The difficult elderly patient: curable hostile depression or personality disorder?

Area of Science:

• Geriatric Medicine
• Psychiatry
• Neuroscience

Background:

• Hostile behavior is common in elderly patients.
• Existing diagnoses like dementia or personality disorders may not fully explain aggression.
• Sedative medications carry significant risks, including mortality.

Purpose of the Study:

• To propose that reversible mood disorders are a frequent cause of hostility in older adults.
• To challenge the assumption that hostility in the elderly is solely due to dementia or personality disorders.
• To advocate for considering mood disorders in the differential diagnosis of elderly aggression.

Main Methods:

• Review of clinical observations and existing literature.
• Hypothesis generation based on symptom overlap and treatment response.
• Discussion of differential diagnosis and therapeutic implications.

Main Results:

• Hostile behavior can be a manifestation of agitated depression or mixed affective states.
• Sedative use for hostility can lead to adverse events like confusion, falls, and increased mortality.
• Prompt diagnosis and treatment of underlying mood disorders are crucial.

Conclusions:

• Reversible mood disorders should be considered in elderly patients exhibiting hostile behavior, even with pre-existing diagnoses.
• Antidepressant trials, potentially with mood stabilizers, are recommended over sedatives.
• Addressing mood disorders can mitigate risks and improve patient well-being.