Conflicts and complexity in inpatient geropsychiatry

In order to illustrate the principles and practice of inpatient geropsychiatric care, the authors present the case of a 73-year-old woman who developed a paranoid delusional syndrome associated with hypothyroidism. The roots of such care, which lie in the network of biopsychosocial losses of late life, are exemplified in their analysis of this patient's multiple medical, psychiatric and social liabilities. The interrelationships among these problems provide the rationale for integrated multidisciplinary assessment and treatment, which is the central organizational concept for geropsychiatric care. Through effective team leadership, efficient case coordination, firm and flexible interdisciplinary boundaries, and incisive prioritization of limited resources and limited options, the multidisciplinary process is shown to provide the basis for a comprehensive and, ideally, a holistic understanding of the patient's strengths and liabilities. The authors highlight this patient's dramatic benefit from such a comprehensive program of medical, psychiatric, and socioenvironmental interventions in order to indicate the fruitfulness of this complex and gratifying process.