By The Royal Australian College of General Practitioners
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Obtaining a history of depressive symptoms, and using depression assessment scales and cognitive testing, can assist in the diagnosis of depression (see Depression). Depression occurring in people with dementia needs to be distinguished from depressive pseudodementia, an uncommon condition of depression presenting as a dementia-like illness. qxd 31/3/06 12:50 PM Page 29 Common clinical conditions Emotions Irritable, aggressive, fearful Apathetic, labile, irritable Flat, unresponsive or sad; may be irritable Sleep Nocturnal confusion Often disturbed; nocturnal wandering and confusion Early morning awakening Other features Other physical disease may not be obvious Past history of mood disorder Table 6.
The purpose of assessment is to: • confirm diagnosis and the severity of depression • differentiate depression from dementia and delirium • identify reversible causes • identify other conditions that may contribute to depression or be aggravated by depression • assess the risk of self harm. Clinical features of depression in older patients include146: • psychological – fluctuating depressed mood, loss of interest in activities, loss of motivation, irritability • somatic – loss of energy, fatigue, headache, pain and palpitations • cognitive – forgetfulness, poor concentration, psychomotor slowing • behavioural – social withdrawal, reduction in activity, disinhibition.
2. Inattention Does the person have difficulty focussing attention? Eg. distracted or having difficulty keeping track of what is being said 3. Disorganised thinking Is the person’s thinking disorganised or incoherent, rambling or irrelevant, unclear or illogical, or unpredictable? 4. Altered level of consciousness Overall is the person lethargic (drowsy, easily aroused), stuporous (difficult to arouse), comatose (unable to be aroused) or hypervigilant (hyperalert)? Table 4. Confusion Assessment Method 79 Differential diagnoses include depression, dementia, anxiety and psychosis.