Elderly depression is the depression seen in the old age people. Most of the old age people are at the risk of Elderly depression with number of risk factors. Nearly 10 to 15 % of aged people about 65 years, suffers from elderly depression. Elderly depression is one of the major public health problem. A research study says that older adults with both diabetes and elderly depression are 36 percent to 38 percent risk of dying from any cause.

Most of the elderly depression are not identified easily in nursing homes and general hospitals. A mental health center is the right place to diagnose elderly depression and to provide appropriate mental health care. Hospitalization and different psychotherapies helps in reducing depression and restoration of mental health.

Somatic complaints and cognitive impairments are main symptoms usually associated with elderly depression. Antidepressant medications  are given to treat depression in elders and the dosage fixing and checking for drug tolerance is very important.

Causes of elderly depression:-

• Normal aging process,
• Loss of spouse or loved one,
• Loneliness,
• Loss of independence,
• Feeling of being neglected form young ones,
• Fear of death or dying,
• Feelings of purposelessness
• Chronic medical illnesses,
• Nutritional deficiency,
• Prolonged drug therapy,
• Psychosocial factors, and
• Mental health problem
• Loss of mobility due to joint deformity,

Symptoms of Elderly depression:-

• Likes to be alone always,
• Refuses to take food,
• Loss of appetite and weight loss,
• Loss of self-worth,
• Deficit sleep,
• Sadness,
• Anxiety and worries
• Neglects personal care,
• Loss of memory,
• Not interested in mingling with family members,
• Social withdrawal and isolation,
• Likes to stay in a dark room,
• Fixation on death and likes to die,
• Becomes alcoholics and drug abused,

Treatment of  Elderly depression:-

Antidepressant therapy : Antidepressant medications  lessens the symptoms of elderly depression. Care should be taken to lessen the side effects of drugs which occurs in elders. Treating underlying cause is also needed. Neuroleptic medications are also beneficial in some individuals.

Psychological counseling : is very beneficial in relieving symptoms of depression. Counseling should facilitate to make off loneliness, and should be according to the need and life situation of elder ones.

Music therapy : Listening to musical songs, devotional songs also helps in treating elderly depression. ECT electroconvulsive therapy can be given to some individuals.

Emotional support : The family members should mingle with elders to remove loneliness. Make the elders to play with small kids. Take a regular walk and advice to love the environment. Make them feel some one is caring and love the elders.

Symptoms of schizophrenia:-

* Hallucinations
* delusions
* racing thoughts
* apathy
* lack of emotion
* poor or nonexistent social functioning
* cognitive symptoms of schizophrenia are disorganized thoughts
* difficulty in  concentrating, in following instructions
* difficulty completing tasks
* memory problems.
* disorganized speech
* disorganized behavior
the signs and symptoms of schizophrenia differ from individual to individual, both in pattern and severity. Not every person with schizophrenia will have all symptoms. The symptoms of schizophrenia may also change with duration of illness.

psychiatrist will make diagnosis with different assessments and procedures and provide a treatment as per need of mental illness. Identifying schizophrenia symptoms is very important to diagnose and treat schizophrenia in adults and children.

Delusions:-

A delusion is a firm and strong belief with something and the schizophrenia affected individual believes even wrong as right. delusions are common schizophrenia symptoms seen in 90% of schizophrenia patients.

Delusions of persecution — Belief that others, may present really are an assumption that they are trying to kill him or harm him. schizophrenia patients complaints that others are mixing poison in food, some one is coming with gun, some one robbed their property, others cheated  etc are the symptoms of schizophrenia with delusions.

Delusions of reference — A neutral environmental event becomes a  special and personal meaning to schizophrenic patients. For example an individual with schizophrenia symptoms might believe that a president has send a message to him, a minister has invited him for a dinner, etc.

Delusions of grandeur — schizophrenia symptoms with delusions of grandeur are that the schizophrenia person believes that he has a super power, he can become god , he is a leader and he can do anything, every one has to follow  his order etc .

Delusions of control — Schizophrenia symptoms  with delusions of control are the patient complaints that some one is copying my thoughts, he has stolen my idea, i invented radio but they cheated me and gave their name etc..

Hallucinations:-

Hallucinations are the wrong or false perception in the absence of stimuli. Hallucinations are the main schizophrenia symptoms  involve any of the five senses, auditory hallucinations such as  hearing voices or some  sound with absence of any external sound are most common symptoms of schizophrenia. Visual hallucinations are also relatively common.

Schizophrenic  hallucinations may be  meaningful to the Schizophrenic person experiencing them.  The voices are those of someone they know and the words they hear are bad to them and like abusing others.  Hallucinations become more when individual is alone.

Disorganized speech:-

Fragmented thinking is one of the  schizophrenia symptoms. They have shift of thoughts, change of topic, talking something unrelated, meaning less speaking, murmuring, making unusual sounds are common  schizophrenia symptoms with disorganized speech. Creating new meaning to words, joining unrelated words, Repetition of words and sentences, meaningless use of rhyming words etc..

The negative schizophrenia symptoms:-

* Flattened or blunted affect: Lack of emotional expression, including a flat voice, failure to have eye contact, and blank or weak facial expressions.
* Avolition: Lack of interest or enthusiasm; unable to pursue goal-driven activities.
* Catatonia: Apparent unawareness about environment, near total absence of motion and speech, unnecessary body movements and different postures, deficit self-care activities such as taking bath etc.
* Alogia: Difficulties with speech, inability to converse, short and sometimes no replies to questions, interrupted communication

Neurosis is one of the psychological disorder, related to distress. Neurosis doesn’t affect the thought, unlike psychosis or other mental disorders. Anxiety, depressed feelings, , low self-confidence, lack of emotions or emotional instability are related to Neurosis.

Neurotic symptoms may manifest as depression, anxiety, obsessive compulsive disorder, Phobias, etc.

Pyromania, obsessive compulsive disorder, and hysteria are the different forms of Neurosis. Phobias are also included in neurosis.

Symptoms of Neurosis:-

*  Anxiety,
*  anger,
*  depression
*  sadness,
*  poor emotions,
*  low sense of self-worth,
*  irritability,
*  mental confusion, etc are main symptoms of neurosis.

Other behavioural symptoms of neurosis are, impulsive or compulsive disorders, vigilance, phobic avoidance, lethargy, etc.. Cognitive symptoms are  Repetition of thoughts, unpleasant or disturbing thoughts, habitual fantasizing, negativity and cynicism etc

Delirium tremens is a withdrawal symptom seen in the individual addicted to Alcohol. Delirium tremens is considered as one of the psychological disorder.

Causes of Delirium tremens:-

* The main cause of delirium is excess alcohol drinking, especially when an individual doesn’t take enough food.
* Head injury, infection, or any illness associated with alcoholism acts as triggering factor of Delirium tremens.
* Chronic heavy alcoholism, previous history of heavy alcoholism.

Symptoms of delirium tremens:-

1. Nervousness
2. Feeling shaky
3. Irritability or easily excited
4. Anxiety,
5. Emotional volatility,
6. Emotional instability,
7. Sudden mood change,
8. unable to mingle in group,
9. Depression,
10. Fatigue ,
11. Difficulty in thinking
12. palpitation (sensation of feeling own heart beat) ,
13. Headache, general, pulsating ,
14. Excess Sweating,
15. Especially the palms of the hands or the face ,
16. Nausea, (sensation of vomiting)
17. Loss of appetite,
18. vomiting,
19. Seizures,
20. Tremors,
21. Mental changes, etc

Diagnosis:-

Physical examination and history collection . Tremors, excess sweating, and other symptoms help  in diagnosis.

Treatment of Delirium tremens:-

Preventing the complications, restoring health, and relieving symptoms are the treatment goals.

Treatment based on the causes and severity of symptoms.

The pharmacological treatment:-

* anticonvulsants such as phenytoin
* clonidine to reduce cardiovascular symptoms and reduce anxiety
* central nervous system depressants
* sedatives such as alprazolam

Psychological care is needed, along with psychological therapies such as group therapy, playing .