When mental health is at issue

By Michael Gordon
Vice-President, Medical Services

"I think I need a different sleeping pill," said the 74-year-old retired history professor. I asked if that was why his family physician had referred him to my geriatric medicine clinic.

"The one I've been using for the past six months is not working, so I guess so," he replied.

The letter from the referring family physician expressed concerns about possible depression, but also mentioned sleep as a major issue. In fact, two different sleeping medications had been tried, each working for a short time, but the family doctor was concerned something else might be going on.

The patient was reluctant to see a psychiatrist, the first recommendation. As he told his doctor, "I don't think I need a shrink, just a good night's sleep."

Because he had some other medical problems, such as high blood pressure and arthritis of the spine, he agreed to see a geriatrician even though he did not think of himself as "old".

The next patient, an 84-year-old woman, was unsure about why she was in the office. She came with her daughter but felt that the visit was a "waste of time." She had been noticing that she was a bit forgetful lately but attributed this to her age.

She was living alone in a senior's apartment and managed to do almost everything by herself with a little help from her daughter and grandson. She had always been a good bridge player and said she could still "hold her own" with her long-time partners.

I asked if they had noticed anything about her memory. She said, "Well, no one has told me yet and I still play."

Another patient was brought to see me from a retirement home by her son and daughter. She had been diagnosed with Alzheimer's disease two years previously. She had managed reasonably well for about a year but lately had become agitated to the point that the home suggested moving her to a nursing home.

The two children were concerned because they liked the home, as did their mother. They felt the move would be too disruptive and too restrictive for their mother who, on good days, was still very sociable and loved to interact with the staff and attend recreational programs.

To my surprise, no one had ever suggested medication for her Alzheimer's disease.

Many people have an aversion to the idea of mental disease. Some continue to claim that, "they are not crazy" if referred to a psychiatrist. Even some physicians feel unsure when dealing with mental disorders and seek out the opinions of specialists.

The range of mental health disorders includes those that effect mood, such as depression; sense of reality, such as delusions or hallucinations; or cognitive or intellectual function, such as Alzheimer's disease and other dementias. Sometimes more than one condition may co-exist.

The primary method of diagnosis for mental health problems is from talking, or as physicians say, "taking a history".

Tests may be ordered, but these are used primarily to make sure that there are no other causes for the symptoms or conditions. For example, many medications may aggravate depressive symptoms or effect cognitive function. These include sedatives and sleeping pills as well as drugs that work on other vital organs but have an effect on the brain.

Some drugs used to control high blood pressure, digestion or heart function may cause mental function to decline. Medical conditions such as under-active thyroid or a deficiency of some essential nutrients, such as Vitamin B12, have caused conditions that may resemble dementia.

"Aging" Column (12-21-2001)
Reprinted with permission from the Toronto Star