Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T08:24:57.441Z Has data issue: false hasContentIssue false

Chapter 12 - Depression and Associated Disorders

Published online by Cambridge University Press:  04 April 2024

By
Wendy Burn ,
George Crowther  and
Eimear Devlin
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
Get access

Summary

An admission to hospital can be extremely distressing, and a life-changing event. This is particularly true for older people with multiple co-morbidities and complex social needs. It is perhaps unsurprising, then, that mood disorders are common in older people in hospital. A mood disorder can also precipitate a hospital admission, for instance through self-neglect or self-harm. When in hospital, altered mood states can impact a person’s ability to engage with the treatment and are associated with worse outcomes.

This chapter describes the prevalence and aetiology of depression, mania, and their associated disorders in a general hospital setting. It goes on to consider the challenges of assessment in this environment, in particular the impact of the admission, morbidity, and medical interventions on a person’s mood state.

It concludes by describing non-pharmacological and pharmacological treatment strategies for managing elevated and depressed mood in a hospital setting, where people may be physically compromised and the environment may not be ideal for meaningful therapeutic engagement.

Keywords

depressionmaniaolder peopleacute hospitalin-patientdepression assessmentdepression treatmentmania assessmentmania treatment
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 157 - 182
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, D.A., Baldwin, B., Barker, B., Forsyth, A., Guthrie, D., Holmes, E. Ratcliffe, J., and Richman, J., , A Who Cares Wins: Improving the Outcome for Older People Admitted to the General Hospital. Royal Collage of Psychiatry, 2005. www.bgs.org.uk/sites/default/files/content/resources/files/2018-05-18/WhoCaresWins.pdf.Google Scholar
Sampson, E., Blanchard, M., Jones, L. et al. Dementia in the acute hospital: Prospective cohort study of prevalence and mortality. British Journal of Psychiatry 2009, 195(1): 61–6.CrossRefGoogle ScholarPubMed
Sampson, E., White, N., Leurent, B. et al. Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: Prospective cohort study. British Journal of Psychiatry 2014, 205(3): 189–96.CrossRefGoogle Scholar
Peterson, J.F., Pun, B.T., Dittus, R.S. et al. Delirium and its motoric subtypes: A study of 614 critically ill patients. Journal of the American Geriatrics Society 2006, 54(3): 479–84.CrossRefGoogle ScholarPubMed
Holmes, J., and House, A. Psychiatric illness predicts poor outcome after surgery for hip fracture: A prospective cohort study. Psychological Medicine 2000, 30: 921–9.CrossRefGoogle ScholarPubMed
Goldberg, S., Whittamore, K., Harwood, R. et al. The prevalence of mental health problems among older adults admitted as an emergency to a general hospital. Age and Ageing 2012, 41(1): 80–6.CrossRefGoogle ScholarPubMed
Cullum, S., Tucker, S., Todd, C. et al. Screening for depression in older medical inpatients. Int J Geriatr Psychiatry 2006, 21(5): 469–76.CrossRefGoogle ScholarPubMed
Tooke, B., Aimola, L., Corrado, O., Crawford, M., Hood, C., Plummer, K., and Quirk, A. Survey of Depression Reporting in Older Adults Admitted to Acute Hospitals. Royal College of Psychiatrists, 2018. www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/ccqi-research-and-evaluation/capss/studies/depression-survey-report-older-adults-2018.pdf?sfvrsn=3ed9de11_4.Google Scholar
Cerejeira, J., Lagarto, L., and Mukaetova-Ladinska, E.B. Behavioral and psychological symptoms of dementia. Fronters in Neurology 2012, 73(3), 1–21.Google ScholarPubMed
Hessler, J.B., Schäufele, M., Hendlmeier, I. et al. Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study. Epidemiology and Psychiatric Sciences 2017: 1–10.CrossRefGoogle Scholar
Maercker, A., Forstmeier, S., Enzler, A. et al. Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: Findings from a community survey. Comprehensive Psychiatry 49(2): 113–20.CrossRefGoogle Scholar
Strain, J.J., Smith, G.C., Hammer, J.S. et al. Adjustment disorder: A multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. General Hospital Psychiatry 1998, 20(3): 139–49.CrossRefGoogle ScholarPubMed
Gaudiano, B.A., Dalrymple, K.L., and Zimmerman, M. Prevalence and clinical characteristics of psychotic versus nonpsychotic major depression in a general psychiatric outpatient clinic. Depression and Anxiety 2009, 26(1): 54–64.CrossRefGoogle Scholar
Jaaskelainen, E., Juola, T., Korpela, H. et al. Epidemiology of psychotic depression: Systematic review and meta-analysis. Psychol Med 2018, 48(6): 905–18.CrossRefGoogle ScholarPubMed
Kessler, R.C., and Walters, E.E. Epidemiology of DSM‐III‐R major depression and minor depression among adolescents and young adults in the national comorbidity survey. Depression and Anxiety 1998, 7(1): 3–14.3.0.CO;2-F>CrossRefGoogle Scholar
Mundt, C., et al. (eds). Interpersonal Factors in the Origin and Course of Affective Disorders. London: Gaskell/Royal College of Psychiatrists, 1996.Google Scholar
Harrison, P., Cowen, P., Burns, T., and Fazel, M. Shorter Oxford Textbook of Psychiatry (7th ed.). Oxford: Oxford University Press, 2018.Google Scholar
Reijnders, J.S., Ehrt, U., Weber, W.E. et al. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord 2008, 23(2): 183–9; quiz 313.CrossRefGoogle ScholarPubMed
Hackett, M.L., Yapa, C., Parag, V. et al. Frequency of depression after stroke. A Systematic Review of Observational Studies 2005, 36(6): 1330–40.Google ScholarPubMed
Thombs, B.D., Bass, E.B., Ford, D.E. et al. Prevalence of depression in survivors of acute myocardial infarction. Journal of General Internal Medicine 2006, 21(1): 30–8.CrossRefGoogle ScholarPubMed
Ballard, C., Bannister, C., Solis, M. et al. The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders 1996, 36(3): 135–44.CrossRefGoogle ScholarPubMed
Bullmore, E. The Inflamed Mind. London: Short Books, 2018.Google Scholar
Yirmiya, R. Depression in medical illness: The role of the immune system. West J Med 2000, 173(5): 333–6.CrossRefGoogle ScholarPubMed
Goodwin, G.M. Depression and associated physical diseases and symptoms. Dialogues in Clinical Neuroscience 2006, 8(2): 259–65.CrossRefGoogle ScholarPubMed
British National Formulary (69th ed.). London: BMJ Group and Pharmaceutical Press, 2015. https://rudiapt.files.wordpress.com/2017/11/british-national-formulary-69.pdf.Google Scholar
Martin, G., and Dendukuri, , N. Risk factors for depression among elderly community subjects: A systematic review and meta-analysis. American Journal of Psychiatry 2003, 160(6): 1147–56.Google Scholar
The Kings Fund. Is your hospital dementia friendly? The Kings Fund, 2014. www.kingsfund.org.uk/sites/default/files/media/ehe-hospitals-dementia-assessment-tool.pdf and www.kingsfund.org.uk/projects/enhancing-healing-environment.Google Scholar
World Health Organisation. The International Statistical Classification of Diseases, 10th Revision: Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization, 1992.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, 2013.Google Scholar
Lykouras, E., Malliaras, D., Christodoulou, G.N. et al. Delusional depression: Phenomenology and response to treatment. Acta Psychiatrica Scandinavica 1986, 73(3): 324–9.CrossRefGoogle ScholarPubMed
Fick, D.M., Agostini, J.V., and Inouye, S.K. Delirium superimposed on dementia: A systematic review. Journal of the American Geriatrics Society 2002, 50(10): 1723–32.CrossRefGoogle ScholarPubMed
Goldberg, S., Whittamore, K., Pollock, K. et al. Caring for cognitively impaired older patients in the general hospital: A qualitative analysis of similarities and differences between a specialist medical and mental health unit and standard care wards. Int J Nurs Stud 2014, 51(10): 1132–43.CrossRefGoogle ScholarPubMed
Dennis, M., Kadri, A., and Coffey, J. Depression in older people in the general hospital: A systematic review of screening instruments. Age and Ageing 2012, 41(2): 148–54.CrossRefGoogle ScholarPubMed
Yesavage, J.A., Brink, T.L., Rose, T.L. et al. Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research 1982, 17(1): 37–49.CrossRefGoogle Scholar
Adshead, F., Cody, D.D., and Pitt, B. BASDEC: A novel screening instrument for depression in elderly medical inpatients. BMJ 1992, 305: 397.CrossRefGoogle ScholarPubMed
Hamilton, M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967, 6(4): 278–96.CrossRefGoogle ScholarPubMed
Evans, M.E. Development and validation of a brief screening scale for depression in the elderly physically ill. International Clinical Psychopharmacology 1993, 8(4): 329–31.CrossRefGoogle ScholarPubMed
Koenig, H.G., Meador, K.G., Cohen, H.J. et al. Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. J Am Geriatr Soc 1988, 36(8): 699–706.CrossRefGoogle ScholarPubMed
Kitchell, M.A., Barnes, R.F., Veith, R.C. et al. Screening for depression in hospitalized geriatric medical patients. J Am Geriatr Soc 1982, 30(3): 174–7.CrossRefGoogle ScholarPubMed
Alexopoulos, G.S., Abrams, R.C., Young, R.C. et al. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988, 23(3): 271–84.CrossRefGoogle ScholarPubMed
Crowther, G.J.E., Bennett, M.I., and Holmes, J.D. How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital? Age and Ageing 2016.CrossRefGoogle Scholar
National Confidential Enquiry into Patient Outcome and Death. Treat as One: Bridging the Gap between Mental and Physical Healthcare in General Hospitals. National Confidential Enquiry into Patient Outcome and Death, 2017. http://www.ncepod.org.uk/2017report1/downloads/TreatAsOne_FullReport.pdf.Google Scholar
Cowdell, F. The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 2010, 5(2): 83–92.CrossRefGoogle ScholarPubMed
Burroughs, H., Lovell, K., Morley, M. et al. ‘Justifiable depression’: How primary care professionals and patients view late-life depression? A qualitative study. Fam Pract 2006, 23(3): 369–77.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Depressoin in adults: recognition and management. 2018 (now updated to 2022). ww.nice.org.uk/guidance/cg90.Google Scholar
McWilliams, L.A., Cox, B.J., and Enns, M.W. Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain 2003, 106(1): 127–33.CrossRefGoogle Scholar
Hammen, C. Stress and depression. Annual Review of Clinical Psychology 2005, 1(1): 293–319.CrossRefGoogle ScholarPubMed
Ehlers, A., and Clark, D. Early psychological interventions for adult survivors of trauma: A review. Biol Psychiatry 2003, 53(9): 817–26.CrossRefGoogle ScholarPubMed
Bowker, L., Price, J., and Smith, S. Oxford Handbook of Geriatric Medicine (2nd ed.). Oxford: Oxford University Press, 2012.CrossRefGoogle Scholar
Taylor, D., Paton, C., and Kapur, S. Prescribing Guidelines in Psychiatry (12th ed.). Oxford: Wiley Blackwell, 2015.Google Scholar
Warden, D., Rush, A.J., Trivedi, M.H. et al. The STAR*D project results: A comprehensive review of findings. Current Psychiatry Reports 2007, 9(6): 449–59.CrossRefGoogle ScholarPubMed
Banerjee, S. The Use of Antipsychotic Medication for People with Dementia: Time for Action. Department of Health UK, 2009. https://psychrights.org/research/digest/nlps/banerjeereportongeriatricneurolepticuse.pdf.Google Scholar
The UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet 2003, 361(9360): 799–808.CrossRefGoogle Scholar
Krautgartner, M., Alexandrowicz, R., Benda, N., et al. Need and utilization of psychiatric consultation services among general hospital inpatients. Soc Psychiatry Psychiatr Epidemiol 2006 41(4): 294–301.CrossRefGoogle ScholarPubMed
World Health Organization. The world health report 2003: Shaping the future. WHO, 2003. https://apps.who.int/iris/handle/10665/42789.Google Scholar
Sampson, E.L., Blanchard, M.R., Jones, L., Tookman, A., and King, M. Dementia in the acute hospital: Prospective cohort study of prevalence and mortality. British Journal of Psychiatry 2009, 195(1): 61–6.CrossRefGoogle Scholar
NICE. Attention deficit hyperactivity disorder. NICE, November 2022. https://cks.nice.org.uk/topics/attention-deficit-hyperactivity-disorder.Google Scholar
Depp, C.A., and Jeste, D.V. Bipolar disorder in older adults: A critical review. Bipolar Disord 2004, 6(5): 343–67.CrossRefGoogle ScholarPubMed
Torales, J., Gonzalez, I., Barrios, I., Ventriglio, A., and Bhugra, , D. Manic episodes due to medical illnesses: A literature review. J Nerv Ment Dis 2018, 206(9): 733–8.CrossRefGoogle ScholarPubMed
Lykouras, L., Vassiliadou, M., and Adrachta, D., et al. Illness behavior in neurological inpatients with psychiatric morbidity. Eur Psychiatry 2006, 21(3): 200–03.CrossRefGoogle ScholarPubMed
Fujikawa, T., Yamawaki, S., and Touhouda, Y. Silent cerebral infarctions in patients with late-onset mania. Stroke 1995, 26(6): 946–9.Google Scholar
Shulman, K.I., and Herrmann, N. The nature and management of mania in old age. Psychiatr Clin North Am 1999 22(3): 649–65, ix.CrossRefGoogle ScholarPubMed
Cassidy,, F., and Carrol, l. Vascular risk factors in late onset mania, BJPsychol Med 2002, 32(2): 359–62.Google Scholar
Nagaratnam, N., Wong, K.-K., and Patel, I. Secondary mania of vascular origin in elderly patients: A report of two clinical cases. Archives of Gerontology and Geriatrics 2006, 43(2): 223–32.Google Scholar
Arai, H., Matsumoto, S., Sekiyama, R., and Fukuoka, T. Secondary mania after cerebral infarction in the recovery phase: Case report. Progress in Rehabilitation Medicine 2018, 3: 2018–21.CrossRefGoogle ScholarPubMed
Semple, D., and Smyth, R. Bipolar illness. In Oxford Handbook of Psychiatry (4 ed.), Oxford: Oxford Academic, online ed., 1 June 2019). https://doi.org/10.1093/med/9780198795551.003.0007 and https://oxfordmedicine.com/view/10.1093/med/9780198795551.001.0001/med-9780198795551-chapter-7#med-9780198795551-chapter-7-div1–3).CrossRefGoogle Scholar
NICE. British National Formulary (BNF). NICE, 31 May 2023. https://bnf.nice.org.uk.Google Scholar
NICE. Bipolar disorder: Assessment and management. NICE, 24 September 2014. www.nice.org.uk/guidance/cg185.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×