Elderly individuals are at risk of psychiatric problems like dementia and depression. Dementia affects 5-7% of those over 65 and 40% over 85, with Alzheimer's disease being the most common type. Depression is also common in the elderly. Treatment involves identifying the precise condition, using drugs like acetylcholinesterase inhibitors for dementia or antidepressants for depression, and providing psychosocial support. Psychiatric disorders in the elderly like schizophrenia require careful use of antipsychotic drugs and family psychoeducation.

2. PSYCHIATRIC PROBLEMS AMONG
ELDERLY

3. Who is at risk
Elderly
 Live alone
 Are economically disadvantages
 no relatives or friends
 experienced recent losses
 Have been ill or have a progressive or chronic
illness
 experienced a head injury

5. • Dementia is an acquired global impairment of
intellect,memory and personality but without
impairment o conciousness
.Primary dementias are those, which the dementia itself is the
major sign of some organic brain disease not directly related
to any other organic illness. Secondary dementias are caused
by or related to another disease or condition,

7. Prevalence
 It affects between 5 to 7 percent of adults
over age 65 and 40 percent of those over
age 85
 Alzheimer’s disease: most common form of
dementia (70%)
 Depression and/or anxiety are common

8. Risk factors
• Age
• Vascular disease
• Diabetes mellitus
• Female gender
• Sedentary lifestyle

9. • Low education level
• Race/Ethnicity
• Cardiovascular accident
• Alcohol abuse
• Head trauma

10. –Marked loss of memory for
recent events
–Losing items
–Getting lost in ‘familiar’ places
–Missing appointments
–Loss of ability for abstract
thought; planning and doing
complex tasks
–Trouble cooking, paying
bills, driving
–Can’t understand
books, movies, or news items

11. Difficulty finding common words and names
Substitution of approximate phrases
Misidentifying people
Difficulty inhibiting behavior
Impulsivity
‘Thoughtless’ comments
Socially inappropriate behaviors

12. Treatment

13. • No single
approach

14. • To identify the precise type and nature of the
individual’s disease
• The use of drugs
Piracetam produces positive effects on elderly
patients with mild to moderate memory impairment.
Psychostimulants such as methylphenidate
hydrochloride also tried
New medications may slow deterioration due to
dementia (Aricept)
Tacrine,rivastigmine-cholinesterase inhibitors

15. Symptomatic relief
benzodiazepines
 antidepressants
antipsychotics
 anticonvulsants

16. Early and
differential
diagnosis is
critical

17.  Effective treatment of
depression or anxiety
 Support for family caregivers
helps them
 Education to family members

18. • is a condition of severe confusion and
rapid changes in brain function. It is
usually caused by a treatable physical
or mental illness

19. • Prevalence:
• it is most common in elderly persons
• 30% of older persons during medical
hospitalization and in 10 to 50% of older
adults during surgical hospitalization.
• 60% of residents in nursing homes may have
delirium

20. symptoms
• Altered awareness, disorientation, clouding
of consciousness
• Impaired attention, concentration, and
memory
• Inability to process visual and auditory
stimuli
• Increased motor activity (e.g., restlessness)
• Anxiety, and agitation
• Misinterpretation, illusions, delusions, or
hallucinations
• Speech abnormalities
• Reduced wakefulness; sleep disturbance

21. Depression

22. • Poor appetite or weight Loss
• Insomnia or hypersomnia
• Loss of energy or tiredness
• Psychomotor agitation or slowing
• Loss of pleasure in usual activities or decrease
in sexual drive
• Feelings of self-reproach or excessive guilt
• Diminished ability to concentrate
• Suicidal ideas, wishes or attempts.

23. Duke Longitudinal Study of Aging
• 3.7% --- found to have a major depressive
disorder requiring treatment.
• Another 4.5% had but without vegetative
signs
• 6.5% had dysphoric mood only with severe
health problems.

24. TREATMENT
• Tricyclic antidepressants. A good
rule of thumb for elderly patients is
to start giving tricyclics and other
antidepressants at about a third the
dose recommended for younger
patients.
• Desipramine hydrochloride (25 mg
each night is a reasonable starting
dosage)

25. Other types of antidepressants
Monoamine-oxidase inhibitors(Risk of
hypertensive crisis must be weighed carefully in
elderly patients who have a baseline
hypertension)
Antidepressant treatment with
methylphenidate(Ritalin), is another option for a
physically frail elderly depressed patient.

26. • Psychotherapy
• Cognitive-behavioral (CBT)
• Problem-solving (PST)
• Interpersonal
• Psychosocial Interventions:
• care management
• exercise
• intellectual/creative/recreational activity
• relationships
• dealing with real life problems

27. • disturbances in thinking
emotions,volitions,and
faculties in the presence of
clear consciousness,which
usually leads to social
withdrawl.

28. • It begins in late adolescence or young adulthood
and persists throughout life.
• first episodes diagnosed after age 65 are rare, a
late-onset type beginning after age 45 has been
described.
• Women are more likely to have a late onset of
schizophrenia than men.
• greater prevalence of paranoid schizophrenia in
the late-onset type.
• About 20 percent of persons with schizophrenia
show no active symptoms by age 65; 80 percent
show varying degrees of impairment.

29. • The residual type of schizophrenia occurs in
about 30 percent of persons with
schizophrenia.
• Because most persons with residual
schizophrenia cannot care for
themselves, long-term hospitalization is
required.

30. • Older persons with schizophrenic
symptoms respond well to
antipsychotic drugs.Medication must
be administered judiciously
• Psycho education for family members
• Supportive Psychotherapy
• Day Programs (esp. focused on
rehabilitation

31. Delusional disorder

32.  The age of onset of delusional disorder
usually is between ages 40 and 55, but it can
occur at any time during the geriatric period.
 Delusions can take many persecutory”
delusions are common
 Somatic delusions also can occur in older
persons.
In one study of persons
older than 65 years of age, pervasive
persecutory ideation was present in 4
percent of persons sampled.

33. • It can occur under physical or psychological
stress and can be precipitated by the death of a
spouse, loss of a job, retirement, social
isolation, adverse financial
circumstances, debilitating medical illness or
surgery, visual impairment, and deafness.
• Delusions also can accompany other disorders
such as dementia of the Alzheimer's
type, alcohol use
disorders, schizophrenia, depressive
disorders, and bipolar I disorder which
• It can also can result from prescribed
medications or be early signs of a brain tumor.

34.  A late-onset delusional disorder called
paraphrenia is characterized by persecutory
delusions.
 It develops over several years and is not
associated with dementia
 Patients with a family history of schizophrenia
show an increased rate of paraphrenia.

35. Somatoform disorders
It is characterized by physical
symptoms resembling
medical diseases, are
relevant to geriatric
psychiatry because somatic
complaints are common
among older adults.

36.  More than 80 percent of persons over 65
years of age have at least one chronic
disease
 After age 75, 20 percent have diabetes and
an average of four diagnosable chronic
illnesses that require medical attention.

37. Hypochondriasis is common
in persons over 60 years of
age, although the peak
incidence is in those 40 to
50 years of age.
The disorder
usually is chronic

38. • Repeated physical examinations
• Clinicians should acknowledge that the
complaint is real, that the pain is really there
and perceived as such by the patient, and
that a psychological or pharmacological
approach to the problem is indicated

39. SLEEPING DISORDERS
 Advanced age is the single
most important factor
associated with the
increased prevalence of
sleep disorders.
 Reported more frequently
in older than younger adults

40.  Primary sleep disorders(dyssomnias
insomnia, nocturnal myoclonus, restless legs
syndrome, and sleep apnoea,
 Mental disorders,
 General medical disorders
 Social and environmental factors.

41. • Alcohol can interfere with the quality of
sleep
sleep fragmentation and early morning
awakening
• Can precipitate sleep apnoea

42. • Changes in sleep structure among persons over
65 years of age involve both REM sleep and non-
rapid eye movement (NREM) sleep.
• The REM changes include the redistribution of
REM sleep throughout the night, more REM
episodes, shorter REM episodes, and less total
REM sleep.
• The NREM changes include the decreased
amplitude of delta waves, a lower percentage of
stages 3 and 4 sleep, and a higher percentage of
stages 1 and 2 sleep. In addition, older persons
experience increased awakening after sleep
onset.

43. Management
• Pharmacological management
Benzodiazepines
• Flurazepam
• Zolpidem
• Trazodone
When prescribing sedative-
hypnotic drugs for older persons, clinicians
must monitor the patients for unwanted
cognitive, behavioral, and psychomotor
effects

44. Cognitive Therapy
• Identify attitudes and beliefs about sleep
• Explore the validity of self-statements about
sleep
• Replace dysfunctional attitudes and beliefs
about
sleep with more appropriate self-statements
• Worry time
– Remove thoughts and general cognitive
activation away from bedtime and moves
them to a better period of the day

46. Addictive
disorders

47. Risk factors
– Having a mental health disorder
– Having an alcoholic parent(family history)

48. Alcohol abuse
Definition:
A disorder characterized by the excessive
consumption of and dependence on
alcoholic beverages, leading to physical and
psychological harm and impaired social and
vocational functioning

49.  Alcohol withdrawal, which may be a problem in as many as
20% of elderly persons in hospital
 When absolutely necessary, diazepam can be used briefly
in an elderly person with alcoholism at doses of 2 mg twice
a day.
 Detoxification: Outpatient/Inpatient
 Rehabilitation: Community-based or residential
 Mutual aid/self-help: e.g. AA

50. • Definition:
A type of medication known as
tranquilizers. Familiar names include Valium
and Xanax. When people without
prescriptions take these drugs for their
sedating effects, use turns into abuse

51. • Prevalence:
Older adults represent only 14% of the U.S.
population, yet they receive 27% of all prescriptions
for anxiolytic benzodiazepines and 38% of hypnotic
benzodiazepines
• Risk factors
– Medical hospitalization is a significant risk factor
for initiation and continuation of
benzodiazepines

53. • Gambling may provide:
* Social support to older adults
* Excitement
*Entertainment
* Winnings
* Challenge
* time pass

55. • Persons older than age 65 represent high
percentage who commit suicide.
• Of all suicides, 20 % are committed by this
age group and suicide is the 15th leading
cause of death among the elderly .
• Risk group especially appears to be white
men.

56. • Previous suicide attempt(s)
• History of
-mental disorders
-alcohol and substance abuse
• Family history of suicide
• Family history of child maltreatment
• Feelings of hopelessness
• Impulsive or aggressive tendencies

57. • Barriers to accessing mental health treatment
• Loss
• Physical illness
• Easy access to lethal methods

58. • Unwillingness to seek help because of the
stigma attached to mental health and
substance abuse disorders or suicidal thoughts
• Cultural and religious beliefs
• Local epidemics of suicide
• Isolation

59. Prevention
 Identify any sign of helplessness or
hopelessness
 Demonstrations of genuine
concern, interest, and caring; indications of
empathy for their fears and concerns;
 Effective clinical care for mental, physical, and
substance abuse disorders
 Arrange for Family and community support

60. • Support from ongoing medical and mental
health care relationships
• Skills in problem solving, conflict
resolution, and nonviolent handling of
disputes
• Cultural and religious beliefs that discourage
suicide and support self-preservation
instincts

61.  Identification of risk by “Gatekeepers”
 Primary care physicians
 Home health providers
 Social service workers
 People in the neighborhood
 Depression treatment and care management
 Public education

62. Anxiety disorder

63. Definition
A psychiatric disorder involving
the presence of anxiety that is so
intense or so frequently present that it
causes difficulty or distress for the
individual

64. – Excess or undue worry
or fear
– Fatigue
– Disturbed sleep
– Jumpiness, jitteriness, t
rembling
– Muscle aches, tension
– Dizziness, lightheadedn
ess
symptoms

65. – Gastrointestinal upset
– Dry mouth, sensation of a lump in the
throat, choking sensation Clammy
hands, sweating
– Racing heartbeat, chest discomfort
– Shortness of breath, or the feeling of being
smothered
– Numbness or tingling of hands, mouth, or
feet

66. Risk factors
Personal history of:
• Depression
• Anxiety disorder
• Chronic medical illness
• Loss of significant person during childhood
• Cognitive impairment
• Alcohol abuse/dependence
• Social isolation

67. – Family history of:
• Alcohol abuse
• Anxiety disorders
• Mood disorders
– Other factors:
• Female gender
• Exposure to traumatic event

68. Treatment
 Anxiolytics
 Benzodiazepines
 Most common agents
 Alprazolam (Xanax)
 Lorazapam (Ativan)
 physical symptoms
 Assist client to identify thoughts
that arouse the anxiety & their
bases
 Assist client to change unrealistic
thoughts to more realistic though

69. Cognitive-behavioral therapy CBT
may involve
relaxation training, cognitive restructuring
(replacing anxiety-producing thoughts with
more realistic, less catastrophic ones) and
exposure (systematic encounters with feared
objects or situations).
• CBT can take up to several months and has
no side effects.

70. • Maintain sleep hygiene
• Other treatments effective for some people
include
 meditation
 biofeedback
massage
 acupuncture