Medical Assessment

Abstract

Although the association between specific mental disorders and physical disorders is discussed in the relevant chapters of Part II, this chapter presents a brief overview of the comprehensive medical assessment that every older adult presenting with a mental problem should receive. Such an assessment often plays an important role in the diagnostic process and treatment planning of late-life mental disorders because of the complex interaction between psychological and physical problems in the elderly (Cohen-Cole & Stoudemire, 1987). As in younger persons, initial manifestations of a medical problem may be predominantly “psychological” (e. g., hypothyroidism with complaints of fatigue and low motivation). A known or unknown underlying medical disorder may directly produce an organic mental syndrome (e. g., a dementia due to vitamin B₁₂ deficiency). The psychological and physiological stress associated with a significant medical illness (e. g., a myocardial infarction) or surgical procedure (e. g., coronary artery bypass) can trigger onset of a nonorganic mental disorder (e. g., a major depressive disorder). Finally, the comorbid occurrence of physical and mental problems (in particular depression) has been associated with increased somatization, as if mental disorders amplify the experience of discomfort that arises from physical illnesses (Mulsant et al., 1994; Waxman, McCreary, Weinrit, & Carner, 1985). For these reasons, older adults presenting with psychological distress or with a psychiatric problem (in particular of late onset) deserve a thorough medical assessment.