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Good mental health requires good physical health for seniors

Monday, May 12, 2003

SIKESTON - While patients are admitted to Missouri Delta Medical Center's Senior Lifestyles unit for mental health issues, it's often something the physical doctors fix that gets them back to normal.

Dr. Abhilash Desai, psychiatrist for Missouri Delta Medical Center's Senior Lifestyles unit, said he often finds himself often getting credit for curing psychiatric disorders actually cleared up by doctors specializing in internal medicine. "You can not be mentally healthy until you are physically healthy - like two sides of a coin," he said. "They are really intertwined."

Regular physician practices focus on physical and psychiatrists focus on the mental, Desai pointed out. "So you miss out on the other side of the coin. At the Senior Lifestyles unit, each patient is seen by a psychiatrist and an internist. We address both mental and physical health aggressively."

Desai said in addition to the physicians, support staff such as physical therapists, occupational therapists, speech therapists and a nutritional specialist are also important for the patients.

There is also a social worker and activity therapist to address things like environmental and social issues. "They address issues - social and physical - that a psychiatrist like me can not really adequately address," Desai said. "This is what's needed for mental health - all aspects need to be addressed."

When a patient come into Senior Lifestyles, the first thing the staff does is review what medications the patient is taking. "Sometimes medications themselves can cause mental health problems," Desai said.

At this time they also determine if the patient should be taking some psychiatric medicine and, if so, what their best option and dosage are.

One of the most important things they do in the Senior Lifestyles unit, however, is to check the patient for physical problems that may cause mental problems.

For example, Desai offered, an infection or thyroid problem may be behind what appears to be a mental problem. "They change the brain chemicals directly," Desai said, "making the patient depressed, agitated, aggressive."

Desai said in many cases, fixing the physical problem means they never even need to prescribe any psychiatric medicine.

Depression and behavioral disorders in dementia patients are the two conditions that make up 80 percent of the mental health problems at Senior Lifestyles with Alzheimer's Disease being one of the leading causes of dementia. "We specialize in Alzheimer's-related health issues," said Desai.

Dementia in and of itself is not necessarily a reason for inpatient care. "Some dementia patients are calm," said Desai. About 80 percent, however, are aggressive, refuse to eat or won't sleep, or "even have psychotic symptoms like paranoia or hallucinations."

While Senior Lifestyles caters only to those 55 and older, Desai said there is no reason the benefits enjoyed by patients in his unit should be restricted to only older people. Desai said he would like to see the "interdisciplinary care" model applied to all ages in the community. "The idea is to keep them well in the community so they don't need in-patient care at all," Desai said.

Psychiatrist and internist coordination is not seen in most psychiatric wards, Desai said, and while gaining popularity in geriatric wards, "it is still much less than what it should be."

"The lack of close interaction between health care providers increases the cost of health care," Desai added. "It can drastically reduce the need for hospitalization."

May is Mental Health Awareness Month, according to Rebekah Halter, marketing director for Missouri Delta Medical Center's Senior Lifestyles unit.