Put your knowledge and skills to the test with the case of Mr. X, a 67yo male, who presents with new-onset cognitive impairment, gait disturbance, dyskinesia, and urinary incontinence of 2 months duration. Mr. X now requires assistance with most ADLs including ambulation. 

In terms of psychiatric history, he was diagnosed with ‪‎bipolar‬‪ ‎depression‬ 8 years ago, and has since been effectively treated with ‪valproic acid‬ and venlafaxine. Serum valproic acid level is within the therapeutic range.

What work-up would you order? What diagnosis or differential diagnosis are you considering?
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"Treated with a mood stabilizer, he becomes incontinent and walks oddly" by Kumari S, Sridhar R, and Rao M (Current Psychiatry). 

Spoken word poet Rachel Rensby shares two poems in the video below, "Depression" and "Teach Me", in which she describes her haunting and difficult experiences with depression‬. What makes Rensby's art stand out however, is that hope and strength shine through, providing inspiration for all to move forward and overcome their battles.

"I was 14 and my wrists were bleeding.
Every step felt like I was shackled to the bed post.
I thought I was just different, awkward,
uncomfortable in the skin that never felt like my own.
I felt frail, paper thin,
like I would rub away at the mere tough of limestone.
I was 16 when the pain of getting out of bed, each and every day was pushing intolerable.
See, a few years back, they wanted to diagnose me with a term,
I never wanted to hear.
Tried to make me pop pills I never wanted to take,
so I pushed it away, built my walls high, ignored it..."

When asked what population is most at risk of suicide the first response is often teenagers or young adults. In reality, however, adults over the age of 65 have the highest rate of suicide in Canada according the CMHA.  Evelyn Burns-Weinrib is an 80-year-old woman from Toronto who has experienced depression later in life and survived a suicide attempt 3 years ago. She has made her experience of living with mental illness public in hopes of breaking down many of the barriers and stigma associated with depression and aging that often prevent individuals from seeking professional help. "I think that this is something that should be talked about, not brushed under the carpet. I will talk about it whenever and wherever I can … When you get older, you face a lot of losses - the loss of your job due to forced retirement or it just disappears, the loss of family members and friends. You lose your physical health, have less money to live on, and you become more dependent on others. I've learned that these are all factors that can trigger depression in seniors," says Evelyn. In order to further educate older adults about depression and mental illness in later life she has also made a monetary donation to Baycrest in Toronto, Ontario, to develop a website targeted at seniors living depression. To learn more about Evelyn's story of survival and resiliency check out this media release from Baycrest and this video interview from CityNews Toronto.

To access Baycrest's seniors' mental health website visit www.baycrest.org/mentalhealth

Does meditating help improve levels of psychological stress and mental wellbeing? Goyal et al's recent review and metanalysis of the existing literature points to the intriguing possibilities - and limitations - of meditation and its role in stress and mood management. A preview of their conclusions: "... meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress."

Here's neuroscientist Sara Lazar explaining some of the effects meditation can have on the mind and its ability to handle stress.