Mental disorders in the elderly

náhled|Geriatrie

The basic psychiatric disorders in the elderly include dementia, delirium and depression. Their danger lies not only in the basis of the disease itself, but also in influencing a person's overall health:


 * occurrance of new diseases
 * exacerbation of an existing disease
 * increased frequency of hospitalizations
 * extension of hospitalizations
 * overall increase in morbidity and mortality

Dementia
Dementia is a syndrome that can have roots in several diseases, especially in old age.

In seniors, it often leads to:
 * dehydration
 * malnutrition
 * noncompliance(forgeting to take medication)
 * loss of self-sufficiency
 * the need for external help (from family members)
 * the need for institutional care

The most common causes of dementia in the elderly

 * Alzheimer's disease
 * Ischemic-vascular dementia
 * Dementia in Parkinson's disease
 * Alcoholic dementia
 * Mixed

The treatment of Alzheimer's dementia in particular consists in delaying the more severe stages of the disease. Brain acetylcholinesterase inhibitors - donepezil, rivastigmine - are being used.

Derepression
Depression in the elderly is generally a relatively underestimated condition. It is based on chronic illness, life-changing situations (loss of a loved one, loss of life role) which is often associated with moving into a nursing home. The results are noncompliance treatment (not taking medication, often intentionally), dehydration, malnutrition and weight loss due to lack of appetite. Depression can manifest itself as a general depression or as agitated restlessness with aggressive tendencies. In older age, the number of suicides also increases - high jump, hanging. Depression should therefore not be underestimated, but treated (psychiatric counseling).

Suitable antidepressants in old age :
 * the most suitable are selective inhibitors of serotonin reuptake (sertraline, citalopram)
 * serotonin and norepinephrine reuptake blockers (SNRIs)
 * noradrenergic and specifically serotonergic antidepressants (NASA) - mirtazapine
 * tricyclic antidepressants are unsuitable (they have an anticholinergic effect)

Delirium
Delirium is often caused by dehydration, a change in the environment or by certain medications (typically ATB - fluoroquinolones), hypoxia, infection, psychosocial stress, but also withdrawal delirium.

Acute treatment of delirium:
 * elimination of the root cause (metabolic imbalance, infection, neurological disease, ...)
 * sufficient hydration
 * neuroleptics - typically tiapridal, risperidone, haloperidol
 * hypnotics - adjusting the sleep-wake rhythm can lead to an improvement in the condition

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