PSYCHIATRIC THERAPY IN THE GERIATRIC PATIENT

Remarkable changes have occurred during the course of the last fifty years in the relative numbers of patients in different psychiatric categories constituting the population of psychiatric hospitals. At about the turn of the century, a considerable proportion of patients were suffering from general paresis, but the discovery of the spirochete and the institution of curative and preventive measures have reduced the incidence of this condition to the extent that many young psychiatrists have never met the disorder. Following the advent of electroshock therapy in 1936, the chronically depressed patient no longer needed to wait for a spontaneous remission; and nowadays the duration of hospitalization has been reduced to much shorter periods so that a large number of beds, and indeed wards, previously assigned to depressed patients have been turned over for the care of other types of illnesses. In fact, many such patients, now able to receive electrotherapy in the office, do not require hospitalization. For decades, because of the early age of onset and of the poor prognosis, schizophrenia has been the category under which the greatest number of patients have been admitted and under which the largest number of patients have been hospitalized. Insulin shock therapy has had marked effects in shortening the duration of hospitalization of many schizophrenics, even though adequate follow-up studies now becoming available appear to indicate that the number of long-term “cures” is not significantly greater than in untreated cases (1). In recent years another change has been occurring in the distribution of the population of mental hospitals-a change that will probably produce results of major significance not only medically but also socially, politically, and economically. With the distinct increase in life expectancy due to the many advances in other fields of medicine, psychiatry is being presented with a problem for which, with conventional attitudes, there appears no answer. The number of patients admitted to hospitals with the diagnosis of senility and arteriosclerosis (“organic” disorders) has been rapidly approaching the number admitted with the diagnosis of schizophrenia (2). Whereas insulin shock therapy offers some hope for schizophrenics, it has been customary to look upon senile or arteriosclerotic patients as entering the hospital for purely custodial purposes until illness and death remove them from the hospital ward.