Chest pain, memory loss,
mania and peripheral oedema: just a hint of the breadth of
conditions I encounter on a daily basis!
I am currently half way
through my four month placement as a foundation year 2 (FY2) in old
age psychiatry in Edinburgh. Old age psychiatry is an expanding
speciality concerned with the mental health needs of those over the
age of 65. My work as an FY2 revolves around the running of a ward
of twenty-six elderly inpatients, suffering from functional and/or
organic illnesses, within a large general hospital. At present, we
have patients who have severe cognitive impairments being cared for
in the same environment as patients with intact cognition who are
experiencing mania, severe depression and psychosis. Providing a
therapeutic environment for this mixture of disorders can be
challenging for all staff involved. Along with two consultant old
age psychiatrists and a core trainee year 2 (CT2) psychiatric
trainee, we comprise the medical team for this ward and also cover
day-hospitals, memory clinics and long-term care facilities. I try
to make time as often as possible to catch up with my patients, be
that as a stroll down the corridor, over coffee or for a more
formal assessment of their mental state.
The ward has a packed
timetable of activities such as aerobics, dominos, reminiscence
therapy, current affairs, manicures and day trips. My patients
often have multiple co-morbid diseases, thus I apply knowledge from
both my medical and psychiatric training to their management. The
main challenges in this job come, not from acute psychiatric
illness, but from the management of chronic medical conditions and
assessment of seemingly trivial symptoms. Particularly testing is
the assessment of various rashes, lumps and bumps! In recent weeks
I have contacted otorhinolaryngology, dermatology, cardiology,
endocrinology, urology and general surgery for specialist opinions.
Admission to old age psychiatry is often a time for reassessment of
both physical and mental health, organising investigations and
optimising medications. It is no surprise then that I am
practically on first name terms with the medical consultants.
The management of
patients in old age psychiatry is a truly multidisciplinary task
involving community psychiatric nurses, social workers, general
practitioners, psychologists, occupational therapists,
physiotherapists and voluntary organisations and it can take place
in a wide range of settings. Families have a key role to play in
management and continue to surprise me by the lengths they go to to
maintain patients’ independence in the community. I frequently meet
with different family members, more often than not on an impromptu
basis.
I have two clinics each
week, mainly assessing patients with varying degrees of cognitive
impairment. I am allocated a one hour appointment per new patient,
such is the nature and difficulty of this assessment. It can be
particularly challenging and upsetting when a patient is unaware of
their memory loss, despite reports from their family and GP to the
contrary. I enjoy the detective work involved in this area, as a
naturally inquisitive individual, and adore listening to patients
recount their colourful life stories. Outside of the ward I am
scheduled to assist at electroconvulsive therapy (ECT) sessions,
have shifts on-call for psychiatry and form part of the medical
hospital at night team.
My job here in old age
psychiatry is an enjoyable, unpredictable rollercoaster of an
experience in both psychiatry and medicine of the elderly. I can
honestly say that I take a holistic approach to the management of
each individual patient; considering both mind and body. To succeed
in this area you need to be adaptable, a team player, patient,
empathetic and a competent communicator; all qualities the
foundation curriculum aims to achieve. Our elderly population is
expanding and thus this is a useful experience for my future
medical career, whatever path it takes. As for my next job, general
surgery, I am certain that I will not be greeted with so many
smiles, a verse of “how do you solve problem like Maria”
and a kiss each day!
Maria Casserly, foundation year 2 trainee, old
age psychiatry
Page last updated on 22 May
by E Baker-Glenn