ABSTRACT
Christina Stannard is an 81-year-old unmarried woman who has lived in residential care for several years. She has no known contact with psychiatric services. There is a wide differential diagnosis. Almost any biological, psychological or social stressor can precipitate a behavioural change in the older person and therefore a broad-based questioning approach is necessary. It is possible that she has developed a single delusional system over time that would account for her symptoms. There may not be any other Schneiderian first-rank symptoms. Edith Jenkins, a 76-year-old widow, is an inpatient with a diagnosis of depression. She appears to be deteriorating as her appetite is worsening. The mortality risk associated with the use of general anaesthetic is low and it should be considered less of a risk than allowing her depression to deteriorate further. There has been a three-month decline and it is important to distinguish whether the decline has been progressive or stepwise.
