TITLE PAGE GERIATRIC PSYCHIATRIC SYNDROMES IN ELDERLY PATIENTS IN A HOMOEOPATHIC HOSPITAL Dr. Tapeshwar Kumar Yadav 1 & Dr. D Basu 2 1 PGT 2 Professor Department of Practice of Medicine National Institute of Homoeopathy, Kolkata, India 1
TEXT PAGES TOTALLING FIVE GERIATRIC PSYCHIATRIC SYNDROMES IN ELDERLY PATIENTS IN A HOMOEOPATHIC HOSPITAL ABSTRACT: A survey work done on 34 patients aged 65 years or above showed the occurrence of one or more of the seven different types (in various combinations) of geriatric psychiatric syndromes (as listed by American Psychiatric Association) in as many as 27 patients. The frequency of occurrence of each type alone or in various combinations was analysed. The study attempted to provide physicians with a realistic assessment of the psychiatric problems to be given importance during interaction with patients of geriatric age group who come for homoeopathic treatment for any type of medical problem. This awareness of the possible mental problems would improve the thoroughness of the case taking in clinical practice. KEYWORDS: Geriatrics, Geriatric psychiatric syndromes, Case taking, Elderly INTRODUCTION: Homoeopaths give more importance to the mind than physicians of other systems of medicine. It is also claimed that the response of mental disorder through homoeopathy is extremely good. As geriatric medicine has developed worldwide, there has been development of the super-speciality called geriatric psychiatry. This superspecialist approach is not applicable to homoeopathy. The homoeopathic physician will treat the patients including geriatric patients as a whole and take into consideration all the mental aspects of the patients. Worldwide both in geriatrics and in psychiatry of modern medicine, there is an increasing recognition that there is a definite pattern of psychiatric problems in the geriatric population. There are seven psychiatric syndromes that are most prevalent among older individuals and can be referred to as Geriatric Psychiatric Syndromes. (1) Anxiety Depression Memory loss Suspiciousness Insomnia Acute Confusion Hypochondriasis 2
It is quite obvious that all patients will not have all problems and that various combinations are expected. So a survey was carried out on geriatric patients under homoeopathic care to find out how frequent are such psychiatric syndromes, and the various combinations thereof, in that segment of geriatric population who are coming for homoeopathic management for their various physical complaints. The information has more than just epidemiological or statistical utility. It will help the homoeopathic physicians to understand what type of psychiatric problems are occurring in the geriatric population and which types of problems the physician should try to identify during interaction with the patient. Since the patient may not always himself or herself mention the problem, it is the duty of the physician to detect the presence of such psychiatric problems, if actually any such problem exists in the patients. METHOD AND MATERIALS: The survey was done on 34 patients (M-19, F-15) aged 65 years or above, admitted in IPD(n=12) and OPD(n=22) at National Institute of Homoeopathy over a time period of three months. The patients came to hospital for various medical complaints and their mental problem(s) became evident during the process of homoeopathic case taking. This information on their psychiatric problem was tabulated, analysed and presented in mathematical form. RESULTS: The data obtained on the 34 patients is shown in Table 1. It indicates which of the seven problems was present or was not present in each of the patients. The Table also shows how many of the seven problems were present in each individual case. It was observed that 27 patients out of 34(79 %) had one or more of the problems (male 17/19 i.e. 89%, female 10/15 i.e. 67%). Table 2 shows how many types of problems occurred in each of the 27 patients. Table 3A shows the frequency of occurrence of each of the seven problems. It is found that Insomnia was the most frequent (17cases) followed by Anxiety and Memory loss (each 11 cases). Depression was seen in 10 cases and Suspiciousness in 03 cases. Confusion and Hypochondriasis were least frequent (only one case each). In Table 3B, the various combinations of two problems, three problems and four problems are shown along with frequency of occurrence. It is noted that there were 2 cases each with four problems, and both of them had both Insomnia and Depression; but their other two problems were Anxiety and Memory loss in one patient, and Suspiciousness and Confusion in the other patient. All this suggests wide variability in the clinical presentation. 3
Patient Serial No Age/ Sex Insomnia Anxiety Memory loss Depression Suspiciousness Hypochondri asis Confusion How many Yes Table 1 1. 65/M Yes Yes No Yes No No No 3 2. 68/M Yes No No No No No No 1 3. 65/M No Yes Yes No No No No 2 4. 70/F Yes No No No Yes No No 2 5. 65/M Yes Yes Yes Yes No No No 4 6. 72/F No No No No No No No 0 7. 70/F No No No Yes No No No 1 8. 66/M Yes Yes Yes No No No No 3 9. 74/F Yes Yes No No No No No 2 10. 67/M No No No Yes No No No 1 11. 65/M Yes No Yes No No No No 2 12. 67/F No No No No No No No 0 13. 75/M No No No No No No No 0 14. 72/M Yes No No No No No No 1 15 66/F Yes No No Yes No No No 2 16 65/F No No No No No No No 0 17 72/F Yes Yes Yes No No No No 3 18 68/M Yes No No No No No No 1 19 69/M Yes No No Yes No No No 2 20 68/F No No No No No No No 0 21 68/M No No No Yes No No No 1 22 65/M Yes No Yes No No No No 2 23 68/M No Yes No No No No No 1 24 70/M No Yes Yes Yes No No No 3 25 76/M Yes No No Yes Yes No Yes 4 26 70/F No No Yes No No No No 1 27 66/M No No No No No No No 0 28 65/F Yes No No No No No No 1 29 73/M Yes Yes Yes No No No No 3 30 68/F No Yes No Yes No No No 2 31 66/F No No No No No No No 0 32 70/F Yes No Yes No Yes No No 3 33 74/F No Yes Yes No No No No 1 4
34 65/M No No No No No Yes No 1 Total Patients 34 (M19,F15) With GPS 27 (M17, F10) Without GPS (M02,F05) Table 2 Variety of Number of Patients problems Total Male Female Four 2 2 0 Three 6 4 2 Two 9 4 5 One 10 7 3 Table 3 A Syndrome Number of Cases Total Male Female Insomnia(I) 17 11 6 Anxiety(A) 11 7 4 Memory loss(m) 11 7 4 Depression(D) 10 7 2 Suspiciousness(S) 3 1 2 Hypochondriasis(H) 1 1 0 Confusion(C) 1 1 0 Table 3 B Different Combinations A+M I+S I+A I+A+D I+A+M I+A+D+M No. of Patients 2 1 1 1 3 1 Different Combinations I+M I+D A+D I+M+S A+M+D I+D+S+C No. of Patients 2 2 1 1 1 1 DISCUSSION: Physicians are well aware of the manifestations of the seven geriatric psychiatric syndromes and it is not necessary to describe them again. Some relevant rubrics taken from Kent are mentioned that may be useful in such situations. (2) Homoeopathic prescription must however be based on the homoeopathic principles with a holistic approach and considering the totality. ANXIETY SADNESS, mental depression SUICIDAL disposition MEMORY, weakness of, labor, for mental (compare stupefaction) labor, for mental ( compare stupefaction letters, for the names of the names, for proper occurrences of the persons, for places, for SUSPICIOUS 5
Talking about her, that people are DELUSION, persecuted, that he That he was about to be medicine being SLEEPLESSNESS night, first part of : after 11 p.m. until 1 a.m. midnight, before CONFUSION of mind ( See Concentration) ANXIETY o health, about, o hypochondriacal The rubrics mentioned are merely illustrative and are not exhaustive; physicians will themselves understand which rubrics or sub-rubrics to use for individual patients. It is expected that every homoeopathic physician will follow the accepted homoeopathic principles of case taking and prescriptions and that patients will have very good response to such medicines. WHO issued a Consensus Statement On Psychiatry Of The Elderly in 1996 which highlights its importance (3) Geriatric psychiatric problems are very important in Western society, but they were thought to be less important in our patients because of different social environment and family relationships. (4) Recent indications are that psychiatric problems in the elderly in Indian population are important. (5) This study has attempted to provide a realistic assessment of the geriatric psychiatric syndromes mentioned in western textbooks of psychiatry. (1) This survey indicates that some of these problems do occur even in our patients. From this small survey sample it is not possible to understand the situation in the community as a whole. But there is sufficient indication that the problem exists and needs the attention of physicians who treat patients of geriatric age group for any type of medical problem. The list of seven problems will be helpful to physicians so that they may give special attention in geriatric case taking, even when the patient has not told anything specifically of such nature. This will improve the thoroughness of the case taking in clinical practice. REFERENCES 1. Dan Blazer, Geriatric Psychiatry. In: The American Psychiatric Press Textbook of Psychiatry [Robert E. Hales et al] Vol-2. 3 rd ed: (Ind ed) Jaypee Brothers 2001. Pg 1447-59 2. Kent JT. Repertory of The Homeopathic Materia Medica, Indian edn [6 th American edn] :Allied Med Publ, Kolkata: 2010. Pg 8,53,65,76,85, 1253 3. Consensus statement regarding Psychiatry of Elderly, WHO 1996. 6
4. Goodwin J:Common psychiatric disorders in elderly persons. West Journal of Medicine :1983. Pg 502-7 5.Pilani M et al. Elderly depression in India. From internet: http//dx.doi.org/amj2013 7