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Arch Hellen Med, 37(6), November-December 2020, 821-830


The psychogeriatric patient in the primary health care setting

V. Peritogiannis,1 C. Lixouriotis2
1Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina,
2Health Center of Distomo, General Hospital of Livadia, Distomo, Greece

Use of primary health care facilities may be the only opportunity for elderly patients to receive assessment and treatment for a mental disorder. Depression in the elderly may have a less typical presentation, such as prominent physical symptoms, or cognitive disturbances, that may impede diagnosis. Older adults may present with psychotic symptoms, mostly in the context of a psychogeriatric syndrome, such as dementia, or as part of a general medical condition. Differential diagnosis may require detailed clinical and laboratory investigation. Several forms of dementia, mostly Alzheimer's type and vascular dementia are encountered in the elderly. Symptoms of dementia should be differentiated from those of depression and mild cognitive disorder. The main clinical characteristics of delirium are its acute onset and disturbance of consciousness and attention. Treatment of the underlying condition may resolve the symptoms. Psychiatric drug treatment in the elderly is generally safe, but careful monitoring of the patients is necessary. Second generation antipsychotics are preferred for the treatment of psychotic symptoms in the elderly patient, while sedative and anticholinergic medications and benzodiazepines should be avoided. In Greece, a large proportion of older adults present depressive symptomatology. Primary care physicians in this country, with appropriate training, are able to diagnose several mental disorders in the elderly. In rural areas, co-operation of the primary care staff with the mobile mental health units can contribute significantly to the diagnosis and effective treatment of psychogeriatric syndromes.

Key words: Delirium, Dementia, Depression, Primary health care, Psychogeriatric syndromes, Psychotic symptoms.

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