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Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
Lecture 11- Mental Disorders Overview
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Lecture 11- Mental Disorders Overview

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  • 1. Lecture 11- Mental Disorders Overview
    • 1. Defining Psychopathology
    • 2. Cognitive Disorders
    • Dementia
    • Delirium
    • 3. Other Mental Disorders
    • Depression
    • Anxiety (see text)
  • 2. Lecture 11- Mental Disorders Overview
    • 4. Clinical Concerns
    • Elder Abuse
    • Suicide (see text)
    • 5. Psychological Issues in
    • Long-Term Care
    • 6. Myth Busting: Facts on Aging
    • Revisited
  • 3. Psychological Disorders in Adulthood Psychopathology= Science of psychological disorders Lie outside range of ordinary human experience
    • Subjective distress
    • Impaired in everyday life
    • Cause risk to self or others
    • Engage in socially or culturally unacceptable behavior
  • 4. Psychological Disorders in Adulthood: Diagnosis of Psychological Disorders Diagnostic and Statistical Manual of Mental Diseases (DSM-IV)
    • Based on field studies of specific disorders
    • Not developed specifically for older adults
    Diagnostic process
    • Match symptoms to those in manual
    • Must meet specific criteria
    • Develop treatment plan
  • 5. Psychological Disorders in Adulthood: Diagnosis of Psychological Disorders DSM-IV Diagnostic Axes Axis I Axis II Axis III Axis IV Axis V Clinical syndromes or disorders Personality disorders and mental retardation Medical conditions Psychosocial stressors General level of functioning
  • 6. Terminology Epidemiology
    • Lifetime prevalence - percentage of people who ever have had the disorder
    • Incidence- new cases within given period
  • 7. Cognitive Disorders (DSM-IV)
    • 1. Dementia
    • 2. Delirium
    • 3. Amnestic Disorder
    • 4.Cognitive Disorder Not Otherwise Specified
  • 8. Cognitive Disorders: Dementia Dementia
    • Clinical condition/syndrome
    • Loss of cognitive function
    • Interferes with normal activities
    • Interferes with social relationships
    1. Impairment of memory 2. Multiple disturbances of cognition 3. Impairment of executive function. 4. Disorientation. 5. Behavioral changes. Definition of Dementia Common signs
  • 9. Dementia: Causes
    • 1. Reversible
    • 2. Irreversible
  • 10. Reversible Dementia (some causes) Dementia due to treatable condition:
    • infections
    • toxic effects of drugs (polypharmacy)
    • normal pressure hydrocephalus
    • head injury
    • nutritional deficiencies
    • Korsakoff’s syndrome (vitamin B1) Wernicke’s disease
    • metabolic problems (e.g., hypothyroidism)
    • mental and sensory deprivation
    • Depression (pseudodementia)*
    • Delirium*
    Important to treat early Can become irreversible
  • 11. Irreversible: Neurological Diseases that Can Cause Dementia Disorder Cause Major symptoms Vascular dementia Transient ischemic attacks More rapid decline than AD, decline occurs in spurts Frontal lobe dementia Damage to frontal lobes Personality changes- apathy, lack of inhibition, obsessiveness, loss of judgment Parkinson’s disease Lack of dopamine in basal ganglia Tremors, shuffling gait, postural instability, speech problems Lewy Body dementia Accumulation of Lewy bodies Confusion, hallucinations, motor deficits HIV dementia Accumulation of Pick bodies Frontal and temporal lobe deterioration, personality changes, loss of speech. Pick’s disease Final stages of AIDS Apathy, confusion, concentration problems, flattened emotions
  • 12. Irreversible: Neurological Diseases that Can Cause Dementia Disorder Cause Major symptoms Huntington’s Hereditary (chromosome 4) Choreiform movements, loss of detailed memories, decreased higher order executive skills Creutzfeld- Jakob Slow virus rapid dementia and decline Down’s Syndrome Extra chromosome 21 Alzheimer’s Disease Detailed notes Detailed notes Mental retardation
  • 13. Normal Dementia 8% of all Canadians aged 65+ meet the criteria for dementia. Canadian Study of Health and Aging (1991-1992) Prevalence
  • 14. Prevalence of dementia in Canada: Canadian Study of Health and Aging (1991-1992)
    • Female to male ratio is 2:1
    • 2.4 % for 65-74 years
    • 34.5% for those aged 85+
    • If prevalence estimates remain constant, 592,000 persons will have dementia by 2021
  • 15. Prevalence of Alzheimer’s Disease and Vascular Dementia in Canada
    • Alzheimer’s 5.1% for 65+
      • 1.0% for 65-74 years
      • 26% for 85+ years
    • Vascular dementia 1.5% for 65+
      • 0.6 % for 65-74 years
      • 4.8 % for 85+ years
  • 16. Features
    • Associated with damage to the cerebral blood vessels
    • through arteriosclerosis
    • found in middle and later life (age of onset between 50-70)
    • accumulated effect of multiple cortical and subcortical infarcts
    • lead to clinical presentation
    • incidence higher in men
    • first sign delirium or small stroke
    Dementia: Vascular Dementia
  • 17. Clinical Presentation
    • Abrupt onset
    • step-wise deterioration
    • somatic complaints
    • emotional incontinence
    • history of hypertension
    • history of cebrovascular accidents
    • focal neurological symptoms
    • focal neurological signs
    Dementia: Vascular Dementia
  • 18.
    • Patient Auguste D. had dementia symptoms
    • Brain studies after her death revealed microscopic changes
    Alois Alzheimer (1864-1915)
    • Symptoms due to neuronal changes
    Dementia: Alzheimer’s Disease History
  • 19. NINCDS/ADRDA Guidlines
    • Dementia
    • Significant cognitive deficiencies
    • Progressive deterioration
    • No loss of consciousness
    • 40-90 years of age
    • No other diseases
    Criteria for probable Alzheimer’s diagnosis= Also includes
    • Medical tests
    • Family history
    • Brain scans
    • Other symptoms
    Dementia and Related Neurological Disorders: Alzheimer’s Disease
  • 20. Early Middle Late Memory loss for familiar objects and events Personality changes Behavior changes Loss of ability to perform simple everyday functions Regular progression of loss Alzheimer’s Disease: “Stages” of Progression Psychological Symptoms People do not die of Alzheimer’s per se.
  • 21. Clinical Presentation:
    • Memory loss
    • Aphasia
    • Apraxia
    • Agnosia
    • Disturbance in executive functioning
    Diagnosis done by exclusion Autopsy is only reliable method
  • 22. Clinical Presentation
  • 23. Amyloid Plaques
    • Collection of waste products of dead neurons around a core of amyloid.
    • Formation occurs long before symptoms are evident
    • Amyloid-42 most common form found in plaques
    Alzheimer’s Disease Amyloid plaque
  • 24.
    • Beta amyloid fragments eventually clump together.
    • Proteases snip the APP into fragments.
    • If APP is snipped at wrong place, beta amyloid 42 is formed.
    Alzheimer’s Disease Formation of amyloid plaques
  • 25. http://www.ahaf.org/alzdis/about/AmyloidPlaques.htm Alzheimer’s Disease Tangles
  • 26. Neurofibrillary Tangles
    • Made up of tau protein
    • Tau maintains microtubules within axons
    • Tangles form when tau changes chemically and can no longer support the microtubules
    • Leads to collapse of transport system within neuron
    Neurofibrillary tangle Alzheimer’s Disease
  • 27. http://www.alzheimers.org/tangle.html Neurofibrillary Tangles Alzheimer’s Disease
  • 28. Genetic theory Familial Alzheimer’s Disease
    • Early onset
    • Late onset
    supports Alzheimer’s Disease Causes of Alzheimer’s Disease ApoE gene 19 APP gene 21 Presenilin 1 14 Presenilin 2 1 Gene Chromosome
  • 29. Genetic theory Familial Alzheimer’s Disease
    • Early onset
    • Late onset
    supports Alzheimer’s Disease Causes of Alzheimer’s Disease Majority of early-onset cases ApoE gene 19 APP gene 21 Presenilin 1 14 Presenilin 2 1 Gene Chromosome
  • 30. Environmental Life style Head injury
    • Twin data
    • Japanese men who moved to Hawaii
    • Nun Study on mental activity
    • Severe injuries involving loss of consciousness
    • Causes damage to neurons
    Alzheimer’s Disease Causes of Alzheimer’s Disease
  • 31. Category Labazimide Anticholinesterase Glutamate enhancers Action Name Nerve growth factors Stimulate neuron growth Increases available acetylcholine Tacrine No trade name Antioxidants Anti-inflammatory Not known Advil HRT Not known Estrogen Facilitate glutamate Seligiline Stop free radicals Treatment: Alzheimer’s Disease
  • 32. Psychosocial Treatments
    • Person
    • Prompts, cues, and guidance
    • Modeling
    • Positive reinforcement
    • Structure daily activities
    • modifications to environment
    • caregiver
    • Respite care
    • Provide education
      • info on the disease progression
      • communication strategies
      • support groups
    Caregiver burden Alzheimer’s Disease: Care for Person and Caregiver
  • 33. Lecture 11- Mental Disorders Overview
    • 1. Defining Psychopathology
    • 2. Cognitive Disorders
    • Dementia
    • Delirium
    • 3. Other Mental Disorders
    • Depression
    • Anxiety (see text)
  • 34. Definition
      • Fluctuating clinical state characterized by
      • disturbances of attention, cognition, arousal,
      • mood and self-awareness
      • common in the elderly
      • often undiagnosed
    Delirium (confusional state)
  • 35. Symptoms
    • Impairment in attention and disorientation
      • -distracted, slowed, disorganized thinking
    • Hallucinations may be present
    • -usually more visual than auditory
    • Fluctuating level of awareness
    • -mild confusion to stupor or active delirium
    • Speech may be incoherent
    • Confusion regarding day-to-day procedures or roles
    • Remote and recent memory impaired
    Delirium (confusional state)
  • 36. Symptoms
    • Restlessness, aggressiveness, frightened
    • Delusions of persecution possible
    • Disturbance of sleep-wake cycle
    • Anxiety and lack of cooperativeness
    • Fluctuations throughout day
      • worse in the evening
      • can be lucid intervals
    Delirium (confusional state)
  • 37. Causes
    • Infections or fever
    • strokes/cardiovascular disorders
    • drug intoxication (polypharmacy or abuse) or withdrawl
    • exacerbation of underlying medical illness
    • metabolic and nutritional disorders
    • postoperative stress*
      • or other factors related to hospitalization such as
      • sleep loss, excessive sensory input
    Delirium (confusional state)
  • 38. Course and Treatment
    • Brief duration (usually less than a week)
    • some forms resolve on own
    • other forms, treatment depends on cause
    • while delirious
      • carefully-controlled environment (not too stimulating)
      • brief and continued reassurance
      • monitor nutritional and fluid status of person
      • help the caregivers understand what is going
    Delirium (confusional state)
  • 39. Differential Diagnosis Delirium Dementia
    • Rapid onset
    • marked attentional disturbance
    • confusion prominent/clouding of consciousness
    • fluctuating clinical course
    • agitation and behavioral symptoms
    • potentially reversible
    • Usually insidious onset
    • memory systems impaired
    • consciousness intact
    • slower, progressive course
    • subtle behavioral symptoms
    • can be irreversible
  • 40. Lecture 11- Mental Disorders Overview
    • 1. Defining Psychopathology
    • 2. Cognitive Disorders
    • Dementia
    • Delirium
    • 3. Other Mental Disorders
    • Depression
    • Anxiety (see text)
  • 41. Depression Mood Disorders and features
    • Depressive disorders- sad mood
    • Bipolar disorders- involve manic episode
    • Dysthymic Disorder-chronic but less severe
    • Mood disorders due to a general medical
    • condition
  • 42. Diagnostic Features of Major Depressive Episode (DSM-IV) E ssential Features Associated Symptoms (1 of 2 required) (5 of 9 required)
    • Depressed mood
    • Loss of interest or pleasure
    • Depressed mood for most of the day
    • marked reduction in interest in daily activities
    • 5% weight loss or significant change in appetite (increase or decrease)
    • almost daily insomnia or hypersomnia
    • almost daily physical agitation or retardation
    • almost daily decreased energy or fatigue
    • almost daily feelings of worthlessness or feelings of guilt
    • almost daily decreased concentration or decreased decisiveness
    • frequent thoughts of death or suicide
  • 43. NCS= 13% men 21% women Lifetime prevalence: Persons over 65: 1% major depressive disorder 2% dysthymia (chronic but less severe depression) Depression Prevalence of Depressive DIsorders However, 8-20% of older adults report symptoms
  • 44.
    • 12-20% in clinics and hospitals
    • 30% in long-term care settings
    Higher Prevalence of Mood Disorders in Medical Settings: Depression Can lead to greater risk of more serious disorder and even fatal impairment
  • 45. Depression Prevalence of Depressive DIsorders Myth: aging leads to depression- old age is depressing Reality: rates for major depression are lower in the elderly compared to younger adults
  • 46. Depression Features of Mood Disorders in Older Adults
    • Less likely to report traditional symptoms involving negative feelings
    • More likely to seek treatment for bodily complaints
    • Seek treatment for disorders other than mood (anxiety, cognitive, bodily delusions)
  • 47. Depression Features of Mood Disorders in Older Adults/causes Depletion syndrome
    • Lack of energy
    • Hopelessness
    • Loss of appetite
    Late-onset depression
    • Mild or moderate
    • First appears after age 65
  • 48. Depression Causes of Age Differences in Mood Disorders
    • Personality and emotional changes associated with aging
    • Cohort differences in experience of depression
  • 49.
    • Older adults do not report symptoms accurately
    • Professionals not attuned to diagnosis of older adults
    • Not enough time spent with older adults
    • Wish to avoid stigmatization
    • Therapists unaware of benefits
    • cognitive difficulty can accompany depression
    • dementia and depression can both be present
    • “ pseudodementia”
    Problems in Diagnosis of Mood Disorders: Depression
  • 50.
    • Dementia has insidious onset (years)
    • history of psychiatric problems more common in
        • pseudodementia
    • dementia (mild) complains little about memory/concealment
    • depressive pseudodementia complains
    • dementia- behavior in line with clinical severity
    • depression- incongruities between behavior and
      • severity of cognitive deficit
    Differentiating Dementia and Pseudodementia Depression
  • 51.
    • Drug therapies
    • Psychotherapy
    Treatment Depression
  • 52. Lecture 11- Mental Disorders Overview
    • 4. Clinical Concerns
    • Elder Abuse
    • Suicide (see text)
    • 5. Psychological Issues in
    • Long-Term Care
    • 6. Myth Busting: Facts on Aging
    • Revisited
  • 53. Elder Abuse Types of Abuse
    • Physical
    • Sexual
    • Emotional or psychological
    • Neglect
    • Abandonment
    • Financial or material
    Actions taken against older adults through inflicting psychological or physical harm
  • 54. Elder Abuse Prevalence Estimates in Canada
    • Podnieks et al. (1989) interviewed (by phone) community dwelling seniors
    • Rate for abuse and neglect among seniors
        • is 4% overall
      • material abuse (2.5%)
      • chronic verbal agression (1.4%)
      • physical violence (.5%)
      • neglect (.4%)
  • 55. Elder Abuse Prevalence Estimates in Canada (region)
    • B.C. 5.3%
    • Prairies 3.0%
    • Ontario 4.0%
    • Quebec 4.0%
    • Atlantic 3.8%
  • 56. Elder Abuse (see this table in the text) Children most frequent abusers Highest risk for oldest old
  • 57. Lecture 11- Mental Disorders Overview
    • 4. Clinical Concerns
    • Elder Abuse
    • Suicide (see text)
    • 5. Psychological Issues in
    • Long-Term Care
    • 6. Myth Busting: Facts on Aging
    • Revisited
  • 58. Psychological Issues in Long-Term Care Biopsychosocial Factors Differences among residents in physical functioning BIO- PSYCHO- Variations in psychological resources and needs SOCIAL Cultural factors further influence relationships
  • 59. Psychological Issues in Long-Term Care Competence-Press Model of Environmental Adaptation Negative affect Maladaptive behavior Negative affect Maladaptive behavior Positive affect Adaptive behavior Adaptation Level Zone of maximum performance potential Tolerable affect Marginally adaptive behavior Tolerable affect Marginally adaptive behavior Press Competence
  • 60. Lecture 11- Mental Disorders Overview
    • 4. Clinical Concerns
    • Elder Abuse
    • Suicide (see text)
    • 5. Psychological Issues in
    • Long-Term Care
    • 6. Myth Busting: Facts on Aging
    • Revisited
  • 61. Myth Busting: Facts on Aging Revisited
    • #1 The majority of old people (age 65+) are senile (have defective memory, are disoriented, or demented)
    • False
  • 62. Myth Busting: Facts on Aging Revisited
    • #5 The majority of old people feel miserable most of the time.
    • False
  • 63. Myth Busting: Facts on Aging Revisited
    • #7 At least one tenth of the aged are living in long-stay institutions (such as nursing homes, mental hospitals, homes for the aged, etc.)
    • False (see text)
  • 64. Myth Busting: Facts on Aging Revisited
    • #10 Over three fourths of the aged are healthy enough to do their normal activities without help.
    • True
  • 65. Myth Busting: Facts on Aging Revisited
    • #13 Depression is more frequent among the elderly than among younger people.
    • False

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