Clinical
Assessment,
Mental Health and
Mental Disorders
Chapter 4
Defining mental health and
psychopathology
 What is normal?
 Standards for behavior change across time
 What are the ch...
Multidimensional life-span
approach to psychopathology
Biological Forces
Physical problems provide clues
Physical problems may present as
psychological
Psychological
Forces
 Key to understanding
psychopathology
 Normal changes in aging can
mimic or cover up mental
disorde...
Sociocultural forces
 Customs differ across cultures
Is it normal?
Or is it just
crazy?
Life-Cycle factors
 Past experiences
Ethnicity and mental health
Developmental issues in
assessment and therapy
 What is assessment?
Multidimensional assessment
Factors Influencing Assessment
• Negative biases
• Positive biasesBiases
• Not always ideal
environment
• Physical health
...
Assessment methods
Interview
Self-report
Report by others
Psychophysiological
assessment
Direct observation
Performance-ba...
Depression
• Most common
• Most treatable
Delirium
• Disturbance of
consciousness
• Change in
cognition
Dementia
• Losing ...
0
2
4
18-29
30-44
45-64
>65
% of depression
Depression
 General Symptoms and Characteristics of People
with Depression
1. Dysphoria—feeling “down” or “blue”
2. Accom...
Older ethnic minorities=higher
rates of depression
Treatment of Depression
 All forms of depression benefit from some form of
therapy
 Medication – selective serotonin reu...
 Electroconvulsive therapy
 Psychotherapy
Behavior therapy
Cognitive therapy
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders
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Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders

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  • The difference has never been clearly defined
    When these characteristics are absent, mental disorders are more likely
    Book talks about how some maladaptiveness is good for older adults, I don’t agreec
  • Prevalence of mental disorders with age
  • If a young man and an old man walked into your clinic complaining of lack of sleep, changes in appetite, lack of energy and feeling down—what would you say?
    Can’t identify them identically
    Same with psychopathology-symptoms have different meaning, different causes and different symptoms for disorders throughout the lifespan
  • Health problems increase with age so must be more aware of them
  • Physical problems may provide clues about underlying psychological difficulties
    changes in appetite may mean depression
  • Some physical problems may present as psychological
    Irritability and depression = thyroid problem
    memory loss = vitamin deficiency
  • People’s relationships are also a key dimension in understanding how psychopathology is manifested
  • Younger people are expanding social networks
  • Older people are shrinking them
  • Must ask, is the behavior appropriate in that setting?
  • How you behave is strongly affected by past experiences
    Grow up a cheerful little boy in healthy, loving family-grow into cheerful old man
  • Grow up in the middle east and you could become a great scholar…or a suicide bomber
  • Minorities tend to have more mental health problems in America
    Japanese may have been put in concentration camp during WWII—this man just scaled everest at 70
    Little is known about minorities other than blacks
  • Formal process of measuring, understanding, and predicting behavior
    Gather information: Medical, psychological, socioculture
    How?
    Through interviews, observation, tests, clinical examinations
  • Approach from different angles-most effective
  • Negative biases: racial, ethnic, age stereotypes
    May diagnose problems that don’t exist, especially untreatable problems rather than treatable
    Positive biases can also work against people: “older adults are cute” “educated women aren’t victims of domestic violence”
    Assessment may take place in emergency room
    Physical health may lead to negative bias
  • Interviews most common
    Self-report: give info about self--may not be honest
    Report by others: family members and friends—won’t tell the whole story
    Psychophysiological-EEG measures brain activity, reaction to anxiety
    Performance-based give them activities to do
  • Depression is becoming more common among elderly
    2-5% among adult population, 1-2% among older population
    15% of community residents
  • Dysphoria the most prominent symptom
  • Older ethnic minorities show higher rates of depression. EXCEPT blacks, eskimos, etc. bcuz they value the elderly more
    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.
  • Beck’s Depression Inventory
    Diagnosis of depression should never be made on the basis of test score alone.
  • SSRIs have lowest side effects, though may cause suicidality
    Boosts serotonin-Prozak
  • Behavior therapy focuses on altering behavior without addressing underlying causes
    Cognitive alters way people think
  • Figure 10.2 Percentage of patients responding to psychotherapy versus medications and pill placebo.
  • Chapter 4 - Clinical Assessment, Mental Health and Mental Disorders

    1. 1. Clinical Assessment, Mental Health and Mental Disorders Chapter 4
    2. 2. Defining mental health and psychopathology  What is normal?  Standards for behavior change across time  What are the characteristics of people with good mental health?  positive attitude toward self  accurate perception of reality  mastery of the environment  Autonomy  personal balance  growth and self-actualization
    3. 3. Multidimensional life-span approach to psychopathology
    4. 4. Biological Forces
    5. 5. Physical problems provide clues
    6. 6. Physical problems may present as psychological
    7. 7. Psychological Forces  Key to understanding psychopathology  Normal changes in aging can mimic or cover up mental disorders so it’s tricky
    8. 8. Sociocultural forces  Customs differ across cultures Is it normal? Or is it just crazy?
    9. 9. Life-Cycle factors  Past experiences
    10. 10. Ethnicity and mental health
    11. 11. Developmental issues in assessment and therapy  What is assessment?
    12. 12. Multidimensional assessment
    13. 13. Factors Influencing Assessment • Negative biases • Positive biasesBiases • Not always ideal environment • Physical health Environmental Conditions
    14. 14. Assessment methods Interview Self-report Report by others Psychophysiological assessment Direct observation Performance-based assessment
    15. 15. Depression • Most common • Most treatable Delirium • Disturbance of consciousness • Change in cognition Dementia • Losing your mind • Confusion • Vegetative
    16. 16. 0 2 4 18-29 30-44 45-64 >65 % of depression
    17. 17. Depression  General Symptoms and Characteristics of People with Depression 1. Dysphoria—feeling “down” or “blue” 2. Accompanying physical symptoms  Insomnia  Changes in appetite  Diffused pain  Trouble breathing  Headaches  Fatigue  Sensory loss
    18. 18. Older ethnic minorities=higher rates of depression
    19. 19. Treatment of Depression  All forms of depression benefit from some form of therapy  Medication – selective serotonin reuptake inhibitors (SSRI)  Fluoxetine (Prozac)  Paroxetine (Paxil  Sertraline (Zoloft)  Escitalopram (Lexapro Other types  Norepinephrine reuptake inhibitors (SNRI)  Norepinephrine and dopamine reuptake inhibitors (NDRI)  Combined reuptake inhibitors and receptor blockers  Tetrecyclic antidepressants
    20. 20.  Electroconvulsive therapy  Psychotherapy Behavior therapy Cognitive therapy

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