engleski

Specificities in psychiatric care for older age patients – somatic comorbidities as possible factors leading to decompensation and persistence of psychiatric symptoms

Aim: We aim to present a patient with diabetes mellitus type 2 (DM) hospitalized at our clinic with symptoms starting as a depressive episode that progressed from deterioration of cognitive functions and functionality to delirium, accompanied by severe somatic complications. Methods: We present a case report with anamnestic and clinical data, diagnostic tests and consultations with internal medicine specialists. Results: A 69-year-old female patient with DM was hospitalized at the University Psychiatric Hospital Vrapče during 2018 under the diagnosis of mood disorder due to known physiological condition. Upon admission to the hospital, she manifested depressive symptoms including sadness, anxiety, tension, apathy and functional decline. Within a few days, despite psychopharmacological treatment, her state worsened with anxiety and negative anticipations of the future progressing to psychotic level along with confusion, disorientation, incoherent thinking and disorganized behaviour. Diagnostics revealed only dysregulated glycaemia. Although DM was previously well-controlled, new laboratory results showed high blood glucose levels. An internal medicine specialist was consulted several times. Despite multiple corrections of therapy, hyperglycaemia and psychiatric symptoms remained unchanged for weeks. Only after the normalization of glycaemia, our patient showed slight improvement of psychiatric symptoms. However, her recovery was once again interrupted as she developed pulmonary embolism due to vein thrombosis. After treatment at a somatic unit of another clinic, she was re- admitted to our hospital in stable somatic state. With new somatic therapy, surveillance of internal medicine specialist and minor psychopharmacotherapy corrections, she started to show gradual improvement in cognitive functions, mood and behaviour. Conclusions: Psychiatric care for older age patients has its own specificities, mostly due to somatic comorbidities that require consultations with other specialists. Somatic complications as a possible factor leading to worsening of psychiatric symptoms should always be taken into consideration in diagnostic and treatment plan for older age patients, especially since often a remission of mental illness is possible only with an improvement of somatic state.

patients ; elderly ; comorbidity ; somatic ; psychiatric symptoms ; care ; decompensation

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