Abstract
Although the psychiatric disorders of the elderly have some special features, they do not significantly differ from younger adults. However, the elderly have unique features that may confound the diagnosis. Primary depressive disorder has been divided into early-onset depression (EOD) and late-onset depression (LOD). A family history of depression is more likely with EOD, and LOD is closely linked to clinical and neuroimaging evidence of cerebrovascular disease, and hence the term ‘vascular depression’ is used to describe LOD. A number of neurotransmitters have important roles – serotonin, dopamine, norepinephrine and glutamate. Dysregulation of neurotransmission and hypothalamus-pituitary-adrenal axis together with immunological and morphological alterations has been postulated in major depression. Late-onset mania is a heterogeneous group of neurological disorder, and there is a strong resemblance of mania to disinhibition syndrome. Newly onset anxiety of the elderly with exception of phobia is usually combined with physical disorder, depression, cognitive dysfunction or personality disorder. Suicidal rate increases progressively with age. Suicidal behaviour is associated with serotonin neurotransmitter system, hyperactivity of the hypothalamus-pituitary-adrenal axis and noradrenergic neurotransmission. Substance abuse in the elderly includes alcohol and, to a lesser degree, illicit substances, prescription medicines and over-the-counter medications. In the elderly the pattern of alcohol consumption may not change, yet age-related changes may increase the likelihood of adverse reactions to alcohol.
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Appendices
Multiple Choice Questions
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1.
The following are true with depression in the elderly, EXCEPT:
-
A.
Late-onset depression (LOD) is due to age-associated neurobiological changes, stressful events, a higher interaction with cognitive decline and impaired effect of genes.
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B.
A family history of depression is more likely with early-onset depression (EOD) than late-onset depression.
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C.
Late-onset depression is closely linked to clinical and neuroimaging evidence of cerebrovascular disease.
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D.
Structural imaging changes vary considerably between LOD and EOD with more severe vascular pathology associated with EOD compared to LOD.
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A.
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2.
The following statements are true with mania in late life, EXCEPT:
-
A.
After many years of depression, many are converted to bipolarity and suffer from mania in late life.
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B.
Late-onset mania is closely associated with medical disorders, most commonly stroke, dementia or hypothyroidism and also the use of medications.
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C.
Secondary manias are used to describe late-onset mania associated with medical and pharmacological states.
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D.
There is no supporting clinical and neuroimaging evidence of cerebrovascular disease that link it with ‘late-onset’ depression.
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A.
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3.
The following are true in relation to major depression, EXCEPT:
-
A.
Serotonergic activity is reduced in depression.
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B.
There is overproduction of glutamate.
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C.
Dopamine circuits do not have any role in depression.
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D.
Noradrenergic containing circuits are involved in the aetiology of mood disorders.
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A.
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4.
The following are true in the metabolism of alcohol in the elderly, EXCEPT:
-
A.
Age-related changes may increase the likelihood of adverse reactions with alcohol consumption.
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B.
Gastric ADH is decreased with ageing so much so the amount of alcohol metabolised in the stomach is reduced resulting in an increase in the load to the liver.
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C.
The liver however will not be able to metabolise the extra alcohol and the blood levels of alcohol will rise.
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D.
Alcohol is distributed only in the body fat.
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A.
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5.
The following that are associated with suicidal behaviour in the elderly are true, EXCEPT:
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A.
There is hyperactivity of the hypothalamic-pituitary-adrenal axis.
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B.
Suicide is generally associated with major depression and is a major problem in the elderly especially elderly females.
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C.
Factors such as bereavement, serious illness, isolation, retirement and organic brain disease contribute to suicide in older people.
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D.
There is dysregulation of the serotonergic system.
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A.
Answers to MCQs
1 = D; 2 = D; 3 = C, 4 = D; 5 = B.
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Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2016). Psychiatry of Older Adults. In: Diseases in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-25787-7_15
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