Other aspects of the mental state examination

These do not differ in essence from that in younger adults and are not covered in this section. Physical assessment Physical examination

Since physical comorbidity is extremely common, the old age psychiatrist needs to be able and willing to conduct a basic physical examination. In the patient's home this may not always be easy. For instance, it may not be kind to ask a frail person who takes an hour or more to dress and come downstairs in the morning to return to her bed and undress, but it is usually possible to make a reasonable examination of the arterial pulse, blood pressure, and jugular venous pulse, and to auscultate the heart and lungs when the patient is seated. Similarly, a partial neurological examination for signs of focal deficits is also possible. However, if something alerts the doctor to the need to examine an undressed and supine patient, the duty should not be shirked, lest a hitherto unsuspected abdominal mass or a strangulated hernia are missed.

Patients admitted to psychiatric hospital or nursing home beds should all undergo a physical examination. Focal neurological signs may indicate the cause of dementia. Carcinoma of the breast which either dementia or fear has prevented the patient from declaring may be much more treatable than she has believed. All the physical disorders which may be revealed are too numerous to mention, but their detection and treatment nearly always contribute to an improvement in mental function.

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