Magazine article Clinical Psychiatry News

Competency Evaluations Must Be Multifaceted. (Medical Charts Provide Key Information)

Magazine article Clinical Psychiatry News

Competency Evaluations Must Be Multifaceted. (Medical Charts Provide Key Information)

Article excerpt

RANCHO MIRAGE, CALIF. -- Competency evaluations in the elderly cannot be rushed, except, perhaps, when a critical medical decision must be made, Dr. Carla Rodgers said at the annual meeting of the American College of Forensic Psychiatry.

Even then, a psychiatrist owes it to a padent to revisit the question about competency once the medical crisis has passed.

"If somebody really needs to go to surgery for a lower GI bleed, let's get them to surgery and deal with [potentially confounding] depression later," explained Dr. Rodgers, a board-certified geriatric psychiatrist and forensic psychiatrist who is in private practice in the Philadelphia area.

Competency is not "created equal," she emphasized during a comprehensive presentation on determining an elderly person's ability to make a medical decision, draw up a will, stand trial or testify in court. It also may be a fluid concept, susceptible to a change in circumstances.

An elderly person who may not be able to understand his medical predicament at the moment may be fully competent to decide whether to return to his own home in a few weeks. A mentally ill person may well be able to make decisions about his estate. A depressed elderly person may improve enough with adequate therapy to be able to testify in court.

In the elderly, competency can be a particularly confounding issue. Physical incapacitation, dementia, depression (still referred to as "pseudodementia" in the elderly) and pressure from family members may blur the distinction between competency and incompetency. As a result, a psychiatrist needs to use all available resources to come to a conclusion.

Reviewing medical, legal, and psychiatric records--including a patient's current medical chart--can be quite helpful. Vital signs, medications, and particularly lab values can provide critical information. …

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