This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose and treat. The good news is that there are innovative programs, tools and resources that can help.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
Mental health includes a broad range of factors, from emotional and psychological well-being to the ability to handle stress and adapt to life's challenges. It's essential to acknowledge and address mental health concerns just as we would with physical health issues. Seeking help, support, and treatment when needed is crucial for individuals to lead happy and productive lives.
The stigma surrounding mental health issues is slowly decreasing, which is a positive step toward encouraging people to talk about their mental health and seek assistance without fear of judgment. Remember, taking care of your mental health is not a sign of weakness; it's a sign of strength and self-awareness. It's also essential to support others in their mental health journeys, as we all have a role to play in creating a more compassionate and understanding society.
Absolutely, mental health matters greatly. Mental health is a fundamental aspect of our overall well-being and quality of life. It affects how we think, feel, and act, and it plays a significant role in our ability to cope with stress, build and maintain healthy relationships, and make choices that lead to a fulfilling life.
Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose and treat. The good news is that there are innovative programs, tools and resources that can help.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
Mental health includes a broad range of factors, from emotional and psychological well-being to the ability to handle stress and adapt to life's challenges. It's essential to acknowledge and address mental health concerns just as we would with physical health issues. Seeking help, support, and treatment when needed is crucial for individuals to lead happy and productive lives.
The stigma surrounding mental health issues is slowly decreasing, which is a positive step toward encouraging people to talk about their mental health and seek assistance without fear of judgment. Remember, taking care of your mental health is not a sign of weakness; it's a sign of strength and self-awareness. It's also essential to support others in their mental health journeys, as we all have a role to play in creating a more compassionate and understanding society.
Absolutely, mental health matters greatly. Mental health is a fundamental aspect of our overall well-being and quality of life. It affects how we think, feel, and act, and it plays a significant role in our ability to cope with stress, build and maintain healthy relationships, and make choices that lead to a fulfilling life.
Geriatric Psychology Report prepared by Juvy TorresJuvy Torres
Geriatric psychology is a sub-field of psychology that specializes in the mental and physical health of those in the later stage of life. Also known as the Psychology of Aging( 65 and up).
All images and texts are copyrighted to their respective owners. This is for educational use only.
-Definition of mental health
-Definition of mental illness
-When do you need to see a psychiatrist?
-Causes of mental illness
-Consequences of mental illness
-Treatment team
-Medications used in mental illness
-Myths and facts about mental illness (misconceptions)
We have discussed mental illness of men, women, and children and its causes, types, symptoms, treatments, conditions, and resources on the occasion of World Mental Health Day 10th October 2022
The cornerstone of someone's mental health is how they think, feel, and behave. Mental health specialists can help people with disorders like addiction, bipolar disorder, depression, and anxiety.
Mental health can have an effect on daily life, interpersonal connections, and physical health.
This connection, nevertheless, also functions the opposite way around. Personal circumstances, social ties, and physical ailments can all have an impact on mental illness. Maintaining
The cornerstone of someone’s mental health is how they think, feel, and behave. Mental health specialists can help people with disorders like addiction, bipolar disorder, depression, and anxiety.
Traumatic Brain Injury to temporal lobe and cognitive rehabilitationRavi Soni
This presentation briefs you about temporal lobe basic anatomy, Structures, functions, Mechanisms of Temporal lobe Injury and Cognitive rehabilitation strategies for temporal lobe deficits
Alzheimer's disease: Clinical Assessment and ManagementRavi Soni
This PPT is a seminar on the Alzheimer's disease which was prepared for sensitizing post graduate psychiatry students on the day of World Alzheimer's Day.
Evidence based treatment approaches for prevention of dementiaRavi Soni
This presentation reviews all the available treatment which have been used for prevention of dementia. The evidences were taken from the Cochrane reviews and library.
Relationship of Metabolic syndrome and cognitive impairment has been discussed. Metabolic causes of Dementia and their reversibility has been discussed.
Late onset mania is a kind of Psychiatric illness in which Manic symptoms develops for the first time after the age of 60 years or the continuation of recurrent bipolar illness.
This PPT contains all the important guidelines that are needed to manage a patient of Dementia. It involves diagnosis, psychosocial treatment, non-pharmacological management and pharmacological management. This PPT is prepared from NICE, APA and SIGN guidelines.
This presentation describes various movement disorders and its management strategies with particular focus of management of parkinson's disease. It gives basic overview of the drugs also.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Dr. Ravi Soni
DM Geriatric Psychiatry
Introduction
Consultant Geriatric Psychiatrist
GIPS Psychiatry Clinic
[Memory clinic and Geriatric Psychiatry Clinic]
Mobile No: 7379076870, 9601555370
Area of Work:
o Elderly Psychiatric Illnesses including
Depression, Psychosis, bipolar disorder,
Anxiety disorder etc.
o Management of all types of Dementia
o Expert in Management of Delirium
o Counselling and Psychotherapy
Achievements:
o MD Psychiatry from BJMC Ahmedabad
o DM Geriatric Psychiatry From KGMC, Lucknow
o First and Only Geriatric Psychiatrist of Gujarat
o Faculty and Speaker in Various national and regional
conferences
o Conducted many workshops for “Awareness about
Geriatric Psychiatric illnesses and Dementia”
o Published 4 articles in national and International
Journals
3. What is on the plate today?
Why this specialty is needed?
Aging and Disease?
Life events in Elderly
Fears of Elderly
Triple Ds of elderly
Late life Depression
Delirium
Dementia- Ultra Brief
4. Why this Specialty required?
Psychiatric illnesses may have different
manifestations, pathogenesis, and
pathophysiology from younger adults
Coexisting chronic medical illness
More medicines-Interactions
Cognitive impairment
Effects of aging physiology on drug therapy
Increased risk for social stressors, including
retirement and widowhood
5. Ageing: Demographic Scenario
Advancing Age : Birth of Elderly
o Steady rise in the
population of elderly
globally
o In India - increasing
longevity
o Improvement in Health
Care Services
o Consequently increasing life expectancy
Males Females
1951 32.45 31.66
2001 62.80 63.80
2011 68.90 69.50
o Census 2011 population:
o India- 1220 m; Elderly - 92 m
o Gujarat- 61 m Elderly- 5.25 m
6. Ageing is a progressive
deterioration of physiological
function, an intrinsic age-
related process of loss of
viability and increase in
vulnerability.
(Magalhaes JP de, Integrative Genomics of
Ageing group, 2001, 2004, 2005, 2008)
Ageing
7. Ageing and Diseases
Diseases due to the Ageing Process
The “biological age” of a person is not identical with his “chronological age”.
Years may wrinkle the skin, but worry, doubt, fear, anxiety, tension, and self-distrust
wrinkle the soul.
With the passage of time, certain changes take place in an organism.
The following disabilities are considered as incident to it:
o Senile cataract
o Glaucoma
o Nerve deafness
o Osteoporosis affecting mobility
o Failure of special senses
o Bronchitis
o Alzheimer’s disease
o Rheumatism
o Dental problems
8. Ageing and Diseases (contd.)
Major Mental Health Disorders
Impaired memory, rigid outlook and resistance
to change are some of the mental changes in
the elderly.
Major mental health problems of older adults
are:
Organic Disorders
Late Life Functional Diseases:
Mood (Affective) Disorders
Neurotic, Stress Related and Somatoform Disorders
Schizophrenia, Schizotypal and Delusional
Disorders (Functional Psychoses)
Psychoactive Substance Use Disorders
Suicidal Behaviors in the Elderly
Loneliness
10. Indicators Healthy Ageing
No physical disability over the age of 75 as rated
by a physician;
Good subjective health assessment (i.e. good
self-ratings of one's health);
Length of un-disabled life;
Good mental health;
Objective social support;
Self-rated life satisfaction in different domains;
Marriage; income-related work; children;
friendship and social contacts; hobbies;
community service activities; religion and
recreation/sports.
11. Some useful Suggestions for
Healthy Ageing
o Eat a balanced diet, including fruits and
vegetables daily.
o Maintain sleep-wake cycle.
o Exercise regularly (check with a doctor before
starting an exercise program).
o Do meditation.
o Get regular health check-ups.
o Quit smoking (it's never too late to quit).
o Practice safety habits at home to prevent falls
and fractures.
o Always wear your seatbelt in a car.
o Stay in contact with family and friends.
12. Some useful Suggestions for
Healthy Ageing
Stay active through work, play, and
community.
Active sexual life.
Avoid overexposure to the sun and the cold.
If you drink, moderation is the key.
When you drink, let someone else drive.
Keep personal and financial records in order
to simplify budgeting and investing.
Plan long-term housing and money needs.
Keep a positive attitude towards life.
Do things that make you happy.
13. Aging and the Life Cycle (Erickson)
Young adulthood--intimacy versus
isolation
Middle-aged--generativity versus self-
absorption
Elderly--Integrity versus despair
(Acceptance of mortality,
satisfaction with one’s meaning in
the world)
Fear of death is usually a mid-life
issue
14. Concerns/Life Events of Elderly
Retirement Lowered Self Esteem
Economic Insecurity Loss of Control
Decreasing Health Abuse/Neglect and Isolation
Dependency Loss and Loneliness
Chronic illnesses So many Medications
Lack of caregiver Boredom
Reminiscence is normative
On-time normative incidents do not usually result in crisis
20. Risk factors include
Loss of social roles
Loss of autonomy
Deaths
Declining health
Increased isolation
Financial constraints
Decreased cognitive functioning
21. Persistent depression in older adults ---- enormous individual and
family burden.
Increases mortality both from suicide and concurrent medical
illness.
Under-recognized in primary care settings, general hospitals and
nursing homes.
Different presentation---- Happily sad, suffering with
smile
Late life Depression Common but
Different
presentation
22. Late life Depression
Late onset
Depression- First time
after age 50
Vascular
Depression
Post Stroke
Depression
Psychotic
Depression
23. Phenomenology
“Depression without sadness”
Lack of feeling or emotion
Prominent cognitive complaints
Prominent somatic complaints (eg:
preoccupation with bowel function)
24. Phenomenology (contd..)
Unexplained health worries,
unknown fear
Heightened pain
experience/complaints
Multiple Physician/Hospital visits
without resolution of the problem
Irritability
25. Phenomenology (contd..)
Problems in initiative, self care, household maintenance,
transportation and communication.
Social withdrawal, avoidance of social interaction
Prominent loss of interest and pleasure in activities
Signs of functional impairment or otherwise unexplained
functional decline
26. Epidemiology
Classical major depression is less
frequent in older adults (prevalence
of 1%)
15 to 25 % experience depressive
symptoms that do not meet criteria
for a specific depressive syndrome
but cause distress and significant
dysfunctioning.
Confused
Clinician
27. Theories behind low prevalence of
major depression in elderly
“Resilience” – capacity to adjust and
recover from stressors without loss of
equanimity.
Shared experience or “generational
temperament” give rise to variation in
prevalence across generations
Flaws in the diagnostic approaches and
interview techniques.
28. Risk factors
Medical illness- parkinson’s disease,
stroke, Alzheimer’s disease,
hypothyroidism, malignancies.
Past history, spousal death, separation,
lack of social contact, death of loved
ones and bereavement.
Staying in nursing homes, cognitive
decline, pain problems, under-
nutrition.
29. Suicide
Rates are high
First episode of major depression which was
not diagnosed or untreated
Psychotic depression, alcohol, recent loss or
bereavement, loss of spouse, abuse of
sedatives and hypnotics.
30. Major depression in elderly
Same criteria as for young population
Disturbances in sleep, appetite and sexual
functioning are not always reliable indicator.
Use of HAM-D, MMSE and GDS are useful in elderly
in primary care settings for screening.
31. Age of onset : early vs late
Early onset depression :
childhood, adolescence
or earlier adulthood.
Late onset depression is
with first onset in the
second half of life at age
of 50.
32. Contd...
Early onset depression have more first degree
relatives with depression (genetic loading)
Late onset depression have
More chronic physical illness,
Less complete response to treatment, and
Chronic course,
Poorer prognosis,
Increased mortality and
Frontal and temporal atrophy on scans.
33. Depression with reversible dementia
Depression in elderly is associated with cognitive
impairments
“Pseudodementia of depression” or “depression with
reversible dementia” is now considered obsolete.
Brain dysfunction is “unmasked” by depression or its
just beginning of dementing process
34. Vascular depression
Cerebrovascular diseases both cortical and sub
cortical (chronic microvascular).
Frontostriatal disconnection : executive
dysfunction, reduced interest in activities,
psychomotor retardation, cognitive impairment
and impaired insight.
Impairment in instrumental activities of daily
living and poor prognosis.
35. Post stroke depression
Depression developing a year or more after a
stroke is strongly influenced by impairment in
social and physical functioning.
Depression after a 3 to 6 months period of stroke
have more vegetative features and larger lesion
volumes.
36. Depression with psychosis
Respond not at all to placebos, poorly to
antidepressants used alone, and more
often to combinations of antidepressant
and antipsychotic medications
Hospitalization is typically indicated and
electroconvulsive therapy (ECT) is the
treatment of first choice when agitation,
starvation, dehydration, or suicidality
threaten survival.
37. Delusions in psychotic depression involve guilt, jealousy,
paranoia, or somatic symptoms (e.g., beliefs in suffering a
serious or a fatal medical illness).
Patients frequently complain bitterly of somatic symptoms
without medical explanation, and can express profound
nihilistic beliefs and hopelessness, but hallucinations are
relatively infrequent.
Some patients are unable to urinate or defecate and require
urgent, separate intervention for these problems.
Depression with psychosis
38. Post-bereavement and depression
Many elderly people experience a great deal of
loss, not only in the form of death (e.g., spouse,
friends, relatives, loved pets), but also in other
spheres of life such as loss of
Physical ability,
Financial income,
Social status,
Mobility,
Life ambitions, and
Independence
39. Symptoms favoring major
depression
Guilt about things other than actions taken
or not taken by the survivor around the time
of the death
Thoughts of death other than the survivor
feeling that he or she would be better off
dead or should have died with the deceased
person
Morbid preoccupation with worthlessness
40. contd...
Marked psychomotor retardation
Prolonged and marked functional impairment
Hallucinatory experiences other than thinking
that he or she hears the voice or footsteps, or
transiently sees the image, of the deceased
person
41. Chronic medical illness
Increased medical burden increases
depressive symptoms, and long-term
depressive symptoms increase medical
burden and mortality
Depression lowers self-rated health and
intensifies physical symptoms including
amplifying the perception of pain, and
chronic pain worsens depression.
42. Cerebral abnormalities
Structural brain abnormalities are more frequent in
patients with LOD than EOD.
Depression is especially common with higher grades of
WMHs in the frontal lobes, even after controlling for
vascular risk factors such as hypertension, diabetes,
and ischemic heart disease
43. Pharmacotherapy
SSRI - drug of choice.
Common adverse effects are GI
distrtess, agitation, akathisia,
insomnia, sexual dysfunction and
occasionally parkinson like motor
side effects
Risk of serotonin syndrome
Hyponatremia – inappropriate ADH,
urinary retention
44. TCA- anticholinergic side effects
Nortriptyline and desipramine have less SE.
TCA better for chronic pain management
45. Venlafaxine, desvenlafaxine, mirtazapine,
bupropion, duloxetine and MAOIs can be used as
only agents or as part of augmentation.
Psychostimulants, such as methylphenidate and
amphetamine have inconclusive evidence for
efficacy.
46. Psychotherapy
Evidence is insufficient to recommend
psychotherapy as a first-line treatment
for depression in older adults, but
clinical judgment is the preferred
decision tool in individual cases.
Cognitive-behavioral therapy (CBT) and
problem-solving therapy (PST), and
antide-pressant medication combined
with interpersonal therapy (IPT) has
role.
47. A few studies document the promise of various
forms of psychotherapy (CBT, PST, IPT, , and
dialectical behavior therapy [DBT] group skills’
training) in geriatric depression in outpatients.
Various obstacles to use psychotherapy in elderly.
48. Treatment resistance
Delayed onset of therapeutic activity
because of need to “start low and go
slow”
Lack of full remission frequently
experienced by depressed elderly, even
after having an adequate medication
trial.
50. Treatment resistance (contd..)
Although approximately 50% to 60% of elderly
patients improve clinically with
antidepressant therapy
The efficacy of these agents may be lower
mainly in those with vascular or
neurodegenerative brain disease.
51. ECT
ECT is the most important of the non-
pharmacological somatic treatments
It is the treatment of choice in certain older
patients with severe depression due to poor
tolerance of psychotropic medications, psychotic
features, significant comorbid medical conditions,
or marked disability or urgent risk to life.
52. COURSE AND PROGNOSIS
Left untreated, late-life major depression
tends to remit spontaneously after 12–48
months, but patients with first-episode
depression with onset after age 60 have a
70% chance of recurrence within 2 years.
53. Data from naturalistic studies have identified several
predictors of relapse and recurrence:
Frequent prior episodes,
High pretreatment severity of depression and anxiety,
Supervening medical illness,
History of myocardial infarction or vascular disease,
and
Cognitive impairment.
COURSE AND PROGNOSIS
54. Delirium
Usually acute and fluctuating
Altered state of consciousness (reduced
awareness of and ability to respond to the
environment)
Cognitive deficits in attention,
concentration, thinking, memory, and
goal-directed behavior are almost always
present
56. That is what delirium is …..
Agitation Confusion Sedation Compulsive
Searching
OR
Combination
HallucinationsDistractions
57. Features of delirium
May be accompanied by
Inattention
Hallucinations,
Illusions,
Emotional lability,
Alterations in the sleep-wake cycle,
Evening worsening of symptoms
Fluctuations in Symptoms
Psychomotor slowing or hyperactivity,
Searching and picking behavior
Removing clothes, life support equipments (like IV line, Catheter, Nasogastric
tube, Ventilator support)
Usually abrupt and resolution is also rapid when underlying cause
is corrected.
58. Types of delirium
Types:
Hyperactive , hyperalert
delirium: almost always consultation
Hypoactive, hypoalert delirium: no
consultation
Mixed: Fluctuation between
hyperactive and hypoactive
59. Causes of Delirium: I WATCH DEATH
Infectious Deficiencies
Withdrawal Endocrinopathies
Acute metabolic Acute vascular
Trauma Toxins/drugs
CNS Pathology Heavy Metals
Hypoxia
Note that prescribed medicines may
cause delirium
60. The Mortality of Delirium
The mortality outcome at 6 months post
discharge for delirious patients not identified
was three times higher than the delirious
patients who were identified and treated.
25 percent of delirious postoperative patient
had a lethal outcome; control population 13%
61. Burden of Delirium
Increased mortality
Increased nursing care
Increased length of stay
Increased risk of cognitive decline
Increased risk of functional decline
62. Treatment of delirium
Look for underlying cause “always be
suspicious”
Close supervision, especially by family
Reorient frequently
Adequate lighting
63. Treatment of delirium (continued)
Use consistent personnel
Try not to use restraints, as it can worsen confusion.
Medication only if behavioral attempts fail
Avoid polypharmacy
Low dose neuroleptic is treatment of choice, unless the
delirium is due to withdrawal.
If due to Alcohol withdrawal, use a short-acting
benzodiazepine. (Lorazepam)
64. Treatment
Dose Route Reps
Haloperidol 0.25 -1 mg POIM bid/tid Every 30-60 min
Risperidone 0.25 - 0.5 mg PO bid/tid Every 30-60 min
Olanzapine 2.5 – 5 mg PO/IM Every 30-60 min
Quetiapine 25 – 50 mg PO Every 30-60 min
For excessive agitation
65.
66. Dementia is a syndrome due to disease of the brain, usually
of a chronic or progressive nature.
There is disturbance of multiple higher cortical functions,
including memory, thinking, orientation, comprehension,
calculation, learning capacity, language, and judgement.
Dementia produces an appreciable decline in intellectual
functioning, and usually some interference with personal
activities of daily living, such as washing, dressing, eating,
personal hygiene, excretory and toilet activities.
What is dementia?
67. AD is the most common cause of dementia amongst
people aged 65 and older
Prevalence among people over 60 years–5% to 8 %
Starting with 0.5% prevalence at 55 yrs., it goes on
doubling every five years (60yrs-1%; 65yrs. – 2%; 70 yrs. -
4%; 75yrs.-8% and so on)
Risk at the age of 80 years is around 15 to 20%
At present nearly 35.6 million people worldwide with
dementia. Expected to double by 2030 and triple by 2050.
About 7.7 million new cases of dementia each year.
A new case detected in every 4 seconds somewhere in
world. (WHO)
Epidemiology
68. Common Types of Dementias
Type of Dementia % in total Cases
Alzheimer’s Dementia 50-55
Vascular Dementia 30-35
Lewy body Dementia 5-7
Pick’s Dementia 3-5
Other Dementias 10-15
69. Age: 60-70 years
Gender: female
Prior stroke
Atherosclerosis
Heart disease
High blood pressure
Diabetes
Diet
Risk Factors for Dementia
• Cholesterol problems
• Atrial fibrillation
• Smoking
• Low Education
• Family history
71. Structural Disease or Trauma
Normal pressure hydrocephalus
Neoplasms
Dementia pugilistica
Vascular Disease
Vascular dementia
Vasculitis
Heredo-metabolic Disease
Wilson’s disease
Other late-onset lysosomal storage diseases
Etiological classification of dementia
72. Demyelinating or Demyelinating Disease
Multiple sclerosis
Infectious Disease
Human immunodeficiency virus, type 1
Tertiary syphilis
Creutzfeldt-Jakob disease
Progressive multifocal leukoencephalopathy
Whipple’s disease
Chronic meningitis – e.g. Cryptococcal
Etiological classification of dementia
73. Nutritional deficiency:
Vitamin B12 deficiency, Folate deficiency, thiamine
deficiency.
Organ failure:
Uremic and hepatic encephalopathy
Endocrine disease:
Diabetes mellitus, hyper/ hypothyroidism, Cushing's
syndrome etc.
Etiological classification of dementia
74. D = Drugs, Delirium
E =Emotions (depression) &
Endocrine Disease
M=Metabolic Disturbances
E =Eye & Ear Impairments
N =Nutritional Disorders
T =Tumors, Toxicity, Trauma to
Head
I = Infectious Disorders
A= Alcohol, Arteriosclerosis
Irreversible / Reversible dementias
• Alzheimer’s Dementia
• Lewy Body Dementia
• Pick’s Disease
(Frontotemporal
Dementia)
• Parkinson’s
• Heady Injury
• Huntington’s Disease
• Creutzfeldt- Jacob
Disease
75. Early symptoms
o ભૂલી જવું
o એકની એક વાત વારુંવાર કરવી
o ઘરના વ્યક્તતના નામ ભૂલી જવા
o જૂની વાતો યાદ કરવી
o શક-શુંકા કરવી
o કોઈ ચોરી કરી ગયું એવી વાતો
કરવી
o ખાવાનું ખાઈને વારુંવાર ભૂલી
જવું
o નાવા-ધોવામાું વધ સમય લેવો
o પોતાની કાળજી ના રાખી શકવી
o રસ્તા ભૂલી જવા
o પેશાબ ગમે તયાું કરી દેવો
o રાતભર ભટક્યા કરવું
o અચાનક હસવા-રડવા લાગવું
o ગમસમ બેસી રહેવું
76. Complete Blood Count, ESR
Serum Urea, Creatinine, Electrolytes
Thyroid function tests
Serum B 12 & Folate
Electrocardiogram
Chest X-ray
CT Scan of head/ MRI head
Lumber Puncture (if suspicion of infectious etiology)
Tests for syphilis, HIV
Drug screen if appropriate
Brain biopsy (for confirmatory diagnosis)
Lab and other tests for dementia
77. Diffuse brain atrophy
Enlargement of ventricles
Widening of sulci and gyri
Atrophy more prominent in hippocampus
There can also be evidences of strokes,
lacunar infarcts, and white matter hyper
intensities. These complicate the picture.
Neuroimaging
78. Characteristics Alzheimer’s Disease Vascular Dementia
Sex Women Men
Age Generally over age 75 years Generally over age 60 years
Onset & progression Gradually progressive Stuttering or episodic, with
stepwise deterioration
History of hypertension Less common Common
History of
stroke(s),transient
ischemic attack(s),or
other focal neurological
symptoms
Less common Common
Hypertension Less common Common
Focal neurological signs Uncommon Common
Emotional lability Less common More common
Cognitive deficits Uniform patchy
Alzheimer’s Disease Vs Vascular Dementia
79. a
BPSDActivities of daily
living
Behavioural and Psychological Symptoms
of Dementia:
A heterogeneous range of psychological
reactions, psychiatric symptoms and
behaviours resulting from the presence of
dementia
Cognitive
deficits
80. Dementia is associate with progressive cognitive disability, a
high prevalence of Behavior and Psychological symptoms of
Dementia (BPSD) such as agitation, depression and psychosis.
BPSD are an integral part of the disease process and present
severe problems to patients, their families and caregivers and
society at large.
It increases stress in caregivers.
BPSD are treatable and generally respond better to therapy
than other symptoms of dementia.
Behavioral and psychological
symptoms of dementia (BPSD)
81. They result in:
Excess disability
Increased hospitalization
Premature institutionalization
Suffering for patient and caregiver
Substantial increase in financial costs
Associated with greater functional impairment
Elder abuse
Associated with increased mortality
Why is BPSD important?
82. Seen in:
≈40% of mild cognitive impairment
≈ 60% of patients in early stage of dementia
Affects 90-100% of patients with dementia at
some point in the course of their illness
(Mega et al. 1996).
Gets more frequent and troublesome with
advancing dementia
BPSD
83. BPSD- behavioural symptoms
Most common Common Less common
•Apathy
•Aggression
•Wandering
•Restlessness
•Eating
problems
•Agitation
•Disinhibition
•Pacing
•Screaming
•Sundowning
•Crying
•Mannerisms
84. BPSD- psychological symptoms
Most common Common Less common
•Depression
•Anxiety
•Insomnia
•Delusions
•Hallucinations
•Misidentification
86. Agitation up to 75%
Wandering up to 60%
Depression up to 50%
Psychosis up to 30%
Screaming up to 25%
Aggression up to 20%
Sexual Disinhibition up to 10%
(Mega, Cumming et al. 1996)
Estimated frequency of common
BPSD
87. 50 – 90% of caregivers considered physical
aggression as the most serious problem they
encountered and a factor leading to
institutionalization (Rabins et al. 1982)
BPSD
Treatment of
Dementia
Very Lengthy Topic to cover: So not
covered
88.
89. Integrity vs despair
Psychosocial
Conflict: Integrity
versus despair
Major Question: "Did I
live a meaningful life?“
Basic Virtue: Wisdom
Important
Event(s): Reflecting
back on life
Integrity: the state of being
whole and undivided
Despair: the complete loss or
absence of hope
This stage occurs during late
adulthood from age 65 through
the end of life.
During this period of time,
people reflect back on the life
they have lived and come away
with either a sense of
fulfillment from a life well
lived or a sense of regret and
despair over a life misspent.
90. THE END
“healthy children will
not fear life if their elders have
integrity enough not to fear
death.”
91. Dr. Ravi Soni
DM Geriatric Psychiatry
Introduction
Consultant Geriatric Psychiatrist
GIPS Psychiatry Clinic
[Memory clinic and Geriatric Psychiatry Clinic]
Mobile No: 7379076870, 9601555370
Area of Work:
o Elderly Psychiatric Illnesses including
Depression, Psychosis, bipolar disorder,
Anxiety disorder etc.
o Management of all types of Dementia
o Expert in Management of Delirium
o Counselling and Psychotherapy
Achievements:
o MD Psychiatry from BJMC Ahmedabad
o DM Geriatric Psychiatry From KGMC, Lucknow
o First and Only Geriatric Psychiatrist of Gujarat
o Faculty and Speaker in Various national and regional
conferences
o Conducted many workshops for “Awareness about
Geriatric Psychiatric illnesses and Dementia”
o Published 4 articles in national and International
Journals