Question: My Mom is in her seventies. She has always been very active. All of a sudden, after she fell in a grocery store for no apparent reason.  She hasn’t been the same. She didn’t break anything.  She had an MRI and it was normal. They didn’t find anything wrong. But she is really spacey now and sometimes, she doesn’t even make so much sense.

Anne Fenton, MD: Your description of the change you have seen in your mother suggests that there may be some additional problem that may not be picked up by an MRI. Often, people tell me about a change in their parent’s status “ever since” some accident or a fall. Because we think in terms of cause and effect, it may seem as though the change is due to the fall. However, many times, it turns out that the fall is due to the change. Older people, for example, often experience “mini strokes” which they may not realize or remember. Such events are caused by tiny events in the brain that can cause temporary or permanent damage, and related personality or behavioral changes. The geriatric specialist is best suited to examine your mother. Sometimes, certain neurological and neuropsychological tests can pick up subtle mental changes that MRI’s and CT scans cannot.

Question: I’m afraid to bring my daughter to a psychiatrist because he/she might only want to prescribe medication for her. She is a depressed teen, but I think she is going through some pretty normal things…peer pressure, boys, school, etc. Still, if she needs medication, I don’t want to stand in the way, either. I’m just afraid that “if the only tool you have is a hammer, all your problems look like nails.” What if something is really bothering her and she just needs to talk to someone?

Anne Fenton, MD: The process of evaluation may result in both identifying the issues or symptoms and recommending treatment. However, if treatment is recommended, only you can give consent. According to Massachusetts law, for a child under the age of 18, only the parent can legally consent or decline a treatment recommendation. By 17, both the child and the parent have to consent or decline treatment.

If you prefer to try a non medication treatment as a first approach, your daughter can see a psychologist or licensed clinical social worker. Your child’s pediatrician can refer you, or you can consult the list of treaters covered by your insurance. School guidance counselors may offer some recommendations as well.

If your child should need a medication, as indicated by lack of improvement or increase in symptoms, it would be wise to consult a child psychiatrist.