Psychiatric comorbidity in the frail patient

The psychopathological syndromes associated with the organic disease in the frail patient are put in the focus of our studies. In the frail patient, mood disorders show a multifacet appearance often associated to the invalidating pathologies or determined by the interaction between the diseases and the individual personality traits. A psychotic break can worsen the evolution of the clinical status. In the clinical practice with the frail elderly, the diagnostic and therapeutic phases change to some extent. The psychiatric diagnosis based upon the DSM-IV-TR shall include a multiaxial approach, with the general medical conditions coded on axis III. The therapeutic planning must be based on rules taken from the field of sciences of complexity; in the field of complexity, the evolution of the clinical status is not expectable and the points of discontinuity are the rule. The difficulties to reach a “secure base” makes the therapeutic dynamics be attracted from areas of stability in the mid of chaos, named “chaotic attractors”.