Assessment of geriatric patients in the psychiatric emergency service.

Abstract

ical emergencies that are related to psychiatric medications. Possible problems include agranulocytosis secondary to antipsychotics, hypotension or cardiac conduction disturbances that are caused by the use of antipsychotics or antidepressants, neuroleptic malignant syndrome, lithium toxicity, anticholinergic delirium, and acute dystonia (4). Another critical factor in evaluating geriatric patients in the psychiatric emergency service is the risk of suicide, which is much higher among geriatric patients than younger patients. The suicide rate for white men aged 80 to 84 years is six times that of the general adult population (5). Clinicians in the psychiatric emergency service need to calibrate their index of concern about the risk of completed suicide for elderly psychiatric emergency service patients who present with depression, alcohol abuse, or other risk factors for suicide. Because of these and other special considerations that apply to the geriatric patient, we suggest certain maxims that may prove useful in guiding the clinician’s work. They are formulated as ten “do’s” and “don’t’s” for the psychiatric emergency service clinician, constituting a list that cannot claim to be comprehensive.