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"Depression is a significant problem that is common among elderly patients. The prevalence is quite high, effecting approximately 15% of the population of over 65 years.1 Among patients with chronic diseases and those with a longer care the prevalence of depression is even higher, which is 10% to 60%. Several studies demonstrate that the comorbidity of depression and physical diseases a patient suffers creates a worse prognosis and increases mortality.2'3 Disease management becomes more difficult and not optimal because depression could cause the patient to eat less and become less cooperative in following the treatment, thus resulting in a poorer medical condition.Depression is generally commonly found in the elderly. Nevertheless, diagnosing depression in the elderly is not easy. Approximately 60% of depression patients have a co-morbid physical disease.2Detection of depression among geriatric patients is often delayed due to unspecific symptoms. Delayed detection results in delayed management, which has a bad impact on the patient's medical condition and response to treatment. This is also why co-morbidity of diseases and depression has a higher mortality rate. The following are several cases of hospitalized patients suffering from depression and a co-morbid illness"

"Gangguan psikiatri meningkatkan risiko penderitanya mengalami obesitas dan sindroma metabolik akibat interaksi faktor genetik, lingkungan, gejala penyakit psikiatri dan pengobatannya. Pengaturan asupan makan dan perubahan pola hidup tetap menjadi tatalaksana awal pada pasien dengan gangguan psikiatri. Penggunaan metformin telah disarankan dalam studi sebagai adjuvan dalam tatalaksana berat badan pada pasien gangguan psikiatri terutama yang menggunakan obat psikiatri dalam jangka panjang. Empat pasien rawat inap dengan gangguan psikiatri dipantau selama perawatan dan sebulan setelah rawat jalan dengan kontak per minggu. Dilakukan pencatatan masalah subjektif, objektif, riwayat peningkatan berat badan, riwayat pengobatan pola asupan serta pengukuran antropometri dan komposisi tubuh. Pola asupan harian dan 24 jam terakhir dikumpulkan dengan metode FFQ semi kuantitatif dan 24h dietary recall. Perencanaan terapi medik gizi dilakukan dengan restriksi kalori, peningkatan asupan protein, penyesuaian asupan karbohidrat, motivasi melakukan aktivitas fisik yang cukup dan pemberian metformin dengan dosis bertahap. Tiga pasien memiliki status gizi obes 2, 1 pasien memiliki status gizi obes morbid yang disertai massa lemak yang tinggi dan massa otot yang rendah. Seluruh pasien memiliki lingkar pinggang diatas normal, kadar kolesterol total, LDL yang tinggi dan HDL yang rendah. Tiga pasien tidak mematuhi preskripsi selama perawatan. Setelah rawat jalan, dua pasien memiliki caregiver yang memberikan pemantauan dan motivasi yang baik terhadap pasien selama sebulan dan terdapat penurunan berat badan, penurunan lingkar pinggang, dan perbaikan komposisi tubuh. Terapi medik gizi pada pasien dengan gangguan psikiatri membutuhkan kerjasama dengan caregiver agar dapat bermanfaat bagi pasien.

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Patients with psychiatric disorders experienced an increased risk of obesity and metabolic syndrome due to genetic, environmental, disease symptoms and medication factor. Diet and lifestyle modification remained the firstline modalities for management of obesity in patients with psychiatric disorders. Metformin as an adjuvant therapy is recommended for preventing weight gain in patients especially with long-time psychiatric medication usage. Four inpatients with various psychiatric disorders were monitored during hospital stay and one month after discharge with weekly contact for monitoring. Subjective symptoms and objective signs, including history of weight gain, psychiatric medication history, intake pattern, anthropometric and body composition measurements were recorded. Daily intake pattern and 24 hour food intake were recorded and analyzed with semi-quantitative FFQ method and 24h food recall, respectively. Energy restriction, adjustment of protein and carbohydrate intake, physical activity encouragement and oral metformin administration with increasing dose were implemented in all patients. Three patients were grade 2 obese, one patients was morbidly obese with high fat mass and low muscle mass. All patients showed an increased waist circumference, high total cholesterol and LDL level, and low HDL level. Three patients failed to comply with nutrition prescription. After discharge, two patients had a supportive caregivers that gave an adequate monitoring and encouragement. Weight loss, reduced waist circumference, and better body compositition were found in 2 patients with supportive caregivers. Medical nutrition therapy on patient with psychiatric disorder will benefit greatly from supportive caregiver to bring benefit for patients."