Academic journal article Indian Journal of Psychiatry

The Geropsychiatric Interview- Assessment and Diagnosis

Academic journal article Indian Journal of Psychiatry

The Geropsychiatric Interview- Assessment and Diagnosis

Article excerpt

Byline: Mathew. Varghese, Ajit. Dahale

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Introduction

The population of elderly persons is growing with extraordinary rapidity. In the 2011 census of India the elderly population comprised over 8 % of the total population, making the estimated numbers of people above 60 years age to over 100 million. Although the majority enjoys good health, many older people suffer from multiple illnesses and significant disability. They tend to exhibit great medical complexity and vulnerability, have illnesses with atypical and obscure presentations, suffer major cognitive, affective, and functional problems, are especially vulnerable to iatrogenic health problems, are often socially isolated and poor and are at high risk for premature or inappropriate institutionalization. Almost 45% of elderly suffer from some chronic illness and many have two to three physical illnesses together with a mental disorder. The prevalence of mental disorders in the elderly ranges from 20-30% of which the commonest are depression (10%) and dementia (3%). Hence it is very important to recognise the magnitude of the problem as India would have the second largest population of elders in the world with a mental disorder. This fact would necessitate that we anticipate and plan for geriatric care both in the health system and in the families and community.

The Psychiatric Interview of the Elderly Patient

The bedrock of the diagnostic workup of an elderly patient with a psychiatric disorder is the psychiatric interview. In this chapter, we would detail the core components of the psychiatric history taking, the mental status examination and other bedside assessments. We would also assess other domains important for the comprehensive management of the patient like the medical, social, financial, environmental areas. A brief note would also be given on the laboratory and other investigations required to confirm a diagnosis. We will also list out some structured interview schedules and rating scales that are of value in the geropsychiatric assessment.

The Psychiatric Evaluation:

The clinician should first interview the patient together with the family members to understand the presenting problem for which the consultation is made. Later it may be necessary to interview the patient and family members separately for information that is pertinent from the respective persons. For example, it is better to interview the patient separately when doing the neuropsychological testing or when patient appears to be inhibited to discuss his/her symptoms and to talk to the family separately while enquiring about caregiver burden and distress. If the patient has difficulty providing a reliable and adequate history, the clinician should elicit the symptoms or problems that the patient perceives as being most disabling and then fill the gaps with data from the family members. Interview techniques for patients with sensory [e.g hearing loss] or cognitive impairment should be appropriately modified to reduce inducing anxiety or irritability, for e.g. by talking slowly and by explaining the nature and rationale of the assessments.

The areas to focus in the history taking interview are given below:

*Presenting complaints and history of the current illness *Past psychiatric and medical history *Medication history *Family history and assessment *Personal history (including habits, nutrition, biological functions and life style) *Premorbid personality *Mental Status Examination

1. The History of current illness

The review of symptoms is most valuable when considered in the context of symptom presentation, including onset, duration, severity and fluctuation, precipitating factors/life events, prior efforts at addressing the symptoms and their success, diurnal or seasonal variation, whether symptoms cluster together, and whether they are ego-syntonic or ego-dystonic. Open ended questioning should be attempted initially followed by structured questioning. …

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