ABSTRACT
This chapter covers the common mental disorders of old age - the dementing illnesses, depression, anxiety and paranoid states. The general practitioner's role in assessing a patient for emergency admission to hospital under the Mental Health Act is much the same whatever the patient's age. Dementia is a clinical syndrome, diagnosed on clinical findings. Visual hallucinations can occur in Alzheimer's disease, and are common in the dementia of Parkinson's disease. Depression is hard to detect in dementia. The best test may be by trial of carefully monitored antidepressant medication. The classical somatic symptoms of depressive illness are found in physical illness in old age, so they may not point so directly to the diagnosis as do the psychological signs of depression, and alterations in behaviour and speech. Hypomania and mania are certainly seen in older people, but generally only in people with recognized manic-depressive disorder over the course of their lives. Rarely, a physical illness or medication can precipitate hypomania.
