Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
This powerpoint presentation represents definition of the Somatoform disorder, its subtypes, etiology in perspective of theories along differential diagnosis in an attempt to shed light on the disorder adequately
Depression, ICD 10 – Diagnostic criteria for Depressive episode, DSM IV Criteria for major Depressive episode, Types of depression, Causal factors, signs, suicide, Alcohol, Treatment,........
Disorders in psychiatry are often described as syndromes, a constellation of signs and symptoms that together make up a recognizable condition. this ppt help in understanding basic sign and symptoms of psychiatry.
Body dysmorphic disorder (BDD), also known as body dysmorphia, body dysmorphia disorder and BDD disorder, is a mental health condition in which people suffer acute distress in response to perceived physical flaws.
This powerpoint presentation represents definition of the Somatoform disorder, its subtypes, etiology in perspective of theories along differential diagnosis in an attempt to shed light on the disorder adequately
Depression, ICD 10 – Diagnostic criteria for Depressive episode, DSM IV Criteria for major Depressive episode, Types of depression, Causal factors, signs, suicide, Alcohol, Treatment,........
Disorders in psychiatry are often described as syndromes, a constellation of signs and symptoms that together make up a recognizable condition. this ppt help in understanding basic sign and symptoms of psychiatry.
Body dysmorphic disorder (BDD), also known as body dysmorphia, body dysmorphia disorder and BDD disorder, is a mental health condition in which people suffer acute distress in response to perceived physical flaws.
CURRENT CHALLENGES IN WOMEN'S HEALTH,W
OMENS DISEASES,HOW TO MAKE WOMEN HEALTHY,WOMEN EDUCATION AND EMPOWERMENT,EMPLOYMENT,ENVIORMENT,STRATERGIES FOR IMPROVING WOMEN'S HEALTH
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Depression Depression is not a normal part of aging, and studi.docxcuddietheresa
Depression
Depression is not a normal part of aging, and studies show that most older people are satisfied with their lives, despite physical problems (National Institute of Mental Health [NIMH], 2014b). To understand depression, the nurse must understand the influence of late-life stressors and changes and the beliefs older people, society, and health professionals may have about depression and its treatment.
Prevalence
Depression remains underdiagnosed and undertreated in the older population and is considered a significant public health issue (Abbasi & Burke, 2014).
Depression is the fourth leading cause of disease burden globally and is projected to increase to the second leading cause by 2030 (World Health Organization, 2014).
Approximately 1% to 2% of adults 65 years and older are diagnosed with major depressive disorder. An additional 25% have significant depressive symptoms that do not meet the criteria for major depressive disorder (Avari et al., 2014).
Symptoms that do not meet the criteria for major depressive disorder have been referred to as minor depression, subsyndromal depression, dysthymic depression, and mild depression.
The DSM-5 replaced the term dysthymia with the term persistent depressive disorder to describe symptoms that are long standing (lasting 2 years or longer) but do not meet the criteria for major depressive disorder.
Recognition and treatment are important because persistent depressive disorder has a negative impact on physical and social functioning and quality of life for many older people and is associated with an increased risk of a subsequent major depression (Harvath & McKenzie, 2012; Uher et al., 2014).
Rates of depression are higher in older adults who experience physical illness, who have cognitive impairment, or who reside in institutional settings. Fourteen percent (14%) of patients receiving home care meet the criteria for depression, and nearly half of all nursing home residents receive antidepressants for depression (Abbasi & Burke, 2014; Smith et al., 2015).
Depression is a major reason why older people are admitted to nursing homes.
Prevalence rates of depression in older adults likely underestimate the extent of the problem. The stigma associated with depression may be more prevalent in older people, and they may not acknowledge depressive symptoms or seek treatment. Many elders, particularly those who have survived the Great Depression, both world wars, the Holocaust, and other tragedies, may see depression as shameful, evidence of flawed character, self-centered, a spiritual weakness, and sin or retribution. Perceived stigma may be less of a concern for the future older population who are more aware of mental health concerns and more likely to seek treatment.
Health professionals often expect older people to be depressed and may not take appropriate action to assess for and treat depression. The differing presentation of depression in older people, as well as the increased pr ...
-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)
Global Medical Cures™ | Women & Depression
Disclaimer:
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Do you really want to understand what doctors mean when they talk about depression? Do you know that in everyone on earth, 2 out of 3 suffers depression on a daily basis.
A look at how mental health treatment and research have evolved over the last 10 years and about future possibilities for more effective, personalized treatment approaches.
with Dr. Zul Merali, President and CEO, The Royal's Institute of Mental Health Research
Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.
Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.
The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.
Are you drinking TOO much?
Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.
Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/
While terrorism continues to make headlines around the world, some researchers have suggested that terrorists are mentally ill and have used labels such as psychopathic or sociopathic, narcissistic, paranoid and schizophrenic. Others have argued that there is no evidence to indicate that they are mentally ill, disordered, psychopathic or otherwise psychologically abnormal.
The Royal's Dr. AG Ahmed, Dr. Wadgy Loza and Dr. Pius Adesanmi discuss research findings and reflect on the new meanings and manifestations of terrorism and extremism in Canada and around the world.
Our Conversations lecture 'Hope, Humanity and Empowerment: Strengths-focused Cognitive Behavioural Therapy for Psychosis (& Schizophrenia)' was presented by staff members of the Integrated Forensic, Recovery and Schizophrenia programs at The Royal.
Psychosis can be associated with a variety of mental health problems, including schizophrenia, severe depression, bipolar disorder, anxiety, and post-traumatic stress disorders. While traditional treatments for psychosis have emphasized medication-based strategies, research now suggests that individuals affected by psychosis can greatly benefit from talk therapies such as cognitive behavioural therapy for psychosis (CBTP).
Learn more: www.theroyal.ca
The recent attack in downtown Ottawa has deeply affected our city. We have a powerful desire to stay strong as individuals and as a community yet we are all human so it is natural to feel fear, anxiety and loss after this type of event. Recognizing this, The Royal held a special info session on coping with trauma.
Presenters:
Dr. Jakov Shlik, Clinical Director, Operational Stress Injury Clinic and Anxiety program, The Royal
Michelle Antwi, Operational Stress Injury Clinic, The Royal
Katie Bendell, Operational Stress Injury Clinic, The Royal
As presented at The Royal by:
- Dr. Melanie Willows, Clinical Director, SUCD Program, The Royal
- Dr. Kim Corace, Director, Program Development and Research, SUCD Program, The Royal
Opioid addiction is a large and growing problem affecting our community, especially our young people, women and their families. This session addressed:
· The current state of prescription opioid problems
· Opioid use, abuse, and addiction as it relates to women and parenting
· Risk factors for opioid use about women, with a focus on mental health problems
· Treatment options to help women who struggle with opioid problems
· Reducing the stigma and myths regarding women with opioid use problems
This session included information on the collaborative work being done between The Royal’s Sexual Behaviours Clinic (SBC) and Ottawa Police Service’s High Risk Offender Unit (HROU). Dr. Paul Fedoroff was the moderator and began the presentations with an overview of innovative work being done within the SBC and the common goals of the Clinic and the HROU. Staff Sargent Dana Reynolds and Det. Mark Horton discussed the role of their team in the community based management of high risk sexual offenders. More specifically they discussed the role of the Unit and common legal designations utilized for high risk sexual offenders. Lisa Murphy, M.C.A. provided an overview of sex offender registries (SORs) and public notification and made comparisons between the approaches used in Canada and the United States. A discussion period followed the panel presentations.
As presented by Dr. Mathieu Dufour, Psychiatrist at The Royal, at a special Men's Mental Health Awareness event hosted by The Men's D.E.N. (Depression Education Network).
Dr. Andrew Wiens, Head, Division of Geriatric Psychiatry at The Royal, talks about behaviour issues in dementia at our monthly lecture series, Conversations.
As presented at our Conversations at The Royal on March 20, 2014 by speakers Karen James, Cynthia DuBaie, and Richard Cottingham.
More at www.theroyal.ca
“Love Sense” (written by Dr. Sue Johnson): the revolutionary new science of romantic relationships offers the reader a ground breaking guide to the new science of love and loving that has emerged in the last 15 years. The science allows us not just to “fall” in love but to make sense of and shape our most precious relationships.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
Are There Any Natural Remedies To Treat Syphilis.pdf
Women, Aging and Mental Health
1. Women, Aging and
Mental Health
Dr Cathy Shea
Associate Professor
Chair, Division of Geriatric Psychiatry
University of Ottawa
2. Topics we will cover
Demographics of aging
Growing older with early onset mental illness
Stigma
Changes with “normal” aging
Late onset mental illness – the three D’s
Recovery
3.
4. Demography of Aging
The
Baby Boomers are coming!
Babies born in 1946 turned 65 in
2011.
13%
of Canadian population now over
65 and will double in by 2041to 23%
5. Demography of Aging
There are 147 women for every 100
men over age 65
Most older men are married (75-78%)
(and therefore have/will have familiar
caregivers when they are ill)
Most older women are widowed (52%)
6. If you have a mental illness of early
onset and live to grow old
“normal” biological changes might affect your
treatment with medication and the expression of side
effects of that treatment
Aging itself makes you vulnerable to develop mental
illness’ particular to old age (maybe in addition to your
early onset mental illness)
Aging itself makes you vulnerable to develop physical
illnesses which affect your mental illness and the
treatment of both
Aging itself brings psycho-social issues which affect
your access to care and services
7. The triple whammy for stigma!
You have a mental illness (any age)
2. You are old (so you must be frail/confused!)
3. You are a woman (so complain a lot and
express your emotions easily)
All three will affect your ability to obtain
diagnosis, treatment and to access services
for physical and mental illness
Note: Quadruple whammy if you are also a
member of a visible minority!
1.
8. Mental disorders commonly
diagnosed earlier in life
Depression
Anxiety Disorders
Bipolar Disorder
Schizophrenia
Substance Use Disorders
9. Mental disorders commonly
diagnosed earlier in life
All can be diagnosed for the first time in individuals over 65
years of age and are then typically called “late onset” or “late
life” disorders
Depression: 10-15 % of community dwelling elderly have
significant depressive symptoms. Rates are higher in hospitals
and long term care facilities. Female gender is a major risk
factor
Bipolar Disorder: M=F in late onset
Schizophrenia: 3% diagnosed after age 70, mostly women
Substance use disorders: 1.5% alcohol abuse in older
women. Problem drinking however can be as high as 27%.
10. What happens to us
with “normal” aging?
And why does it matter?
11.
12. Physiologic changes with normal
aging
Cardio-vascular changes (meds & dementia)
Increased blood pressure (noradrenergic (antidepressant) drugs can
worsen)
Increased susceptibility to develop heart failure if heart rate is increased
(e.g. by certain drugs with anti-cholinergic properties)
Increased (cumulative) vascular risk factors for dementia
Endocrine changes (metabolic complications)
Increased insulin resistance
Menopausal changes
13. Physiologic changes with normal
aging
Respiratory (lung) changes
Decreased vital capacity and decreased forced expiratory volume (can be
improved by aerobic exercise training)
Decreased pulmonary defense mechanisms & increased risk for
pneumonia (e.g. depressed patients who stay in bed)
Gastro Intestinal changes
Gum retraction + increased risk to lose teeth (ECT consideration)
Decreased acid secretion in stomach + decreased intrinsic factor
(increased risk of B12 deficiency)
Decreased absorption of calcium, osteoporosis (fractured bones with falls
from poor balance)
14. Pharmacokinetic changes with normal aging
(What the body does to the medications)
Absorption
Distribution *
Protein binding
Metabolism *
Renal (kidney) clearance *
15. Drug distribution changes with
normal aging
Aging results in an increased fat over muscle ratio:
So for fat soluble drugs in an aging body:
increased distribution volume of drug
decreased initial blood levels of drug
increased risk of accumulation of drug
Aging result in a decrease in total body water:
So for water soluble drugs in an aging body:
decreased distribution volume of drug
increased blood levels of drug
16. Drug Metabolism with normal aging
Decreased liver mass and blood flow
Decreased de-methylation and decreased
hydroxylation
Decreased rate of elimination = increased levels
of the drug
17. Renal (kidney) clearance of drugs with
normal aging
Decreased glomerular filtration rate, tubular
secretion and decreased renal blood flow
Decreases clearance of drugs eliminated by the
kidney = increased levels of these drugs (eg
lithium)
18. Brain changes with normal aging:
Neuronal loss (<1% per year after age 60)
Greater neuronal loss or loss of connections in:
frontal/prefrontal cortex (executive function)
hippocampus (memory)
locus ceruleus (sleep)
substantia nigra (gait)
olfactory bulbs (smell / taste)
19. Neuro-imaging in normal aging
C.T. brain scan:
shrinkage/atrophy
(increased CSF space/decreased brain volume)
M.R.I scan:
Shrinkage/atrophy
decreased gray-white density
up to 30% white matter abnormalities ?
20. Other changes with “normal” aging that
affect older patients
Decline in mineralization of bones (8-10% per year for
post-menopausal women = fracture with falls)
Impaired postural reflexes and increased sway, poor
balance (falls from side effects of prescription meds or
OTC drugs)
Hearing loss in up to 60% over age 70 ( may appear to
be cognitive problems)
Decreased perception of acute pain
21. So what about the woman with
mental illness who is aging?
Expect to lower doses of psychiatric meds to
reduce side effects/obtain same treatment effect
as when this woman was younger
Expect medical conditions might be caused by
or worsened by psychiatric meds (metabolic
syndromes, parkinsonism, postural hypotension
(low BP), falls and fractures)
New onset of confusion is not “normal” aging –
increasing risk of developing dementia as we
age, increasing risk of delirium from medications
and medical problems
22. Frequent Problems / Common Stresses
of Aging for all Women:
Dealing with death and loss of family/friends
Retirement from work and other active roles
Housing & relocation (planned or unplanned)
Medical illness/physical disability/functional
decline
Changes in family relationships
Caregiver role (whether wanted or not)
23. Caregiver role
Our health care system depends on unpaid
caregivers
Most caregivers of elderly disabled individuals
are women (wives, daughters, daughters-in-law,
sisters, sisters-in-law, nieces)
Many are themselves elderly
Caregivers of elderly individuals with mental
and/or physical disorders are twice as likely to
develop depression
24.
25. Additional frequent problems
/common stresses for older women
with mental illness
Poverty
Social isolation
Lack of transportation
Exclusion from criteria for home care services
Multiple medications with complex instructions
Triaged with a “different lens” in ER and
primary care settings
27. Dementia / Delirium /Depression
The 3 D’s of Geriatric Psychiatry
Dementia: A condition of acquired cognitive deficits,
sufficient to interfere with functioning, in a person
without depression (pseudo-dementia) or delirium
Delirium: An acute, potentially reversible, condition
characterized by fluctuating attention & level of
consciousness, disorientation, disorganized thinking,
disrupted sleep/wake cycle
Depression: Alteration in usual mood with sadness,
despair, lack of enjoyment in previously enjoyed
activities and vegetative symptoms sufficient to
interfere with functioning
28. Common psychiatric disorders
in those over 65 years old
Dementia: estimates are that 8% of
population over 65 and 30% over 85 is
affected by dementia.
Delirium: approx. 30% of general in-pts in
medicine and rehab. More frequent in
neurology and common after surgery,
especially orthopedic procedures.
29. Psychiatric disorders often coexist in the elderly
Dementia is often complicated by delirium,
depression, anxiety and psychotic
symptoms (hallucinations and delusions)
Late onset depression is associated with
high risk of developing dementia.
Anxiety symptoms common in early
dementia, depression, substance use
withdrawal…
30. Medical problems often co-occur
in elderly with mental illness
Medical problems can mimic psychiatric illness (e.g.
Parkinson disease); cause or precipitate psychiatric
illnesses (thyroid, strokes causing depression or mania)
or cause anxiety or depressive symptoms.
Medication for medical problems may interact with
psychiatric drugs or can cause depression, delirium.
Psychiatric drugs can worsen some medical problems
(BP problems, weight gain, blood sugars, falls and
fractures, confusion, visual problems, urinary retention)
31. Dementia
Dementia: A condition of acquired cognitive
deficits, sufficient to interfere with functioning,
in a person without depression (pseudodementia) or delirium
Cognitive deficits: can be a decline compared
to previous levels in language, executive
function, memory, orientation, visuo-spatial
abilities etc.
32. Dementia is Common
% Prevalence
> 65: Overall:
35
30
34.5
25
20
15
10
5
0
Age related risk:
2.4
65-74
11.1
75-84
85+
Lindsay et al. Can J Psychiatry 2004;49:83-91. CSHA CMAJ 1994;
150: 899-913; CSHA. Neurology 2000; 55: 66-73
Incidence: 2 %
Prevalence: 8 %
Prevalence doubles every ~5
years
An intervention that would
delay onset by 5 years would
decrease prevalence by 50%
Females>Males
33. Warning signs of Dementia
10 Warning Signs for
Caregivers*
Difficulty performing
familiar tasks
Problems with language
Disorientation to time and
place
Poor or decreased judgment
Problems with abstract
thinking
Misplacing things
Changes in mood and
behaviour
Changes in personality
Loss of initiative
Memory loss that affects
day-to-day function
Behavioural Flags for Health
Care Professionals
Frequent phone calls
Poor historian, vague
Poor compliance: meds
/instructions
Change in Appearance /
hygiene / makeup
Word finding / decreased
interaction
Appointments - missing /
wrong day
Confusion: surgery, meds
Weight loss / dwindles
Driving: accident / problems
“Head turning sign”
34. How many drivers have
dementia?
100000
90000
80000
70000
60000
50000
40000
30000
20000
10000
0
65+
80+
1986 2000 2028
Hopkins et al. Can J Psychiatry 2004
Combined Ontario
Ministry of
Transportation data
with census data and
dementia prevalence
data to give “best
estimate” of
proportion of drivers
with dementia
F>M
35. Delirium
Delirium: An acute, potentially reversible,
condition characterized by fluctuating attention
& level of consciousness, disorientation,
disorganized thinking, disrupted sleep/wake
cycle
36. Delirium Recognition
Low rate of recognition by health care
professionals – why?
Hospitals are organized around “one-thing-wrongat-once” principle and delirious patients are complex
Patient is often unable to give a history (a sensitive
but non-specific marker!) so viewed as
uncooperative, demented or a “poor historian”
Assumptions are made about “usual” functioning
Frequent falls are not recognized as possible
important marker
37. Delirium – So What?
Patients with delirium have:
- prolonged length of stay in hospital
- worse functional outcomes
- higher rates of nursing home placement
- increased risk of permanent cognitive decline
- higher death rates
- worse rehabilitation outcomes
Delayed recognition → worse outcomes
38. Late life depression
Depression: Alteration in usual mood with
sadness or negative mood state (anger,
irritability, despair), lack of enjoyment in
previously enjoyed activities and vegetative
symptoms sufficient to interfere with
functioning
39. Late Life Depression
Common (but often undiagnosed)
Costly
Debilitating
Potentially lethal
Aging baby boomers are expected to have
higher rates than the current elderly cohort
40. Late Life Depression
View late life depression as a sentinel event
that substantially increases the risk for
decline in general health and function
Frequently heralding the onset of cognitive
decline/dementia
41. Risk factors for late life
depression
FEMALE
Major life events such as widowed or
divorced
Structural brain changes
Peripheral body changes such as major physical
or chronic debilitating illness
42. Risk Factors for late life
depression
Previous history of depression
Caregiver for person with dementia or
other debilitating medical condition
Excessive alcohol consumption
Taking medications, such as centrally
acting BP meds, analgesics, steroids,
antiparkinsons, benzodiazepines
43. Mood Disorder due to Medical
Condition: common in late life
Stroke induced depression or mania
Depression associated with Parkinson's disease
Depression or mania due to endocrine disorders
(thyroid, adrenal)
Depression due to infectious illnesses
Substance-induced depressive or manic syndromes
(alcohol, benzo)
Depression and cognitive problems due to sleep apnea
44. Use of Health Care Services in
Depressed Elderly
Twice the number of medical appointments
Increased number of medications taken
Twice the length of stay in hospital
In Nursing homes:
Increased nursing time
45. Suicide rates in Canada
Highest rates for men:
20-24 age group and 80-84 age group (30/100,000)
85+ highest with 35/100,000
Highest rates for women:
45-49 age group (9/100,000)
Ratio of attempts: completed suicide after 65 much
lower than younger adult
2:1 men; 4:1 women.
46. Improving recognition of late life
depression
Clinician factors
Incorrectly attribute depressive symptoms to the
aging process (“I’d be depressed too!”)
More focus on concurrent medical conditions
Time pressures/fee-for-service payment
Problems in integration of mental health and
primary care systems
47. Improving recognition of late life
depression
Patient factors
Stigma (patient and caregivers)
Ageism (patient and caregivers)
Misinformation
More comfortable to report physical symptoms
Dementia may color the picture
48. Treatment and recovery/well being
Possible for all (early and late onset) mental
disorders for elderly women
Many recent best practice guidelines to focus on
mental disorders in the elderly
Recent enhancement of training/education for
general psychiatrists, primary care physicians
New Royal College official subspecialty in
Geriatric Psychiatry
49. Treatment and recovery/well being
Medication can be an important part of
treatment/recovery
Psychotherapies can be an important part of
treatment/recovery
ECT can be an important part of treatment/recovery
Physical exercise, healthy diet, stable housing, stable
finances, spiritual well being, social connections,
laughter, brain exercise are all important parts of
recovery and well being
50. Take Home Messages
Growing old with mental illness is not for sissies !!
Early onset mental illness requires a fresh perspective
by health care professionals as women grow older
Late onset mental illness can be complex
Prevention, early identification, treatment and followup are key to recovery/well being
Mental health services for the elderly can be
fragmented, lack availability and are plagued by stigma
but improvements are happening!