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1

definitional issues in psychopathology related to aging?

  • Must reflect appropriate age related criteria
  • A healthy person has:
  • Positive attitude towards self
  • Accurate perception of reality
  • Mastery of the environment
  • Autonomy
  • Personality of balance, growth and self-actualization
  • To the extent that these characteristics are absent, mental disorder, or psychopathology is more likely
  • Behaviors must be interpreted in context; what is happening in addition to age and other personal characteristic? 

2

multidimensional approach to psychopathology considers what for accurate diagnosis of mental disorders?

  • Biological Forces  
    • Neuro changes, chronic

  • Psychological Forces  
    • Memory, social intelligence and cognition 

  • Sociocultural Forces  
    • older woman lives in a high crime area

  • Life-cycle factors  
    • After a man retires

  • Ethnicity  
    • Poverty and social class plays a role but not ethnicity

  • Gender
    • being female increases the risk of depression 

      Males with depression are more likely to commit suicide

3

assessment depends on

measuring funcitoning across a spectrum of areas including medical, psychological and social 

4

what factors can inflience the assessment?

negative biases

environmental conditions 

5

Mental status exam 

  • quick screening measures of mental competence used to screen for cognitive impairment

6

What are the major assessment methods?

  • 6 primary methods:
  • Interview
  • Self-report
  • Report by others
  • Psychophysiological assessment (for e.g. link between EEG results and mood)
  • Direct observation
  • Performance based assessment

7

two kinds of treatment 

  • Medical and psychotherapy
  • Medications effect change with age
  • Psychotherapy needs to be geared to the population with an emphasis on
  • Recovery
  • Promotion of successful aging
  • Neuroplasticity
  • Prevention
  • Aid with resilience, social engagement wisdom

8

General symptoms and characteristics of depression

prevalence declines with age

  • 1) dysphoria feeling down or blue
  • 2) most prominent feature are physical symptoms
  • 3) most prominent feature is that it must last at least 2 weeks
  • 4) how is it affecting daily life - involves significant impairment of daily living
  • 5) other causes must be ruled out 

some assessment scales are not sensitive to age differences in symptoms 

9

Causes of depression

  • Rate of depression from young to old actually declines

  • Genetic predispositions
  • Brain changes
  • Bereavement or loss of anything important (in youth good looks in old age death of a loved one)
  • Cognitive reasons such as loss of control over situations /perceiving the cause of negative events as your fault  / rumination
  • Neurotransmitter changes (low levels of serotonin as as result of high level of stress over a long time)

10

flaw in assessment scales depression 

  • Biggest problem is that they are designed for younger so certain measures like physical symptoms apply differently to OA
  • Geriatric depression scale: physical symptoms are omitted
  • Don't depend on just one scale - have to look at the whole picture

11

Medication for depression 

  • SSRI selective serotonin reuptake inhibitors, which has the least side effects
  • Tricyclic antidepressants - higher risk of side effects in older adults
  • Monoamine oxidase (MAO) inhibitors - very rare as they can cause death from really high blood pressure
  • Lithium for bipolar - is a salt, so raises blood pressure - less effective with age
  • ECT for very severe cases and works immediately  - affects cognition and memory

12

Behavioral  therapy focuses on 

  • attempts to alter current behavior without addressing underlying causes
  • The goal is to get them feeling like good things are happening to them - if they do more things there is a likelihood that god things will happen

13

CBT main goal

  • alters the way people think
  • Results from maladaptive beliefs or cognitions about ones self
  • So recognize the thoughts that become automatic
  • Reevaluate more realistically
  • Especially effective in older adults 

14

Delirium

characterized by disturbance of consciousness and a change in cognition that develops over a short period of time

  • Attention
  • Memory
  • Orientation
  • Language
  • Perception
  • Sleep-wake cycle
  • Personality and mood
  • Onset is rapid symptoms in older adults worse than younger
  • Caused by
  • medical conditions (stroke, CVD)
  • Medication side effects
  • Substance intoxication or withdrawal
  • Exposure to toxins
  • Often undiagnosed or misdiagnosed but they are more susceptible because they are taking more drugs
  • 1/3rd are preventable most are curable in some it can be fatal or leave serious effects

15

Dementia is

  • not a specific disease but rather a family of diseases characterized by cognitive and behavioral deficits involving some form of permanent damage to the brain
  • A dozen forms have been identified
  • most OA do not but rates increase significantly with age 

16

Most common dementias are

  • Alzheimer's
  • Vascular dementia
  • Parkinson's
  • Huntington's
  • Alcoholic dementia
  • AIDS dementia complex

17

Alzheimer's is

  • the most common form of progressive, degenerative and fatal dementia accounting for 70% of all cases of dementia, diagnosed at autopsy thorugh neurological changes that include neurobibrillary tangles and neuritic plaques 

18

neuritic plaques 

  • are spherical structures consisting of core beta-amyloid a protein, surrounded by degenerated fragments of dying or dead neurons;
  • Too much tau protein is also associated

19

Symptoms and diagnoses in Alzheimer's

  • Gradual changes in cognitive function (symptoms small at start then get worse)
  • Memory, starting with recent progressing to remote
  • Learning
  • Attention
  • Judgement
  • Disorientation
  • Finding words, communicating
  • Changes in personality
  • Inappropriate social behavior
  • Incontinent, more dependent on others for help

20

Clinical diagnoses of Alzheimers involves 

  • Noting history of symptoms
  • Documenting cognitive impairment
  • Conducting a general physical and neuro exam
  • Lab tests to rule out other diseases
  • Psychiatric evaluation
  • Neuropsychological tests
  • Assessing functioning abilities
  • Ruling out other causes of symptoms

21

sundowning

  • Symptoms are worse in the evening than in the morning, a phenomenon caregivers call

22

Autosomal dominant inheritance patterns

  • possible cause of alzheimer's 
  • are those that require only one gene from either one's mother or father in order to cause a trait or condition to develop

23

Beta-amyloid cascade hypothesis refers to

  • the process by which beta-amyloid deposits create neuritic plaques, that in turn lead to neurofibrillary tangles that cause neuronal death, and when this occurs severely enough, Alzheimer's disease

24

cure for alzheiemers 

none

interventions to relieve symptoms 

respite and adult day care 

25

Differential reinforcement of incompatible behavior (DRI)

  • are providers reduce the incidence of difficult behavior by rewarding the person for engaging in appropriate behaviors
  • Example: a person who throws food at the dinner table could be rewarded for sitting quietly and eating

26

Spaced retrieval 

  • implicit internal memory intervention
  • Teaching to remember new information by gradually increasing time between retrieval attempts
  • Used to teach names of staff members
  • Helps to teach them learn how to swallow

27

Vascular Dementia is

  • a result of numerous small cerebral vascular accidents
  • Most people with this form have a history of cerebrovascular or cardiovascular disease

28

Parkinson's

  •  is known primarily for motor symptoms
  • Caused by deterioration in neurotransmitters that produce dopamine
  • The medulla and olfactory bulb, which control the sense of smell

29

Treatment for parkinson's 

  • Levedopa - raises level of functional dopamine in the brain
  • Neurostimulator acts like a brain pace-maker by regulating brain activity when implanted deep in the brain  may eventually help
  • Some people eventually develop severe cognitive impairment and dementia

30

Huntington's disease

  •  autosomal dominant disorder that begins between the age of 30 - 45
  • Involuntary flicking of the arms and legs
  • Inability to sustain a motor act such as sticking out your tongue
  • Hallucinations, paranoia, depression, mood swings
  • Slow onset and progressive
  • genetic
  • middle age start