The role of the GP in managing mental illness in later life

Abstract

The three major functional disorders of mental health in later life are anxiety, depression and an assortment of psychoses. Although they are distinct and definable entities, they also overlap or co-exist with each other, making their diagnosis and treatment difficult, particularly in the early stages of each disorder when symptoms are emerging from the backdrop of behaviours, emotional responses and relationships accrued over the life-course. Anxiety disorders are prevalent, and when associated with depression give it a poor prognosis. Depression has many different forms, of which the minor and sub-syndromal types are most common and least understood, but there is growing evidence that they have a profound impact on the quality of life of older people and their families, and that intervention (although sometimes difficult) is worthwhile. Psychosis in later life remains a problematic clinical domain to understand and to treat, and one in which close collaboration between generalists and specialists is necessary. ‘Routine’ care of older people with mental ill-health results in poor outcomes, but dedicated case management approaches show promise of better outcomes for both mental and physical health, and their exploration and development is the next step for primary care. The prevention of suicide is another area where general practice can bring to bear its biopsychosocial understanding of later life, and avoid simplistic interventions that could be ineffectual and even counter-productive.