Note when using drugs to treat mental disorders in the elderly

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Mental disorders are more common in the elderly than in the young. The symptoms of psychosis in the elderly can be experienced in many ways. There are now a variety of treatment strategies, both pharmacological and non-pharmacological, for diseases such as schizophrenia and neurodegenerative disorders in this age group.

1. Causes of mental disorders in the elderly

Psychosis is defined as an impairment in the ability to experience reality, causing cognitive and behavioral disturbances and usually manifesting as delusions (abnormal thoughts) or hallucinations (sense abnormalities) ). In clinical practice, the word 'mental disorder' is often used to describe a severe mental illness in which delusions and hallucinations are prominent.
Acute onset is commonly seen in delirium secondary to medical conditions, drug abuse, and drug-induced psychosis. Chronic and persistent psychotic symptoms may be due to primary psychosis (chronic schizophrenia, late-onset schizophrenia, delusional disorder, mood disturbance) and psychosis neurodegenerative disorders (dementia, Parkinson's disease) and chronic medical conditions. It is important to recognize the symptoms of a mental disorder and get treatment promptly, as they can lead to aggressive and disruptive behavior. It is also often the cause of caregiver fatigue. Persistent symptoms reduce quality of life, leading to hospitalization. In some cases, older adults can be abandoned and abused when they are unable to control their behavior.
Schizophrenia: Elderly people with schizophrenia are divided into two main groups, those who develop the disease in old age and those who have it since childhood. Late-onset can be divided into those with the disease after the age of 40 and those after the age of 60 (very late-onset schizophrenia). There are certain similarities between early- and late-onset schizophrenia, notably that both carry a genetic risk, manifesting with subtle alterations in the brain as detected by imaging studies. CT scan, the patient has hallucinations and delusions. Late-onset schizophrenia differs from early-onset in that patients have a better response to medication and they have better overall cognitive function. Dementia: The prevalence of psychosis in people with dementia ranges from 30-50% in Alzheimer's and vascular dementia. Lewy body dementia and Parkinson's disease dementia are thought to be disorders requiring careful management because they are complex, more sensitive to antipsychotic drugs than others, and present with behavioral difficulties. Because. Other causes of psychotic disorders in the elderly: Delirium manifests with hallucinations and delusions, in 30-40% of cases due to drugs, pre-existing medical conditions or poor body hydration. Delusions and hallucinations are also seen in patients with alcohol abuse, mood disorders (depression or bipolar disorder) and personality disorders in the elderly.

2. Problems encountered when taking drugs to treat mental disorders in the elderly

Psychoactive drugs are substances that affect behavior, feelings, thoughts, or cognition, there are 5 main groups of drugs, including: anxiolytics, antidepressants, antipsychotics, mood regulators, stimulate. The purpose of prescribing psychoactive drugs: treatment of anxiety, depression, schizophrenia, bipolar affective disorder, sleep disorders and many other mental disorders by the mechanism of action on the neurotransmitters to improve disease symptoms.
Older adults have a different drug response than younger people and have increased sensitivity to drugs in general and antipsychotics in particular. Age-related physical changes affect the pharmacokinetics and pharmacodynamics of antipsychotics, with adverse effects that may be more persistent and even disabling in the elderly. For the elderly, the elimination of the entire drug from the body takes longer, especially for those with poor liver and kidney function. Besides, the elderly often have to treat many comorbidities. having to take multiple drugs at the same time, increasing the risk of drug interactions, possibly causing increased toxicity or side effects of drugs. Elderly people have poor memory, so it is easy to forget drugs, mistaken drugs, with unwanted effects such as drowsiness, confusion, dizziness, which can easily cause falls in the elderly.

3. Attention when using drugs to treat mental disorders in the elderly

A few important notes when using drugs to treat mental disorders in the elderly:
Apply non-pharmacological treatment interventions: Change behavior, adjust the environment (eg, noise, heat) interruptions), group therapy, psychotherapy, and recreational activities (eg, music therapy, gardening), may be helpful in reducing or eliminating the need for intervention of pharmacology. Accurate medical assessment: This should be done carefully because psychological symptoms in geriatric patients can be caused or exacerbated by other medical conditions. This will help eliminate the mistake that the symptoms are solely caused by mental illnesses and that psychotropic treatment should be initiated. Proper identification of the underlying causes of dementia-related psychosis and agitation helps physicians to aggressively treat the causes with the most appropriate pharmacological and non-pharmacological interventions. Drug treatment according to the principle of “start low, slow, and monitor often”: In the elderly, the initial dose should be based on the dosing guidelines for the elderly with gradual titration and close monitoring. frequent. Ongoing evaluation for appropriate adjustment of psychotropic drug therapy is essential. The physician will need to observe to detect the patient's response to the indicated therapy. This requires the observation support of the patient and the patient's family. Patients and family members need to inform the doctor about all the diseases they have and the medicines they are taking, including non-prescription drugs, traditional medicines, dietary supplements, etc. Should keep the medicine box for the doctor. The doctor knows exactly what medication the patient is taking. During the course of treatment, if you encounter any problems or unusual symptoms, you should immediately notify the treating doctor, do not change the drug, stop the drug or change the dosage of the drug on your own.

In summary, drugs for the treatment of mental disorders are widely and successfully used. Drugs remain the mainstay of treatment for schizophrenia and related psychiatric disorders in the elderly. However, it is not the only option for psychotic symptoms, in some cases non-pharmacological treatment can be used. For optimal care for seniors with mental disorders, a holistic, multifaceted approach should be taken in the search for safer and more effective medications.
Currently, Vinmec Times City International General Hospital has a Development Psychology Clinic with the functions of examining, consulting and outpatient treatment of psychological and mental health problems by implementing psychological tests. , specialized psychotherapy for medical examination and treatment. In addition to the problem of using drugs, the application of these treatment methods is considered to be highly effective, helping to improve the patient's condition in the best way.
Hospital visits are always performed by a team of experts, doctors with many years of experience. Along with good medical quality, the hospital always invests in modern facilities, leading in the current medical field.

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