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The Chief Physical Complaints

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On-Call Geriatric Psychiatry

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Abstract

This chapter focuses on the approach to medical symptoms that commonly occur among geriatric patients on inpatient psychiatric units and provides general guidance for psychiatrists who will be called first to assess the patient and initiate medical management. This chapter is not intended to be a comprehensive review of medical diagnosis and treatment, and for this, the reader is encouraged to consult a textbook of medicine or geriatrics, or to utilize an accessible online reference, such as UpToDate® (www.uptodate.com). The amount of work-up and management of medical complaints on a psychiatric unit should be tailored to the psychiatrist’s level of comfort in this role, as well as the skills and comfort of staff to carry out needed monitoring and treatment. The on-call psychiatrist may be faced with atypical presentation of illness, as well as inadequate or misleading history from the patient. Suggested approaches to selected geriatric and general medical conditions are provided.

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Notes

  1. 1.

    Conditions with acute onset can be divided into two types: those precipitated by a new intervention (e.g., medication or surgery) or those representing a potential medical emergency.

  2. 2.

    The history of exposure and the patient’s symptoms suggest transmission of a viral gastroenteritis, possibly complicated by lithium toxicity. Thus, serum lithium level and “watchful waiting” would be justified, provided the patient can receive adequate fluids by mouth or parenterally.

  3. 3.

    Olanzapine’s anticholinergic activity, in the setting of probable prostatic hypertrophy in this 77-year-old man, contributed to urinary retention.

  4. 4.

    Worsened parkinsonism should alert the examiner to associated dysphagia and the risk of aspiration.

  5. 5.

    Because of self-neglect, the patient may not have taken his aspirin or clopidogrel, resulting in stent occlusion and acute coronary ischemia or heart failure, manifested atypically by acute exhaustion without chest pain or shortness of breath.

  6. 6.

    The H2 blockers, ranitidine and cimetidine, should be avoided because of their anticholinergic properties. Famotidine is safer. Proton pump inhibitors may take up to 24 h to provide symptomatic relief. Magnesium-containing liquid antacids should be avoided in patients with stage IV and V chronic kidney disease.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of General Medicine, University of California Davis Medical Center, Sacramento, CA, USA

    Calvin H. Hirsch MD

  2. Division of Geriatric Internal Medicine, McMaster University, Hamilton, ON, Canada

    Tricia Woo MD

Authors
  1. Calvin H. Hirsch MD
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  2. Tricia Woo MD
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Corresponding author

Correspondence to Calvin H. Hirsch MD .

Editor information

Editors and Affiliations

  1. Dept. of Psychiatry & Behavioural Neuros, McMaster University, Hamilton, Ontario, Canada

    Ana Hategan

  2. Dept. of Psychiatry/Langley Porter Psych, University of California San Francisco, San Francisco, New York, USA

    James A. Bourgeois

  3. Dept.of Internal Med.,Div of General Med, University of California Davis, Sacramento, California, USA

    Calvin H. Hirsch

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Hirsch, C.H., Woo, T. (2016). The Chief Physical Complaints. In: Hategan, A., Bourgeois, J., Hirsch, C. (eds) On-Call Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-30346-8_11

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  • DOI: https://doi.org/10.1007/978-3-319-30346-8_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30344-4

  • Online ISBN: 978-3-319-30346-8

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