Geriatrik Özen: Eşlik Eden Psikiyatrik Hastalıklar ve Diğerleri
Özet
65 yaş ve üzeri geriatrik popülasyonda eşlik eden psikiyatrik hastalıkların (eş tanı) tanı ve tedavi süreçlerini inceleyen metinde, yaşlılık dönemindeki ruh sağlığı değişimlerinin normal yaşlanmanın bir parçası sayılarak göz ardı edildiği ve bu durumun tanı süreçlerini karmaşıklaştırarak daha yoğun tedaviler gerektirdiği belirtilmektedir. Yaşlılarda ilaç kullanımının fazla olması sebebiyle yeni belirtilerin ilaç yan etkisi ya da hiponatremi gibi klinik sorunlar olabileceği unutulmamalı ve tedavilere düşük dozla başlanmalıdır. Geriatrik depresyon gençlere kıyasla daha az depresif duygudurum, daha fazla ilgisizlik ve somatik yakınmalarla seyrederken; yalnız yaşama ve kronik hastalıklar gibi risk faktörleriyle tetiklenmektedir. Tedavide Seçici Serotonin Geri Alım İnhibitörleri (SSRI) ilk sırada yer almakta, uygun hastalarda psikoterapiler de etkili olmaktadır. Yaşlılarda anksiyete sıklıkla nörolojik ve kardiyovasküler hastalıklarla birlikte görülmekte ve düşme korkusu gibi durumlar agorafobi ile karıştırılabilmektedir. Benzodiazepin kullanımı bağımlılık riski nedeniyle 2-4 hafta ile sınırlandırılmalı ve kademeli olarak azaltılmalıdır. Yaşlılıkta psikoza yol açan nedenler birincil ve ikincil olarak ikiye ayrılmakta, deliryum ve demans gibi ikincil nedenlerin öncelikle dışlanması gerekmektedir. Son olarak, yoğun bakım ünitelerinde yatan geriatrik hastalarda depresyon, anksiyete ve TSSB gibi psikiyatrik eş tanıların genel popülasyona göre anlamlı derecede yüksek olduğu ve bu durumun erken tarama ile tedavi edilmesinin önemi vurgulanmaktadır.
This study investigates the diagnosis and treatment processes of concomitant psychiatric disorders (comorbidity) in the geriatric population aged 65 and older, noting that mental health changes in late life are often overlooked as a normal part of aging, which complicates diagnostic processes and requires more intensive treatments. Due to polypharmacy in the elderly, it must be considered that new symptoms could be drug side effects or clinical issues like hyponatremia, and treatments should be initiated at low doses. Geriatric depression presents with less depressive mood and more apathy and somatic complaints compared to younger individuals, and it is triggered by risk factors such as living alone and chronic illnesses. Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line choice in treatment, and psychotherapies are also effective in suitable patients. Anxiety in the elderly frequently co-occurs with neurological and cardiovascular diseases, and conditions like fear of falling can be confused with agoraphobia. Benzodiazepine use should be limited to 2–4 weeks due to the risk of dependence and must be tapered gradually. Causes leading to psychosis in old age are divided into primary and secondary, and secondary causes such as delirium and dementia must be ruled out first. Lastly, it is highlighted that the prevalence of psychiatric comorbidities such as depression, anxiety, and PTSD is significantly higher in geriatric patients hospitalized in intensive care units compared to the general population, emphasizing the importance of early screening and treatment.
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