Psychic disorders were studied with a naturalistic design in 125 consecutive patients of a medical-geriatric department in a general hospital. Based on the clinical examination and the values of the Mini-Mental-State-Examination (2), 51 patients were classified as unable for diagnostic procedures concerning psychic state. The other 74 patients underwent these diagnostic procedures including clinical investigation and three screening-scales (Geriatric Depression Scale (11); Hospital Anxiety and Depression-Scale (4)). If these examinations led to the suspicion that a patient suffered from a psychic disorder, an interview was performed by a psychotherapist with experience in gerontopsychosomatic treatment and information was collected from the medical and nursing staff. Dementia was detected or excluded by neuropsychological tests. Psychic disorders were found in 41 patients, mostly adaptation disorders and depressions. In more than half of the patients, the disorder was estimated to be relevant for the whole hospital therapy. The screening instruments turned out to be reliable, so they can be recommended for further use. Difficult to answer remains the question, how the treatment of the psychic disorders--in our sample necessary for each 5th to 6th patient--can be implemented in a medical-geriatric department.
In palliative medicine, the doctor's role towards the patient changes from curing to looking after and depends on the different organizational forms. A key topic for the doctor remains the decision, how far medical treatment should be extended - according to patient's will. Studies for palliative medicine have also showed considerable communication deficits. This leads to the following aims of communication with the dying: Recording of somatic, psychic, social and spiritual problems of the patients, informing about illness and prognosis, responding to the patient's emotional situation and to the existential dimension of dying as well as involving relatives in communication. "Active listening" is proposed as a communication form to be learned by doctors. Training programs and possibilities of improving the emotional situation of doctors are described.
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