Psychiatric disorders in older adults

Neuropsychiatric syndromes are common in elderly patients and complicate the evaluation and treatment of medical conditions for which these patients are referred to specialists. Depression and anxiety disorders may accompany any illness and may mimic or exacerbate many. They tend to emerge during early adulthood, but may become symptomatic for the first time in late life. They can be managed successfully if they are recognized and treated appropriately. Delirium and dementia are characterized by core deficits in attention and cognition, respectively. They often co-occur, presenting challenges in differential diagnosis. Delirium generally resolves with treatment of the underlying medical condition but may point to the existence of a previously unrecognized emerging dementia syndrome. Psychosis is a generic term describing the presence of delusions, hallucinations, and other signs of impaired “reality testing." It is the hallmark of schizophrenia and related disorders (e.g., delusional disorders) but may also complicate severe depression, delirium, and dementia. New onset psychosis should be considered a sign of delirium until proven otherwise and should prompt a thorough medical evaluation. Clinicians often need to assess the ability of their patients to consent to treatment. This requires determining whether a patient has a potentially capacity-compromising neuropsychiatric condition and, if so, whether the symptoms of that condition are interfering with the capacity of the patient to make a particular decision. Specialists can develop the skills to evaluate and treat neuropsychiatric conditions in many cases but shouldn’t hesitate to consult with psychiatrists and other mental health specialists when uncertain how to proceed.