Gerontopsychiatry
The Geriatric Psychiatry (from Greek. Γέρων , Geron , "the old man" and ψυχιατρική , psychiatrike , "the soul medicine") is a field of psychiatry.
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The German Society for Geriatric Psychiatry and psychotherapy (DGGPP) defines the geriatric psychiatry as a separate part of the field of psychiatry, said she was not to be construed as a simple extrapolation of the "adult" psychiatry, but rather with reference to the results of research of gerontology and of Geriatrics developed their own preventive, diagnostic, therapeutic and rehabilitative strategies.
Gerontopsychiatry deals with older people and their mental illnesses, ie with people over the age of 60. Sometimes the line is drawn at the age of 55. Gerontopsychiatry deals in particular with mental illnesses that typically only appear in this later phase of life, such as dementia .
Large psychiatric institutions usually have special departments for geriatric psychiatry.
Gerontopsychiatry can also be understood as a sub-area of geriatric medicine, geriatrics or, furthermore, gerontology . Gerontopsychiatry has relationships with gerontology, geriatrics and neurology, among others . In Germany, specialists in psychiatry and psychotherapy who specialize in geriatric psychiatry can acquire an optional additional title in “clinical geriatrics”.
development
The term geriatric psychiatry only developed after the Second World War . However, CF Canstatt published the first coherent descriptions “Diseases of old age and their healing” as early as 1839. In 1975 the psychiatry enquête , which was carried out by an expert commission on behalf of the Bundestag, and in 1988 an expert recommendation , defined geriatric psychiatry as "the science of pathology, diagnosis , therapy and prevention of mental illnesses of old and old". It is assumed that since there is no biologically definable age limit, all areas of aging research are linked to a variable retirement limit. Due to the demographic development, this subject area is becoming increasingly important, as mental illnesses in old age must also be given greater economic consideration.
Main clinical pictures of geriatric psychiatry
dementia
Dementia is derived from the Latin mens (understanding) and de (decreasing) and describes a state of progressive brain degradation. The term dementia is generally defined as the loss of acquired skills due to organic brain diseases. The impairments include knowledge and thinking, but also the ability to judge and adapt to new situations. Thus, the cognitive functions are at the center of the psychopathological findings . In the past, the term dementia encompassed all irreversible processes with increasing intellectual impairment.
According to ICD-10 , four main criteria are used as evidence for the diagnosis. Criterion A1 describes the decrease in amnestic and criterion A2 the decrease in other cognitive performance. The impairment of everyday skills is used as a limit value in the diagnosis. An intact perception of the environment distinguishes dementia from delirium (criterion B). To prove dementia, the presence of at least one non-cognitive disorder in the areas of drive, affect and social behavior is required (criterion C). For a reliable clinical diagnosis, the symptoms described should be present for at least 6 months (criterion D). As a rule, the diagnosis is divided into 3 degrees of severity, mild, moderate and severe impairments. Dementia is the most common cause of the need for long-term care in old age, the most common forms being Alzheimer's disease and vascular dementia. Dementia increases sharply with increasing age: from less than 2% at 65 years of age to more than 35%, when including mild dementias up to 60% at over 90 years of age. The prevalence of vascular dementia appears to have a smaller age increase compared to the prevalence of Alzheimer's dementia and to be relatively lower in women.
A distinction is made between degenerative, primary dementias (caused by brain damage) and potentially recoverable, secondary dementias. The degenerative, primary dementias include Alzheimer's dementia (AD) or dementia of the Alzheimer's type (DAT) and vascular dementia (VD). The potentially correctable, secondary dementias are secondary dementias of other diseases, the causes of reversible (reversible, curable) dementias are, according to Beyreuther (2002), in decreasing frequency. According to the Berlin Aging Study (1996), dementia is the second most common mental illness in old age after depression.
Around one million people in Germany suffer from dementia, around 20,000 from pre-existing dementia in Alzheimer's disease with early onset (between 40 and 64). Around two thirds develop Alzheimer's disease with late onset, 15 to 20% from vascular dementia and 10 to 20% from mixed forms: women predominate with Alzheimer's disease, men with vascular dementia. The duration of Alzheimer's disease is five to seven years for 65 to 80 year-olds and three to four years for over 80-year-olds; Patients with vascular dementia have a shorter survival time or life expectancy. The treatability of dementia depends on the underlying cause, so dementias due to circulatory disorders in the brain (vascular dementia) can be treated with medication. In most cases, however, the therapy only has a suspensive effect.
Delirium
In German-language literature, the term state of confusion is often used synonymously with delirium . According to the ICD-10 , the term delirium describes all acute psychological disorders that have an organic cause or are caused by exogenous substances, such as B. medication or alcohol, and are associated with a cognitive disorder and a clouding of consciousness. The duration of a delirium is generally given as less than 14 days, but can also be up to a year. Delirium occurs in all age groups, but is more common in elderly patients. They can occur postoperatively or as part of internal treatment. In the diagnosis (according to ICD-10) delirium is differentiated with the help of essential and facultative criteria; the duration is also decisive here. Delirium can develop acutely, subacutely, or fluctuatingly. Five different groups of psychopathological symptoms are required according to ICD-10, whereby the limitation of cognitive abilities, especially attention, is decisive.
The frequency of delirium is strongly dependent on the definition used and on the sample and can vary widely, in those over 65 from 0.8% to 16%. There is no specific therapy for delirium; if possible, the cause must first be determined in order to be able to treat the underlying somatic diseases, followed by symptomatic treatment of the delirious symptoms.
depression
In old age, depressive syndromes belong to the most common psychiatric illnesses after dementia syndromes. The term depression comes from the Latin depressio and means "depressing", usually referred to in medicine as a depressive episode. Depression is a psychological disorder characterized by the main symptoms of depressed mood, inhibited drive, lack of interest and joyless as well as impaired self-esteem. In addition to the main symptoms already mentioned, many sufferers suffer from feelings of inferiority, helplessness and hopelessness, feelings of guilt, fatigue, reduced ability to concentrate and make decisions , senseless thought circles, slower thinking, irritability, anxiety, reduced emotional life, and even the inability to show an emotional reaction and reduced sexual interest . Often there is complete demotivation in acute depression. Those affected become passive and in some cases are unable to perform the simplest activities such as shopping and washing up. Getting up in the morning can cause problems. Negative thoughts and impressions are often overestimated and positive aspects are not perceived or considered accidental. Depression often manifests itself in physical symptoms (vital disorders) such as loss of appetite, sleep disorders, weight loss, weight gain, tension, pain sensations throughout the body, headaches and slowed movements. An increased susceptibility to infection can also be observed. The sleep disorders usually manifest themselves in great daytime sleepiness, difficulty sleeping through the night and falling asleep, as well as waking up and staying awake early in the morning with circular thinking. Depending on the severity of the depression, it can be associated with latent or acute suicidality. It is assumed that the majority of the approximately 12,000 suicides in Germany each year can be traced back to depression.
Addictions
Since the turn of the millennium, there has been a significant increase in addictions among older people. In addition to alcohol and the often neglected tobacco consumption, drugs play a special role. However, addiction problems in old age are often not or incorrectly diagnosed. Of the 60 to 64 year olds, 1.2% take sleeping pills every day and 1.5% take sedatives every day. Many of these drugs are highly addictive. A survey of nurses in inpatient and outpatient facilities showed that they accept alcohol and / or medication problems in 14% of geriatric patients requiring care. A quarter of men over 60 drink so much alcohol that the risk of other diseases is significantly increased. Contrary to the demographic development, however, people over 60 are clearly underrepresented in both outpatient and inpatient addiction support facilities ; only 4.5% of the users of addiction counseling centers and 5% of the patients of addiction clinics have passed the age of 60, compared with a proportion of the population of over 27%). There are special offers for the treatment of addiction disorders in old age, but further special concepts for this age group have yet to be developed or tested.
further reading
- Hans Förstl (Ed.): Textbook Gerontopsychiatrie. Thieme, Stuttgart 2002.
Individual evidence
- ↑ Press release on the KOALA therapy study. LVR Clinic Essen. Retrieved June 21, 2017
- ↑ a b Symposium “Addiction in Old Age” on March 5, 2015, XII. Congress of the German Society for Gerontopsychiatry and Psychotherapy eV on dggpp.de. Retrieved June 21, 2017
- ↑ Addiction problems in old age . German headquarters for addiction issues 2014 (page 6). Retrieved June 21, 2017 (PDF file).
- ↑ Addiction and Age. Alcoholism often goes undetected . Kölnische Rundschau , March 4, 2009.
- ↑ Addiction problems in old age . German headquarters for addiction issues 2014 (page 32). Retrieved June 21, 2017 (PDF file).