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Geriatrics
Disorders psychotics at the old people
Courses of Geriatrics
 

The psychosis is a combining syndrome is delirious and hallucinations without conscience of the disorder.

Three entities:

• Confuso-delirious States: curable

• Be delirious Them out-of-date

• Be delirious of late appearance

 

Be delirious out-of-date:

A - BE DELIRIOUS SCHIZOPHRENIC:

1% of the total population.

20% among the SDF.

Only 0,1% of the population of more than 65 years.

Undoubtedly due to a surmortality of this population. 

Perhaps due to a bad classification.

Possibly due to an improvement.

Lost sight of the fact by institutional psychiatry.

Insulation. Return to oneself.

Poverty of contact.

Improvement with a nerve sedative desinhibitor.

B - BE DELIRIOUS CHRONIC NONSCHIZOPHRENIC:

Often occur after 40 years.

1) OUT-OF-DATE CHRONIC HALLUCINATORY PSYCHOSIS:

Hallucinatory mechanism with topic of persecution.

2) OUT-OF-DATE PARAPHRENIA:

Well adapted subjects

No reserves.

Rather merry speech.

Delirious ideas of imaginative mechanism.

3) BE DELIRIOUS PARANOIAC AGED:

a) In sector:

Remaining in a field of the life:

• Professional

• Passion: jealousy, erotomania

• Of claim: quérulents litigious, inventive ignored

b) In network:

Extending to all the fields.

Paranoid evolution joining schizophrenia.

Be delirious of late appearance:

A - BE DELIRIOUS ACUTE Of LATE APPEARANCE:

• Confuso-delirious States

• Delirious Épisodes at a patient lunatic

• Delirious Disorders of mood

B - BE DELIRIOUS CHRONIC Of LATE APPEARANCE:

1) THEY ARE RARE:

One can find all the psychoses chronic:

• Schizophrenia

• Chronic hallucinatory Psychosis

• Paraphrenia

Clinically, the topics most frequently found are:

• Persecution

• The hypochondrie the mechanisms are generally:

• Interpretative

• Hallucinatory

• Imaginative

Sometimes one finds with release a multi-factorial origin with the appearance of these are delirious:

2) WITHOUT THERAPEUTIC CONSEQUENCES:

• Recent Event of life as the death of a spouse

• Features of personality

• Irrational State

3) WITH THERAPEUTIC CONSEQUENCES:

• Catch of drugs

• Alcoholization

• Weakening of the 5 directions

• Insulation and loneliness

• Depressive State or maniac

C - DIAGNOSIS:

1) IT IS CLINICAL:

It rests on the anamnèse collected auprès:

• Of the patient

• Of the family

• Of the doctor

• Of the reports of hospitalization

2) CLINICAL EXAMINATION:

Test in 30 points: mental minis scale (MMS).

3) COMPLEMENTARY EXAMINATIONS:

Seek of a somatic affection or an intoxication.

D - POSSIBLE DIAGNOSTIC ERRORS:

1) BY EXCESSES:

a) Iatrogenic cause Drugs.

b) Alcohol

c) organic Causes Aphasia.

d) Insanity

e) Another psychiatric pathology

f) Nonsick old people with pseudohallucinations of emotional nature

2) DIAGNOSTIC ERRORS BY DEFECT:

has) Hebephrenic schizophrenes

E - TREATMENT:

1) NERVE SEDATIVES:

Smaller possible effective amount.

The strong amounts are confusogenes.

2) TO TREAT the FACTORS WHICH HAVE PU TO SUPPORT the BLOSSOMING OF IS DELIRIOUS:

Stop of a treatment.

Treatment of test antidepressant.

3) RELATION Of ASSISTANCE:

To reassure. Not to counter.

In front of one is delirious, it is necessary to spare a distance with the patient all while maintaining a bond and a making safe place.

It is necessary to respect is delirious it without approving it.

It is necessary to know to speak with the patient without fear and anguish of the phenomena which invade it.

It is not a question to confirm them or to be opposed, but to note to it.

When is delirious it is not expressed more, it is not recommended of réaborder the topics which fed it.

The disappearance of is delirious does not mean the end of the care.

Often, the patient remembers what occurred.

That involves a severe risk of depression and apragmatism.

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