Figure 10.1 Lifetime prevalence of age-of-onset distribution of DSM-IV
Figure 10.2 Percentage of patients responding to psychotherapy versus medications and pill placebo.
Figure 10.4 Prevalence of past-year DSM-IV alcohol dependence by age in the United States
10 HUS 133 Mental Disorders
Assessment & Mental Disorders Chapter 10 October 6, 2010
True / False1. Mentally healthy people have positive attitudes, accurate perceptions, autonomy, and personal balance.2. A good assessment would include medical, psychological, and social functioning.3. The “Big Three” are Dementia, Depression, and Decubitus .4. Depression is the most common mental disorder in adults, but declines in frequency with age.5. Dementia is a family of disorders.
True / False• Alzheimer’s Disease is progressive and fatal.• Major changes with dementia include memory loss, emotional changes, and loss of motor function.• The recommended treatment for Parkinson’s Disease is Electroconvulsive Therapy (ECT)• Anxiety Disorder symptoms may include chest discomfort, sweating, difficulty breathing, and acute memory loss.• People with early-onset Schizophrenia often improve over time as neurotransmitters become more balanced.
Assessment & Mental Disorders Chapter 10 October 6, 2010
Mental Health & the Adult Life CourseLearning Objectives• How is mental health and psychopathology defined?• What are the key dimensions used for categorizing psychopathology?• Why are ethnicity and aging important variables to consider in understanding mental health?
Mental Health and the Adult Life Course• What is the difference between mental health and mental disorder? Characteristics of mentally healthy people: • Positive attitude toward self • Accurate perception of reality • Mastery of the environment • Autonomy • Personal balance • Growth and self-actualization• For older people, what would be considered abnormal may be adaptive under some circumstances. – Isolation – Passivity – Aggressiveness
Mental Health and the Adult Life CourseViewing adult’s behavior from a lifespan prospective Psychological forces • Normative changes can mimic mental disorders. • Nature of personal relationships Sociocultural forces • Being paranoid may be adaptive in certain circumstances. • Cultural differences must be taken into account. Life-Cycle Factors • An older person who wishes to go back to school. • Resistance to revealing personal information. • Sleeping patterns
Mental Health and the Adult Life CourseSociocultural influence in assessing behavior Older minorities may have experienced: • Inadequate health care • Environmental health risks • Stress of prejudice and discrimination Ethnic differences found: • Older Hispanic men show higher rate of alcohol abuse then women. • Older Hispanic women show higher rates of phobias and panic attacks than men. • Native American men also have high rates of alcohol abuse. • Older African-American men have lower rates of depression than other ethnic groups.
Development Issues in AssessmentLearning Objectives• What key areas are included in a multidimensional approach to assessment?• What factors influence the assessment of adults?• How are mental health issues assessed?• What are some major considerations for therapy across adulthood?
Development Issues in AssessmentMental status exams Useful as a quick screening of measures of mental competence • Mini-Mental Status Exam (MMSE)Psychological functioning assessed through: – Interviews – Observation – Test or questionnairesThree dimensions of social functioning: – Ties with social network – Content of interaction with one’s social network – Number and quality of interactions
Development Issues in AssessmentFactors Influencing AssessmentNegative biases – Racial – Ethnic – Age stereotypesPositive biases – Women do not abuse alcohol.
Developmental Issues in AssessmentAssessment methods: – Interview – Self-report – Report by others – Psychophysiological – Direct observation – Performance-based assessment
Developmental Issues in AssessmentDevelopmental Issues in TherapyMedical treatment – Dosage may be different for older adults. – “Start Slow; Go Slow”Psychotherapy – Different ages present different problems.
The Big Three: Depression, Delirium, and DementiaLearning Objectives• What are the most common characteristics of depression? How is depression diagnosed? What causes depression? What is the relation between suicide and age? How is depression treated?• What is delirium? How is it assessed and treated?• What is dementia? What are the major symptoms of Alzheimer’s disease? How is it diagnosed? What causes it? What are some other major forms of dementia?
Dementia, Depression, & DeliriumDepressionMyth: most older adults are depressed – Fact: rates of depression decline from young adulthood to old age for healthy people. – Less than 5% of older adult living in the community show signs of depression. – For those receiving home health care, the rate is 13%.
Dementia, Depression, & DeliriumDepressionGeneral Symptoms and Characteristics of Depression 1. Symptoms must last at least two weeks. 2. Other causes must be ruled out. 3. Clinician must determine how symptoms are affecting daily life.Older ethnic minorities show higher rates of depression. – Especially true for Chinese and Mexican Americans – One fourth of older Latinos show depressive symptoms.Gender and Depressive Symptoms – Women tend to be diagnosed with depression more than men.
Dementia, Depression, & DeliriumDepressionAssessment Scales – Beck Depression Inventory – Geriatric Depression Scale Diagnosis of depression should never be made on the basis of test score alone.Causes of Depression – two types –Situational –Organic
Dementia, Depression, & DeliriumDepressionTreatment of Depression – Most forms of depression benefit from treatment • Medication – Prozac – Paxil – Zoloft – Lexapro • Electroconvulsive therapy • Psychotherapy – Behavior therapy – Cognitive therapy Most effective? A combination of medication and therapy.
Medication vs. TherapyMost effective? A combination of medication and therapy.
Dementia, Depression, & DeliriumDeliriumCaused by: – Medical conditions • Stroke • Cardiovascular disease • Urinary Track Infection • Dehydration • Metabolic conditions – Medication side effects, substance intoxication or withdrawal, exposure to toxins, or a combinationDementiaAffects over 5 million Americans – About one half of all person over the age of 85 are affected with some form of dementia. – Could increase to 8 million in 2030 and triple to 2050 to 16 million
Dementia, Depression, & DeliriumDementiaThe family of Dementias Alzheimer’s Disease – Progressive – Fatal Characteristics of Alzheimer’s Disease – Neurological Changes ~ Definitive diagnosis can only be done by autopsy ~ Rapid cell death ~ Neurofibrillary tangles ~ Amyloid plaques Symptoms and Diagnosis – Gradual changes in cognitive function: declines in memory, to loss of remote memory, learning, attention, and judgment; disorientation in time and place; difficulties in word finding and communication; declines in personal hygiene and self-care skills; inappropriate social behavior; and changes in personality.
Dementia, Depression, & DeliriumSundowning • symptoms are worse in the eveningIntervention Strategies • Memory improvement drugs – Aricept – Namenda – ExelonCaring for Patients with Dementia at Home • Over 23 million households provide an average of 21 hours of care per week in unpaid care for relatives. • Caregivers are at risk for depression. • Effective Behavioral Strategies – Include financial plans, rethinking issues such a bathing, dressing, grooming – Reduce wandering – Incontinence – Create safe environment
Dementia, Depression, & DeliriumOther Forms of Dementia Vascular Dementia • Numerous small cerebral vascular accidents – Occurs with greater rapidity than Alzheimer’s Parkinson’s Disease • Characteristics – Slow walking – Difficulty getting into or out of chairs – Slow hand tremors – “ratcheting” • Celebrities with Parkinson’s – Muhammad Ali – Michael J. Fox • Treatment – Levodopa: raises the levels of dopamine in the brain – Sinemet: a combination of levodopa and carbidopa – Stalevo: combination of Sinemet and entacapone
Dementia, Depression, & DeliriumOther Forms of Dementia Huntingtons Disease • Involuntary flicking movement of the arms and legs • Hallucinations, paranoia, depression, and clear personality changes Alcohol Related Dementia • Wernicke – Koraskoff’s syndrome AIDS Dementia Complex (ADC) • Encephalitis, behavioral changes, decline in cognitive function • Progressive slowing of motor functions
Other Mental Disorders and ConcernsLearning Objectives• What are the symptoms of anxiety disorders? How are they treated?• What are the characteristics of people with psychotic disorders?• What are the major issues involved with substance abuse?
Other Mental DisordersAnxiety DisordersTreating Anxiety Disorders • Medication – Benzodiazepine (Valium and Librium) – SSRIs (Prozac, Paxil, and others) – Buspirone and beta-blockers • Psychotherapy – Relaxation training – Substituting rational for irrational thought – Gradual exposure to images or situations that generate anxiety
Other Mental DisordersSchizophreniaWhat is Schizophrenia? • Onset occurs most often between ages 16 and 30 • Severe impairment of thought processes to include: – Distorted perceptions (delusions) – Loss of touch with reality – A distorted sense of self – Abnormal motor behaviorTreating Schizophrenia • Anti psychotic medications • Therapy to learn symptom management & coping skills • Likely to have depression or anxiety as well
Other Mental DisordersSubstance AbuseElderly person’s drug of choice is alcohol Alcoholism includes four symptoms: • Craving • Impaired control • Physical dependence • Tolerance Alcohol dependency drops significantly with age Middle age shows effects of earlier alcoholism • Disease of the liver and pancreas • Various types of cancer • Cardiovascular disease Treatment focuses on three goals: • Stabilization • Reduction of consumption • Treatment of coexisting problems
Mental Health / Geriatric Report 1. Must be 3-4 (stapled pages) using 12 pt font 2. Must be in APA format 3. Must be original work in your own words unless data is considered common knowledge or you provide the reference. If you plagiarize (copy, lift, steal, use illegally), you will get an “F”. 4. Must have Title Page to include: • Topic / Title • Your name • Your Student Number • Date 5. Must include Reference Page to include at least 4 references 6. Topic must chosen from the list provided or approved by instructor by 10/13/10 7. Due October 27, 2010 during class
Mental Health / Geriatric ReportApproved Topics for Report• Nursing Homes Facilities (Alabama)• Assisted Living Facilities (Alabama)• Specialty Care Assisted Living Facilities (Alabama)• Depression in the elderly• Alcohol Abuse in the elderly• Schizophrenia (include geriatric specific information)• Bipolar Disorder (include geriatric specific information)• Major Depression• Obsessive-Compulsive Disorder (include geriatric specific information)
True / False• TRUE Mentally healthy people have positive attitudes, accurate perceptions, autonomy, and personal balance.• TRUE A good assessment would include medical, psychosocial, and social functioning.• FALSE The “Big Three” are Dementia, Depression, and Decubitus .• TRUE Depression is the most common mental disorder in adults, but declines in frequency with age.• TRUE Dementia is a family of disorders.
True / False• TRUE Alzheimer’s Disease is progressive and fatal.• TRUE Major changes with dementia include memory loss, emotional changes, and loss of motor function.• FALSE The recommended treatment for Parkinson’s Disease is Electroconvulsive Therapy (ECT)• FALSE Anxiety Disorder symptoms may include chest discomfort, sweating, difficulty breathing, and acute memory loss.• TRUE People with early-onset Schizophrenia often improve over time as neurotransmitters become more balanced.