Important factors in rehabilitating the psychiatric patient.

Family conflicts, retirement, bereavement, and isolation often precipitate emotional and physical decompensation in the elderly. Such stresses can cause a precipitous regression, and as the ego tries to master the intense anxiety, massive denial, hypochondriasis, projection, introjection, and helplessness can take over. Evaluation of an emotionally distraught patient with behavioral changes should include comprehensive assessment of medical, psychologic, and social problems. The physician should not be concerned only with physical disorders and ignore psychosocial data; neither should the psychiatrist focus on the psyche and disregard obvious somatic disorders. Treatment must be realistic, prompt, and energetic. Undertreatment for fear of drug toxicity, overtreatment by plying the patient with multiple drugs, and delay in treatment are equally destructive. Appropriate medication and group psycho-therapy are extremely useful, but the most important element of treatment is a doctor-patient relationship that supports and sustains hope in the distressed patient.