Vignette Number OAP 014
Speciality:
Old Age Psychiatry
Date:
10 October 2001
Vignette:
You are asked to visit a 70 year old lady at her home. Her
husband died six months ago and she now lives alone. She has grown
up children, with whom she keeps in touch but who live in different
parts of the country. She has been losing weight, neglecting
herself and not doing the housework. Previously she was a capable
and houseproud woman.
Tell us how you would go about assessing and managing this
situation.
Suggested Probes:
- What diagnoses might you consider?
- What are the risk factors in this case?
- What psychological treatments might you consider?
- Differential diagnosis - depressive illness; dementia; grief
reaction, alcohol or drug misuse, concurrent physical illness or a
combination of these.
- Risk assessment - ability to care for herself; suicidality;
available support.
- Need for admission to hospital.
- Meaning of loss of husband - precipitant of depression; loss of
role as spouse/carer; loss of support reveals pre-existing
dementia.
- Treatment - use of day care; use of antidepressants in elderly
- consider ECT, role of psychological treatments.