psychiatry psychiatry „Old age” „Old age” psychiatry psychiatry Zoltán Hidasi MD Zoltán Hidasi MD
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Page 1: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Geriatric psychiatryGeriatric psychiatry„Old age” psychiatry„Old age” psychiatry

Zoltán Hidasi MDZoltán Hidasi MD

Page 2: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Geriatric psychiatryGeriatric psychiatry

What is „Geriatric”?What is „Geriatric”? Physical, mental and social aspectsPhysical, mental and social aspects Mental disorders in generalMental disorders in general Different disorders in the elderlyDifferent disorders in the elderly Psychiatric therapies in the elderlyPsychiatric therapies in the elderly

Page 3: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

„„Old age”?Old age”?

Page 4: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Gladys Burrill 92 yGladys Burrill 92 y

Honolulu Marathon 2010.Honolulu Marathon 2010.

Fauja Singh 100 yFauja Singh 100 y

Toronto Marathon 2011Toronto Marathon 2011

(Guinness record)(Guinness record)

Page 5: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Getting older v. living longerGetting older v. living longer

Physical changes – somatic diseasesPhysical changes – somatic diseases Musculosceletal Musculosceletal CardiovascularCardiovascular MetabolicMetabolic EndocrinEndocrin GastrointestinalGastrointestinal Sensory deficitsSensory deficits

Brain (vascular, degenerative, etc.)Brain (vascular, degenerative, etc.)

Page 6: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Getting older v. living longerGetting older v. living longer

Mental changesMental changes PersonalityPersonality

• amplification of character traitsamplification of character traits Cognition, memoryCognition, memory

• mental slowingmental slowing• transformed memory structuretransformed memory structure• summerised experiencessummerised experiences

Emotional changesEmotional changes• Emotional maturityEmotional maturity

Page 7: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Getting older v. living longerGetting older v. living longer

Social changesSocial changes Retirement (financial difficulties)Retirement (financial difficulties) Decrease in social statusDecrease in social status Facing somatic and mental disfunctioningFacing somatic and mental disfunctioning Somatic diseasesSomatic diseases Grief (loss of spouse, brothers or sisters, Grief (loss of spouse, brothers or sisters,

friends)friends) Social isolationSocial isolation Moving to nursing/residential home Moving to nursing/residential home

Page 8: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Mental disorders in elderly?Mental disorders in elderly?QuestionsQuestions

65+ ??65+ ?? Prevalence? 10-25%Prevalence? 10-25% DSM? ICD?DSM? ICD? Child – adult –geriatric psychiatry?Child – adult –geriatric psychiatry? Geriatry – psychiatry –internal medicine?Geriatry – psychiatry –internal medicine? Organic – old age – neuro-psychiatry?Organic – old age – neuro-psychiatry? GP? GP?

Page 9: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Mental disorders in generalMental disorders in general

Biological, psychological, social factors Biological, psychological, social factors (bio-psycho-social model)(bio-psycho-social model)

Internal medical, neurological, psychiatric Internal medical, neurological, psychiatric aspectsaspects

Multidimensonal approachMultidimensonal approach Polimorbidity!Polimorbidity! Syndromatology (atypical) – etiologySyndromatology (atypical) – etiology Cross-sectional –long term courseCross-sectional –long term course

Page 10: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Mental disorders in the elderlyMental disorders in the elderly

DementiaDementia Other „organic mental disorders”Other „organic mental disorders”

Affective disorders (depression)Affective disorders (depression) DeliriumDelirium Delusional disorders (psychosis)Delusional disorders (psychosis) Anxiety disordersAnxiety disorders Substance abuse disordersSubstance abuse disorders

Psychiatric patients getting oldPsychiatric patients getting old

Page 11: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Dementia - SyndromatologyDementia - Syndromatology

Chronic course Chronic course (10% above 65 y, 16-25% above 85 y)(10% above 65 y, 16-25% above 85 y)

Multiple cognitive deficits incl. memory Multiple cognitive deficits incl. memory impairment impairment (intelligence, learning, language, (intelligence, learning, language, orientation, perception, attention, judgement, problem orientation, perception, attention, judgement, problem solving, social functioning)solving, social functioning)

No impairment of consciousnessNo impairment of consciousness Behavioural and psychological symptoms of Behavioural and psychological symptoms of

dementia (BPSD)dementia (BPSD) Progressive - staticProgressive - static Reversible (15%) - irreversibleReversible (15%) - irreversible

Page 12: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Dementia - ClassificationDementia - Classification

SeveritySeverity Mild cognitive impairment (MCI)Mild cognitive impairment (MCI) Mild dementiaMild dementia Moderate dementiaModerate dementia Severe dementiaSevere dementia

Localization Localization Cortical Cortical SubcorticalSubcortical

EtiologyEtiology

Page 13: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Dementia -EtiologyDementia -Etiology Alzheimers disease (60-70%)Alzheimers disease (60-70%) Vascular dementia (10-20%)Vascular dementia (10-20%) Neurodegenerative disorders Neurodegenerative disorders

(Pick, Lewy body dis, Parkinson, Huntington, etc.)(Pick, Lewy body dis, Parkinson, Huntington, etc.) Drugs and toxinsDrugs and toxins Intracranial massesIntracranial masses AnoxiaAnoxia TraumaTrauma Infections Infections (JCD, HIV, etc)(JCD, HIV, etc) NutritionNutrition MetabolicMetabolic PseudodementiaPseudodementia

Page 14: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Affective disorders (depression)Affective disorders (depression)

Major depression prevalence: 10-16%Major depression prevalence: 10-16%

(hospital, residential homes)(hospital, residential homes) Minor depression: 47-53 %Minor depression: 47-53 %

Suicide in elderlySuicide in elderly 2-3 x average over 65 2-3 x average over 65 Major depression in 80%Major depression in 80%

Page 15: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Suicidal attempts in 5 years age groups in Hungary, 2002

(Hungarostudy: Kopp et al)

Suicidal attempts

Page 16: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Depression in old ageDepression in old age

Dysthymic disorder, subthreshold depression Dysthymic disorder, subthreshold depression Atypical syndromatology Atypical syndromatology Cognitive symptoms (attention, concentration, memory Cognitive symptoms (attention, concentration, memory

problems) - pseudodementiaproblems) - pseudodementia Somatic complaints –somatoform symptoms (e.g. pain), Somatic complaints –somatoform symptoms (e.g. pain),

hypochondriasis hypochondriasis negativism, inactivity, loss of energy, fatigue, insomnia negativism, inactivity, loss of energy, fatigue, insomnia psychomotor agitation (or retardation), irritability, anxiety psychomotor agitation (or retardation), irritability, anxiety Psychotic symptoms, paranoid symptoms Psychotic symptoms, paranoid symptoms Comorbid somatic disorders Comorbid somatic disorders Increased suicidal risk Increased suicidal risk

Page 17: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Delusional disorders (psychoses)Delusional disorders (psychoses)

Late onset schizophrenia (over 40 y)Late onset schizophrenia (over 40 y) Very late onset schizophreniform disorder Very late onset schizophreniform disorder

(over 60 y)(over 60 y) Other delusional disordersOther delusional disorders Organic delusional disorderOrganic delusional disorder Delusional symptoms of dementia (BPSD)Delusional symptoms of dementia (BPSD) Multiple etiology, multiple syndromatology Multiple etiology, multiple syndromatology

(schizophreniform, persecutory, hallucinosis, (schizophreniform, persecutory, hallucinosis, coenaesthesias, etc.)coenaesthesias, etc.)

Page 18: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Psychosocial factors

Personality

„Endogenous” origin

Organic (CNS) background

Sensory impairment

Other biological factors

Delusional disorder in elderly

Page 19: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Anxiety disordersAnxiety disorders

High prevalenceHigh prevalence Atypical symptomsAtypical symptoms Somatoform/behavioural symptomsSomatoform/behavioural symptoms Psychosocial stressorsPsychosocial stressors ComorbidityComorbidity

somaticsomatic psychiatricpsychiatric

Page 20: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Substance abuseSubstance abuse

Alcohol/medication abuseAlcohol/medication abuse Common comorbidityCommon comorbidity

somaticsomatic psychiatric (anxiety, depression, etc.)psychiatric (anxiety, depression, etc.)

Page 21: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Psychiatric patients getting oldPsychiatric patients getting old

Schizophrenia / bipolar disorderSchizophrenia / bipolar disorder Personality disorderPersonality disorder Neurotic disordersNeurotic disorders

anxiety, somatoform, etc.anxiety, somatoform, etc.

Changes in clinical picture, therapeutical Changes in clinical picture, therapeutical response, etc.response, etc.

Bio-psycho-social changesBio-psycho-social changes Multidimensional approachMultidimensional approach

Page 22: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

Psychiatric therapies in the Psychiatric therapies in the elderlyelderly

PharamcotherapyPharamcotherapy Other biological therapies (ECT)Other biological therapies (ECT) Psychotherapies –social therapiesPsychotherapies –social therapies

Improving cognitive functioningImproving cognitive functioning RehabilitationRehabilitation Treating primary or associated mood-anxiety Treating primary or associated mood-anxiety

disorderdisorder

Page 23: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.

PharmacotherapyPharmacotherapy

Aspects of pharmacotherapyAspects of pharmacotherapy Mental status, neurological/somatic statusMental status, neurological/somatic status Social statusSocial status EtiologyEtiology

Special aspectsSpecial aspects PolimorbidityPolimorbidity Pharmacokinetics (interactions) Pharmacokinetics (interactions) Dosage (low)Dosage (low) Side effects (cognitive, other)Side effects (cognitive, other)

Page 24: Geriatric psychiatry „Old age” psychiatry Zoltán Hidasi MD.