People’s health changes with age and geriatric patients may encounter some difficulties while describing their problems to a healthcare provider. The existence of comorbidities and different features of some disorders lead to older people having atypical presentations of some disorders (Resnick, 2016). In some cases, the physical symptoms may be perceived by a medical specialist as a regular part of aging. In other situations, the alterations of mental health are not acknowledged as potential signs of illness. For example, geriatric patients often do not have typical symptoms of major depressive disorder, and their diagnosis becomes a challenging task for a medical professional. Thus, healthcare providers need to rely not only on the usual classification of mental disorders but also on personal judgment, possible causes, risk factors, and the patient’s feelings (Holroyd-Leduc & Reddy, 2012). The patient with atypical depression should be diagnosed with the help of tests, physical exams, DSM-5, and personal observations.
Patient Case
The patient in the discussed example is a 74-year-old female who was recently brought to the clinic by her daughter. The patient’s daughter stated that the patient had recently started to eat and sleep more than usual, gaining weight as a result. The patient did not report feeling sad or lonely at all times, and she said that happy events had a positive effect on her moods. However, the patient also noted that was consistently sleepy and often ate more than she would have eaten a year ago. The physical examination showed that the patient had gained weight, possibly due to the incidents of overeating (Lamers, Beekman, Van Hemert, Schoevers, & Penninx, 2016). The daughter also stated that her relationship with her mother had become tense in the last few years, noting that the family had arguments much more often than before. She also said that the patient was alert but very sensitive because she interpreted some statements as criticisms.
The description of the patient’s condition does not present a clear clinical picture. Nonetheless, some of the patient’s symptoms suggest that she has atypical depression (AD) – a type of major depressive disorder. AD is similar to the typical condition in that it also affects one’s mood. However, patients with AD have increased appetite which leads to weight gain (Lamers et al., 2016). They also sleep more, sometimes wanting to sleep during the daytime as well.
The difficulty in diagnosing AD is also connected to the fact that patients with AD often have positive attitudes when they respond to some events. The diagnosis of AD should rely on the physical examination of the patient to exclude physical illnesses and the DSM-5 to compare the symptoms with the description of AD (Holroyd-Leduc & Reddy, 2012). It is noted that usual questionnaires may be ineffective for geriatric patients because older people often do not feel depressed or apathetic (Lamers et al., 2016). To overcome the atypical presentation, the patient’s family has to be consulted to pinpoint the exact chances in the patient’s moods, the onset of these alterations, and their persistence. A referral to a specialist to complete a psychological evaluation should also be included in the diagnostic process.
Conclusion
The patient’s description of symptoms resembles the characteristics of AD. This condition is different from typical depressive disorder because it is defined by excessive eating and sleeping and a lack of depressive moods. The patient’s absence of negative thoughts, however, is replaced by confusion and increased sensitivity which also led to unstable relationships with her family. The diagnosis included a physical examination, a family consultation, as well as the assessment according to the DSM-5 and a psychological evaluation.
References
Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.
Lamers, F., Beekman, A. T. F., Van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H. (2016). Six-year longitudinal course and outcomes of subtypes of depression. The British Journal of Psychiatry, 208(1), 62-68.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.