When should referral to a geriatric psychiatric unit or consultation with a psychiatrist who has expertise in the care of older adults be considered?
If the patient is psychotic, severely agitated, aggressive (i.e., potentially dangerous to self or others), neurovegetative, or suicidal, referral to a geriatric psychiatric unit or consultation with a psychiatrist who has expertise in the care of older adults may be considered. Serious grief or bereavement issues and psychiatric disorders other than depression may complicate a depressive episode. Other complicating behavioral comorbidities may include alcohol dependency, substance abuse, and dementia. A consultant with specific expertise in the psychiatric disorders of older adults may be helpful in evaluating the patient for complications of depression. • Is electroconvulsive therapy (ECT) safe and effective in older adults? ECT is both safe and effective in older adults and this technique may be considered when a rapid response is desired. ECT should be considered if the patient’s condition is rapidly deteriorating or if antidepressant medication is not tolerated or has failed. Howe
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