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Doctor of Physical Therapy
Geriatrics
Depression
Depression
 Most common psychological problem in the
elderly
 4-23% prevalence
 commonly neglected in elderly
 Loss of health
 Stress of physical illness, associated with
physical disability
 Pain
 Life style changes
 Psychosocial response of depression
 Dramatically affect the patient response to
rehabilitation
Depression
 Make rehabilitation a challenge
 Apathy, hopelessness, withdrawal
 They constitute a problem that physical
therapists must deal with frequently
 Characteristics of depression
 Factors associated with depression
 Treatment approaches
 Modifications of the physical therapist’s
treatment plan
 That appropriate for a depressed elderly
patient
Characteristics
 Mood-feelings of sadness, hopelessness, and
loss of interest and pleasure in previously
pleasurable activities
 Cognitive-difficulty in concentrating, memory
complaints, slowed thinking, indecisiveness,
and perceived lack of competence and control
 Feelings of low self-esteem
 Worthlessness
 Decreased motivation
 Apathy
 Excessive guilt
Characteristics
 Difficulties with interpersonal interaction-
withdrawal form family and friends and neglect
previously pleasurable activities
 Somatic symptoms
 Appetite-loss of weight, may involve excessive
eating
 Sleep-insomnia and early morning awakening,
may be hyper insomnia
 Psychomotor function-retarded and may
agitated
Diagnosis-Terminologies-
Types
 DSM- 4 ( diagnosis of mental disorders )
 According to APA
 Two important diagnosis are
1. Major depressive episode
2. Adjustment disorder with
depressed mood
Major depressive episode
1. Depressed mood
2. Markedly diminished interest or pleasure in
all, or almost all, activities
3. Weight loss or weight gain when not dieting,
or increase or decrease in apatite
4. Insomnia or hyper insomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
Major depressive episode
7. Feeling of worthlessness or excessive
or inappropriate guilt
8. Diminished ability to think or
concentrate or indecisiveness
9. Recurrent thoughts of death,
recurrent suicidal ideation, as
suicide attempts or a specific plan
for committing suicide
Adjustment disorder with
depressed mood
1. Emotional or behavioral symptoms in response to an identifiable
stressor occurring with in 3 months of the onset of the stressor
2. Clinically significant symptoms or behaviors as evidenced by
a) Marked distress that is in excess of what
would be expected from exposure to the
stressor
b) Significant impairment in social or
occupational functioning
Assessment
 The diagnosis is based on history, observation
and careful interview of the patient and close
family members and friends
 Self-report scales-good screen devices
 Beck depression inventory
 CES-D (Center for Epidemiological Studies
Depression)
 Zung self rating depression scale-SDS
Models of Depression
 The Cognitive model
 The learned-helplessness model
 The interpersonal model
 The neurobiological model
 Social resources model
Factors associated with
depression
 Presence of illness
 High level of pain
 Physical disability
 Symptoms severity
 Low income
 Decrease social support
Management
 Pharmacotherapy-major depressive
episodes-the most common approach
of treatment
 Psychotherapy-adjustment disorder
with depressed mood
 Exercise-has limited research-it is of
particular interest of physical
therapists
Pharmacotherapy
 Five major categories
 Selective serotonin reuptake inhibitors
 Tricyclic or tetracyclic anti depressants
 Heterocyclic antidepressants
 Serotonin/norepinephrine reuptake inhibitors
 Monoamine oxidase inhibitors
Psychotherapy
 Older patients are less likely to take
psychotherapy
 Health professionals may be biased against
older persons in that they believe that elders
will not benefit from psychotherapy
 Research shows that psychotherapy is an
effective treatment for depression in elderly
 Psychotherapy treatment for elderly include
behavioral, cognitive, and brief psychodynamic
therapies
Psychotherapy
 Behavioral treatments focus on
modifying the behavioral components
of depression
 Cognitive approaches attempt to
change the negative schemata that
accompany depression
 Psychodynamic therapies focus on the
personality characteristics
Exercise
 Occasionally used as an effective
treatment for depression
 Research shows a clear relation ship
between depression and physical
activity
 Vigorous aerobics
 Cardiovascular risk factor
 Heavy aerobics improve depression
 Mild recreational activity will be
associated with increase in feelings of
wellbeing
Exercise
 Time out from periods of psychological
stress
 Increased social interaction
 Increased feelings of mystery
 Increase secretion of amines-
tridepressant effects
 Induce adrenaline response- sleep
regulation and improve symptoms of
depression
 Exercise is not commonly accepted
treatment for treating depression
Working with depressed
patients
 Establishing short term goals
 Emphasizing achievements rather than
pleasure
 Avoid excessive carefulness
 Assess and Treat the patient in his own
time
References
 Andrew A. guccione (2000). Geriatric Physical
Therapy:Mosby

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Depression

  • 1. Doctor of Physical Therapy Geriatrics Depression
  • 2. Depression  Most common psychological problem in the elderly  4-23% prevalence  commonly neglected in elderly  Loss of health  Stress of physical illness, associated with physical disability  Pain  Life style changes  Psychosocial response of depression  Dramatically affect the patient response to rehabilitation
  • 3. Depression  Make rehabilitation a challenge  Apathy, hopelessness, withdrawal  They constitute a problem that physical therapists must deal with frequently  Characteristics of depression  Factors associated with depression  Treatment approaches  Modifications of the physical therapist’s treatment plan  That appropriate for a depressed elderly patient
  • 4. Characteristics  Mood-feelings of sadness, hopelessness, and loss of interest and pleasure in previously pleasurable activities  Cognitive-difficulty in concentrating, memory complaints, slowed thinking, indecisiveness, and perceived lack of competence and control  Feelings of low self-esteem  Worthlessness  Decreased motivation  Apathy  Excessive guilt
  • 5. Characteristics  Difficulties with interpersonal interaction- withdrawal form family and friends and neglect previously pleasurable activities  Somatic symptoms  Appetite-loss of weight, may involve excessive eating  Sleep-insomnia and early morning awakening, may be hyper insomnia  Psychomotor function-retarded and may agitated
  • 6. Diagnosis-Terminologies- Types  DSM- 4 ( diagnosis of mental disorders )  According to APA  Two important diagnosis are 1. Major depressive episode 2. Adjustment disorder with depressed mood
  • 7. Major depressive episode 1. Depressed mood 2. Markedly diminished interest or pleasure in all, or almost all, activities 3. Weight loss or weight gain when not dieting, or increase or decrease in apatite 4. Insomnia or hyper insomnia 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy
  • 8. Major depressive episode 7. Feeling of worthlessness or excessive or inappropriate guilt 8. Diminished ability to think or concentrate or indecisiveness 9. Recurrent thoughts of death, recurrent suicidal ideation, as suicide attempts or a specific plan for committing suicide
  • 9. Adjustment disorder with depressed mood 1. Emotional or behavioral symptoms in response to an identifiable stressor occurring with in 3 months of the onset of the stressor 2. Clinically significant symptoms or behaviors as evidenced by a) Marked distress that is in excess of what would be expected from exposure to the stressor b) Significant impairment in social or occupational functioning
  • 10. Assessment  The diagnosis is based on history, observation and careful interview of the patient and close family members and friends  Self-report scales-good screen devices  Beck depression inventory  CES-D (Center for Epidemiological Studies Depression)  Zung self rating depression scale-SDS
  • 11. Models of Depression  The Cognitive model  The learned-helplessness model  The interpersonal model  The neurobiological model  Social resources model
  • 12. Factors associated with depression  Presence of illness  High level of pain  Physical disability  Symptoms severity  Low income  Decrease social support
  • 13. Management  Pharmacotherapy-major depressive episodes-the most common approach of treatment  Psychotherapy-adjustment disorder with depressed mood  Exercise-has limited research-it is of particular interest of physical therapists
  • 14. Pharmacotherapy  Five major categories  Selective serotonin reuptake inhibitors  Tricyclic or tetracyclic anti depressants  Heterocyclic antidepressants  Serotonin/norepinephrine reuptake inhibitors  Monoamine oxidase inhibitors
  • 15. Psychotherapy  Older patients are less likely to take psychotherapy  Health professionals may be biased against older persons in that they believe that elders will not benefit from psychotherapy  Research shows that psychotherapy is an effective treatment for depression in elderly  Psychotherapy treatment for elderly include behavioral, cognitive, and brief psychodynamic therapies
  • 16. Psychotherapy  Behavioral treatments focus on modifying the behavioral components of depression  Cognitive approaches attempt to change the negative schemata that accompany depression  Psychodynamic therapies focus on the personality characteristics
  • 17. Exercise  Occasionally used as an effective treatment for depression  Research shows a clear relation ship between depression and physical activity  Vigorous aerobics  Cardiovascular risk factor  Heavy aerobics improve depression  Mild recreational activity will be associated with increase in feelings of wellbeing
  • 18. Exercise  Time out from periods of psychological stress  Increased social interaction  Increased feelings of mystery  Increase secretion of amines- tridepressant effects  Induce adrenaline response- sleep regulation and improve symptoms of depression  Exercise is not commonly accepted treatment for treating depression
  • 19. Working with depressed patients  Establishing short term goals  Emphasizing achievements rather than pleasure  Avoid excessive carefulness  Assess and Treat the patient in his own time
  • 20. References  Andrew A. guccione (2000). Geriatric Physical Therapy:Mosby

Editor's Notes

  1. A thought process for developing healthier thinking. Cognitive behavior therapy is based on a cognitive theory of psychopathology. The cognitive model describes how people's perceptions of, or spontaneous thoughts about, situations influence their emotional, behavioral (and often physiological) reactions. 2.  It is characterized by the subject's acceptance of their powerlessness:  3. It is based on the premises that responses to stimuli represent the output of the functional integration of three distinct, although overlapping, systems. ... This modelis a heuristic representation of a neural systems approach to the neurobiology of motivated behavior. 4.