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Mental health is a state of mental wellbeing. The elderly is afflicted by the process of ageing, which causes a decrease in the functioning of all organ systems in the body. In addition there is a change in their personal and social life. They are unable to persue their occupation, loose their productivity and earn ing capacity. Family life is traumatic with exit of their children and from home and loss of spouse and relatives and friends owing to death.

The major psychiatric illnesses in the elderly are affective disorders, organic brain syndromes and paraphrenia.

Affective disorders

The commonest psychiatric illness in the elderly is depression. In a community survey it was estimated to be prevalent at 59/ 100. The other affective disorder is Mania.

Depression

Depressive illness in the elderly is characterised by depressed mood, sleep difficulties, worrying, slowness in thinking and activity.

The patient complains of sadness, multiple body complaints and does not pursue his occupation without clear reason. On enquiry the patient reveals sleep difficulties, poor appetite, constipation, sadness, tends to weep, shows constriction in activity and is generally slow or sometimes agitated. Often during home visits it may be revealed that the patient lies in bed most of the time, does not work, does not like to meet others, worries excessively and talks of suicide. Very often a physical examination does not reveal pathology that could cause so much functional disability.

A patient hearing of the individual's complaint and encouragement to discuss his personal problems helps. Recent stressful life events such as loss of loved ones or property or status may be forthcoming. An assessment of the suicidal ideation should always be undertaken by gentle emphathetic direct questioning. A depressive with suicidal intent should be referred for active inpatient management at the hospital.

A detailed evaluation of the patient's memory and orientation is necessary to exclude organic dementia. He can be managed with antidepressant drugs. Drug treatment may cause retention of urine, constipation, arrhythmias and blurring of vision. The patient is advised not to change his postures suddenly so as to prevent giddiness and falls. Risk of over dosage should always be borne in mind. As far as possible the patient should be allowed to talk freely and the doctor can assist in sorting out any problems in the family. Encouragement and reasssurance form essential part of treatment. ECT is safe in the elderly and is preferred in some cases.

Mania

It is a relatively less common mental illness. Often the patient is brought to the hospital owing to the sudden and dramatic nature of the illness. The patient is usually excited, appears unduly happy, is over-talkative and may harbour grandiose ideas. History often reveals over activity, excessive spending and lack of judgement in social and personal matters. Testing ..for memory defects and examination for any cause of toxicity is undertaken. When these are not present the patient may be sedated and referred to the referral centre for further inpatient management.

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