Ch.6: Mental Health and Mental Health Disorders Flashcards
What is Assessment?
- It is a systematic approach to assessing behavior, cognition, or emotion; ideally it is multidimensional, using interview, standardized measures, self-and family report
- Assessment is an essential first step in developing an appropriate treatment plan
What are 5 assessment measures?
- Mental status examination- assesses current state of mind
- Functional abilities- ADLs and IADLs
- Clinical interview- questions in face-to-faced setting somewhat flexible. In order to be able to truly assess somebody, you want to get an idea of a person’s real abilities & what is their insight
- Physical examination- rule out underlying physical reasons for emotions, thinking or behavior
- Specific symptom measures- Geriatric Depression Scale
Older people have different presentations of depression than younger people do.
Issues in assessing older adults to avoid systematic errors in the assessment process: (3)
- Assessment should be tailored to older adults (ex: geriatric depression scale)
- Need to account for sensory (glasses, hearing aids), motor, and cognitive limitations
- Biases/stereotypes (ex: assuming a person’s first language is English)
Myth: aging leads to depression- old age is depressing
What is the reality?
Reality: rates for major depression are lower in the elderly compared to younger adults
__________ impairment is a positive symptom of major depressive disorder
Memory
Patten and his colleagues (2015) used data from the Canadian Community Health Survey to examine the last-year prevalence rate of depression in a household sample of 25,113 Canadians.
What did they find out?
Depression is not as prevalent in the older age groups as it is in the young and middle-aged groups/
Why are there lower levels of depression for older adults living in the community?
- Older adults may not be correctly diagnosed for major depressive disorder
- Health care professionals may not be trained in diagnosis of older adults
- Older adults may not accurately report symptoms. They might label their feelings as pessimism or hopelessness instead of labeling their feelings as depression
- Physicians spend too little time with them
- Reimbursement rates lower than for medical
- Attitudes toward depression in older adults
- Medical and psychological symptoms may co-occur - Sub-syndromal depressive symptoms (depressive symptom that don’t meet the DSM 5 criteria) may also be more prevalent in older versus younger adults
- Older adults may be better at regulating their emotions and thus report fewer depressive symptoms
- Older adults generally experience less stress than those whoa re younger, and tend to use emotion-focused coping rather than problem-focused coping, and may therefore be better at regulating their emotions
Emotional regulation gets better with age=not seeking help
Treatment for depression
- Selective serotonin reuptake inhibitors (SSRIs) =first medication of choice for olde people depression
- Electroconvulsive therapy (ECT)- If SSRIs aren’t working
- Cognitive-behavior therapy, problem-solving therapy, and interpersonal psychotherapy
What works best in treating depression?
A combination of drugs and therapy
What are some considerations for older adults in SSRI treatment?
- take precautions against drug interactions
- may have serious side effects including addiction
What is a consideration for older adults in ECT treatment?
- may cause short-term memory loss
What is a consideration for older adults when it comes to therapies?
- need to tailor the therapies to older adults= can take a slower pace, shorter sessions, etc.
Pseudodementia
- looks like dementia (because of the memory loss that comes with aging) but it is depression masked as dementia
Distinguishing between Pseudodementia and Dementia
- Pseudodementia patients have a more abrupt onset of cognitive symptoms while there is an insidious onset (years) of irreversible dementia
- Pseudodementia patients realize they memory trouble (are frustrated and will say I don’t know on memory tests) while people with irreversible dementia do not recognize/acknowledge their memory problems even while struggling to give correct answers (more likely to conceal memory difficulties)
- Pseudodementia patients score relatively higher in levels of depression while patients with dementia often show a wide range of emotions, sometimes responding to situations with an inappropriate emotion (such as laughing when others are grim)
SPECT imaging
- important to reveal the underlying cause of symptoms since the treatment for depression.