Depressive disorders have the highest rate of suicide and are the most common psychiatric disorder in older adults. Suicidal behavior is common in elderly patients with depressive disorders, with 55% of elderly patients reported to commit suicide in a depressed state. Suicide often occurs in the presence of physical illness and has a high success rate, making depressive disorders the “invisible killer” of the elderly. However, the clinical manifestations of depression in old age are different from those of young people, and the depression is not typical, but more often manifested by various physical discomforts, which is special and hidden, and not easy to be detected by relatives, not to mention going to a specialist hospital and getting timely treatment. So how to identify and prevent depressive disorder in old age?
A. Clinical manifestations of depressive disorders in old age and common reasons for neglect, underdiagnosis and misdiagnosis
Depressive disorder in old age is a mixed state of anxiety and depression, accompanied by more somatic complaints and autonomic nervous system symptoms, and many combined physical diseases, so the clinical manifestations are more complex.
1.Emotional symptoms
The patient often blames himself and others, such as blaming himself for not doing his duty to his children, blaming himself for not making achievements in his work, blaming his family for not caring about him, etc., and generating dissatisfaction with others. Therefore, family members often think that there is a “thought problem”, and will not think that he is sick, will not mobilize him to go to the hospital to see a doctor, but send someone to do his “thought work”, persuade him to think about it, do not think nonsense.
Some elderly people are also disturbed, fidgety, prone to temper tantrums over trivial matters, looking at everything, mostly regarded as “cautious”, “can not think”, children are afraid to avoid, and the result worsens the patient’s mood.
A few patients are emotionally unresponsive and even laugh bitterly when they talk about their bad moods and thoughts of death, and their pain is not obvious. Not only do they themselves not realize that they have a disease, but also their family members do not observe anything unusual. Therefore, a considerable number of cases of depressed patients are not identified, not to mention what early diagnosis and treatment.
2. Symptoms of cognitive impairment
Many patients experience dull brain reaction, memory loss, and find it difficult to think about problems, so they seldom initiate conversation with others, and in severe cases, they do not say a word. When patients are clinically tested for intelligence, it can be found that there is a decline in calculation, comprehension, comprehensive judgment and memory. However, people often think of it as a normal aging process or mistake it for senile dementia. However, this state is transient and is an illusion caused by depression. Once the mood improves through treatment, the “dementia” will disappear, so it is called depressive pseudo-dementia.
3.Symptoms of will and behavior
On the basis of depressed mood, will-behavior disorder arises. In mild cases, there is a significant decrease in motivation and initiative, less interaction with others, no longer participating in activities of daily interest, lazy life, too lazy to wash and change clothes and do housework. In severe cases, the person is unable to carry out daily tasks, avoiding interactions, shutting the door, or even completely bedridden, unable to take care of themselves. Family members and bystanders often misunderstand the patient as lazy and indolent, but in fact this is only a symptom of illness.
4.Somatic symptoms – the most likely to cause misdiagnosis of symptoms
Somatic symptoms are relative to mental symptoms, that is, physical discomfort. Patients with geriatric depression often do not have the typical depression, but show a variety of physical discomfort, which is actually the result of depressed mood. Common somatic symptoms include.
(1) Pain syndrome, such as headache, chest pain, low back pain, generalized pain, especially common is the pain of the whole body in an irregular area, patients taking painkillers will not help, but taking antidepressants pain will be relieved and disappear;
(2) Severe insomnia, the elderly who had been sleeping well will suddenly become difficult to sleep, or wake up too early, the patient wakes up more than an hour earlier than the original, and as soon as they wake up, they will be in a bad mood, feeling that the day is simply impossible to live, and the day is like a year;
(3) Loss of appetite and weight loss;
(4) Cardiovascular system symptoms, such as chest tightness, shortness of breath, palpitations;
(5) Digestive system symptoms, anorexia, abdominal discomfort, constipation, indigestion;
(6) symptoms of the vegetative nervous system, such as redness, hand trembling, sweating, etc;
(7) Symptoms of suspicion, often worried about heart disease, cancer, etc. Some patients repeatedly go to the hospital, after examination and treatment, no abnormal findings, but still do not feel at ease, and even feel that they are terminally ill and will die soon.
In real life, we often encounter elderly people with various physical discomforts who frequently consult the gastroenterology, cardiovascular, neurology, pain clinics or Chinese medicine departments of general hospitals, but the corresponding organic lesions are not detected and the treatment is not effective, and they mistakenly believe that the doctors’ level is not high or complain that the modern detection level is too low. It is not known that many physical discomforts that do not detect organic pathologies are likely to be somatization symptoms of depression. It is easy to understand why patients with depressive disorders in old age are ignored by their families and doctors. Therefore, it is important to be aware of the presence of depressive disorders in elderly patients who have been suffering from physical discomfort for a long time, especially those who have not been treated for a long time.
5. Combined physical diseases
With the increase of age, the elderly suffer from hypertension, heart disease, diabetes, cerebrovascular disease, cancer, arthritis and other chronic diseases, these diseases are often prolonged, the treatment effect is generally, these will make the elderly feel helpless, frustrated, and even depressed. Some diseases themselves can cause similar weakness, sleep disorders, difficulty concentrating, excessive thinking, and loss of appetite as depression. In addition, many elderly people need to take a variety of medications for a long time because of physical illnesses. Some medications such as reserpine, guanethidine, glucocorticoids, methyldopa, levodopa, etc. can aggravate or cause depression-like symptoms.
However, because of the presence of somatic diseases, people often mistakenly think that it is due to somatic diseases, only focus on and treat somatic diseases, but ignore the existence of depression, and it is easy to miss the diagnosis clinically. Therefore, for patients with somatic diseases, it is necessary to be alert to the presence of depressive disorders when their symptoms are not parallel to the severity of the disease, or when the systemic standardized treatment is not effective, or when they are using drugs that may cause depression
6.Suicide, the most dangerous symptom
Suicidal behavior is common in patients with depressive disorders in old age. Some patients can no longer have a painful expression after making up their mind to commit suicide, but make various arrangements to seek the method and time of suicide. Often, because of these illusions, the loved ones are negligent and can easily make suicide irreversible. Some patients have been ill for many years and have committed suicide to a great extent or even several times, but have not received effective treatment, the reason for this is the low recognition of the disease by society and doctors. Since suicide occurs only when the disease has developed to a certain degree of severity, it is important to detect and treat it early, and not to wait until the patient has already committed suicide before thinking that he may have depressive disorder.
Second, the prevention and treatment of depression disorder in old age
1, strengthen mental health knowledge education, improve people’s ability to identify depression disorder in old age. To the general population to carry out the popularization of mental health, early detection of depressive disorders in old age patients. Depressive disorder in old age is a curable disease, the key is early detection, early diagnosis and early treatment.
2. To strengthen the training of basic psychiatric knowledge of clinical medical personnel to reduce misdiagnosis and omission, and to identify and deal with depressive disorders in old age. Patients who may have depressive disorders should be promptly referred to a specialist consultation or to a specialist hospital for treatment. Since depressive disorders in old age often have a background of other somatic diseases or are even the direct cause; and depression can aggravate somatic diseases or even worsen them and increase mortality. Therefore, while actively treating somatic diseases, antidepressants with high safety and few drug interactions should be selected for treatment.
3.Patients diagnosed with depressive disorder in old age should follow medical advice and take different treatment methods according to their conditions. In terms of treatment, a combination of psychotherapy and pharmacotherapy is usually used. Psychotherapy is very important in the treatment of this disease, the emergence of depressive disorder has a greater relationship with the various losses in old age, the elderly due to the loss of work, reduced economic income, the lack of interpersonal interaction, the loss of family and friends, etc., in the psychological often appear to be maladjusted, the huge gap will produce a sense of loss; the use of psychotherapy can help patients to establish self-confidence, enhance the ability to adapt to society, cope with the environment. On the other hand is drug treatment, psychiatric drugs should be taken under the guidance of a specialist.
4, old age depression disorder is easy to relapse, so drug maintenance treatment is very important. Some elderly people have difficulty in accepting this and think that only no medication is a sign of disease cure, which is another misunderstanding. Patients must follow medical advice, adhere to regular follow-up, maintain close contact with doctors, use antidepressants reasonably under the guidance of doctors, adhere to a sufficient course of treatment, do not stop medication on their own.
5.Strengthen social support and self-regulation. Family members should care more, support and understand the patient, and children should not only take care of the elderly in life, but also give care to them in spirit. Depressive disorders in old age are often anorexic and light-hearted, we should strengthen supervision and prevent them from committing suicide. The elderly themselves should face reality with tolerance, adjust their mental state, maintain a positive spiritual life, avoid staying at home all day to “close” themselves, should cultivate more interests and hobbies, participate in some social activities, try to make the elderly life rich and diverse.