Mental Health in Older People: Diagnosis, Medications, Treatment, and Care

Running head: CASE STUDY
Mental health in older people
Name of the Student
Name of the University
Author Note

1CASE STUDY
Part 1
Diagnosis- The case study encompasses a 72 year old woman X (pseudonym), who
lives with her husband and grandson. Recent reports from her husband suggests that she often
fails to find appropriate words while speaking and also misplaces objects, accompanied with
paranoia. Some of her presenting complaints include rearranging things and washing them
several times, showing persistent depressed mood and negative response to her medications.
Reports from her husband also suggests that she has recently resorted to behaviour that make
her inflict self-harm. Lack of comfortable relationship with her children and grandchildren
have made her more frustrated and anxious in recent times, concomitant with getting upset
and irritated. Although the client used to enjoy her walks earlier, she does not engage herself
in such activity in recent times. Loss of contact with the community members have directly
resulted in her social isolation and made her depressed. This is accompanied by need of
supervision for selecting clothes and toilet transfer. Following retrieval of a vast information
about the client, her medical history and presenting complaints, she has been diagnosed with
dementia. Dementia diagnosis was done with the use of Addenbrooke's Cognitive
Examination III, a tool that aims to evaluate the neuropsychological state of an individual. An
MRI and CT scan was performed, following which presence of symmetrical atrophy in the
frontal lobe determine the presence of dementia in the patient. Thus, atrophy along with focal
lobar predominance helped in narrowing down the condition to the specific
neurodegenerative disease. This screening test has been validated for use in dementia
diagnosis and determines several aspects of cognitive functioning that encompass language,
fluency, attention, memory and visuospatial functions (Noone, 2015).
This test was conducted as per the guidelines provided in the framework for dementia
care, New Zealand that focuses on the need of conducting a cognitive assessment with the use
of validated screening tools (Ministry of Health, 2013). Sum of the items that a patient X

2CASE STUDY
scored in each of the five domains was 42/100. Research evidences suggest that a cut off
score of 82-88/100 is considered appropriate for the diagnosis of dementia in patients being
administered the screening tool (Hsieh et al., 2015). Thus, an analysis of the patient scores
and reports from her husband suggested that she did not meet the cut-off for confirmed
dementia diagnosis. Deficiency of vitamin B12 has often been associated with neurological
disorders and anaemia (Stabler, 2013). Furthermore, the kidneys perform the function of
absorbing vitamin B12, in addition to other vitamins, Moreover, people suffering from
chronic renal disorders are also found at a higher risks of B12 deficiency (Kozyraki & Cases,
2013). Thus, low B12 levels acted as an indicator for the presence of chronic renal disease.
Lithium is a medication, commonly used for treating people suffering from mental disorders.
Long-term use of lithium interferes with the functioning of the kidneys and results in acute or
chronic kidney disease (Kessing et al., 2015). The diagnostic tests confirmed the stage 4
lithium associated CKD in X, which in turn can be accounted for the presence of urinary tract
infections. Positive results for bipolar affective disorder tests also illustrate the fact that the
patient often experiences isolating, frightening and debilitating experiences, as validated by
her husband’s reports. This psychological illness contributes to her frequent mood swings.
Diagnostic tests also reveal hypertension, Colectomy with Ileostomy and migraines, all of
which suggest that she requires a comprehensive care planning. Obtaining health related
histories and conducting comprehensive physical assessments of a patient is imperative for
gaining a sound understanding of the functional, psychosocial and physical status of the client
(Munroe et al., 2013). Thus, the laboratory results and diagnostic tests were interpreted in a
manner that facilitates delivery of optimal care services to the patient.
Medications- The patient X is currently on a medication of diazepam and
amitriptyline. Belonging to the family of benzodiazepines, diazepam has been administered
with the aim of bringing about a calming effect in the patient, due to her frequent mood

3CASE STUDY
alterations. This drug acts as the mainstay treatment in anxiety, seizures, muscle spasms and
alcohol withdrawal syndrome. The anxiety relieving effects of the drug works by acting in
specific GABA receptors in the brain that result in the subsequent release of GABA
neurotransmitters (Ravenelle et al., 2014). GABA neurotransmitters acts as natural nerve
calming agents and help in maintain balance in neuronal activity, thereby inducing sleepiness,
relaxing the muscles and reducing anxiety symptoms. The fact that X reports sleeping
difficulties and an increase in anxiety and frustration might be considered as the primary
reasons for prescribing diazepam. Her migraine problems are treated with the administration
of amitriptyline that belongs to the class of tricyclic antidepressants (TCA). In addition to
migraine, the drug has also been found effective in the treatment of depressive, bipolar and
anxiety disorders. The drug acts on SNRI by creating moderate impacts on the
norepinephrine transporters (Powers et al., 2013). It directly acts to inhibit re-uptake of
serotonin and norepinephrine by presynaptic neuronal membrane in CNS, thereby elevating
their synaptic concentration.
Furthermore, paroxetine and carbamazepine are also administered to the patient.
Administration of paroxetine can be attributed to its role on treating depression, anxiety,
obsessive compulsive disorders, and panic attacks (Stidd et al., 2013). This selective
serotonin reuptake inhibitor binds to the allosteric regions of serotonin transports and inhibit
norepinephrine reuptake. Furthermore, carbamazepine has been prescribed with the intent of
treating bipolar disorder. This sodium channel blocker preferentially binds to voltage-gated
Na+ channels in an inactive state, thereby preventing the sustained and repetitive firing of
action potentials (Yatham et al., 2013). Thus, it can be stated that the medical history and
presenting complaints of the patient X have been taken into consideration before prescribing
proper medications.