Assessment of mental disorder in older patients and of the treatment needs of patients and their carers

Robin Jacoby

The.referral.process Who..refers?

Reasons.fpr., relerraJ Thejnfprmants

Professional informants

Whereto assessthe ..patient At home in..a...psyc,h1iatric„ .hospital

Liaison visits in general hospitals Nursing.. and residentia! homes

Thehistpry

Fami!y...and.., persona!, .history Medicaland,, p,s,y,c,hiatric...hist,or,y

Premorbid .personality

The... mental, .s.tate...examinatipn APPearance,..behayiourJn.andJhe...eny|ronment

Talk

Thought .content Mood

Coqnitive.examination

OtheLasBects... of..t„h,e„ .mental ..state... examination

Physica!...assessment Physica! ..examination

Laboratory.inyestiqations

Genera!., considerations ..in..the..treatment..pf, .olderpsychiatric ..patients Medication..and, physica!, .frailty

Falls Nutrition

SuperimposeddeNrium

Reassessment.. after. treatment Assessment of carers' ..needs Further.reading

Chapter. References

The assessment of older people is not fundamentally different from that of younger patients. The principles of history taking and mental state examination are the same at any age. But if the goals are common, the routes taken to reach them are not necessarily so. For example, an assessment adequate enough to begin treatment of a 30-year-old woman presenting to an outpatient clinic with a depressive illness might take about an hour and involve speaking only to the patient and perhaps briefly to her partner, whereas the equivalent assessment of an 81-year-old woman in whom uncertainty exists as to whether the diagnosis is that of a depressive or a dementing illness may require more than one interview and necessitate enquiry from several informants. This section will not repeat what can be found in Cha£t§I...!.:!0.:.!, but cover only those points which are specific to or need to be emphasized for older patients.

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