Chapter #10: Mental Health Disorders Flashcards
Definition of Mental Health?
self-regard, accurate perception of reality, environmental mastery, autonomy, personal balance, grwoth, and self-actualization
What is the definition of mental health in terms of the Elderly?
Grief, exhaustion, appetite changes, sadness, hostility, passitivity may be justifiaible
* Same symptoms in young/old lead to different diagnosis
* Difficult to differentiate between normal and non as it changes with time, situations, cultures, and age groups
Mental Status Exam
short screening test that assess mental competence
* usually used as a brief indicator of dementia, or other serious cognitive impairments
What are the 2 main factors that influence Assessment?
- Biases (negative & positive)
- Enviornmental Conditions
What Biases affect the assessment process?
- ethnic minorities and “diagnosed” problems that do not truly exist
- Ageism - “diagnosed” with untreatable problems rather than a treatable problem
- Women do not abuse alcohol can have a misdiagnosis
What Enviornmental Conditions affect the assessment process?
- Assessments do not always get ideal environment
- sensory or motor difficulties
- Phyiscal health; mental health issues may be overlooked
What are the 5 components of Culture to consider in Mental Health?
- Emotional Expression
- Shame
- “Power Distance”
- Collectivism vs. Individualism
- Spirituality & Religion
Ethnic & Racial Biases in Mental Health
- There is little research in minorities
- In African Americans - higher total income lower depression, anxiety
- Higher employment = greater anxiety
- Moderated by sex with women even higher in both
Lifespan Approach to Psychopathology
Biopsychosocial
1. Biological Forces
2. Psychological Forces
3. Sociocultural Forces
4. Lifecycle Forces
Prevelance of Mental Disorders?
- Women and men differ in depression and suicide rates
- Women may not perceive or report abuse
- Access to healthcare is different
- Older adults seem to have the lowest rate of mental disorders, while it is higher in 18-29 and 30-40 years old
Assessment
to measure, understand & predict behavior, need medical, psychological, and sociocultural information
What are the 6 main methods of assessment?
- Direct Observations
- Clinical Interviews
- Self-Report/Report by Others
- Psychophysiological
- Neuroimaging
- Performance Based
What Stereotypes affect the assessment process?
Negative
* old, ethnic, poor, or gender causes misdiagnosis, missed symptoms, memory
Positive
* women do not abuse acohol, men do not get depressed
Therapy for menta disorders involve 2 approaches, what are they?
1) Medical Treatment
* monitored by age as metabolism changes
2) Psychotherapy
* enhances positive psychological traits as resilience, social engagement, and wisdom
What are the Symptoms & Characteritics of Depression?
- Dysphoria
- Physical Symptoms - insomnia, changes in apetite, diffuse pain, troubled breathing, headache, sensory loss
- Duration - symptoms must last as least 2 weeks
- Other observed causes must be ruled out
- Clinician must determine how patients’ symptoms affect daily life
Rates of Depression
- Higher in females
- Higher in young adults
- Higher in whites, but higher in those with multiple ethnicities
Dysphoria
feeling down or blue, marked by extreme sadness
Behavior Therapy
focuses on attempts to alter current behavior without necessarily adresisng the underlying cause
Cognitive Behavioral Therapy
which attempts to alter the way people think as a cure for some forms of psychopoathology
Delirium
charactertized by confused thinking and reduced awareness of one’s environment that develop rapidly
* difficulty with attention, memory, orientation, and rambling
* Affects perception, sleep-wake cycle, personaity, mood
What is Dementia?
A family of diseases characterized by cognitive and behavioral deficits involving some form of permanent damage to the brain
* involves severe cognitive and behavioral decline, gets worse over time
What is Alzheimer’s Disease?
most common form of progressive & degenerative, and fatal dementia, accounting for betwene 60% - 80% of all cases
What is Beta-Amyloid?
a type of protein involved in the formation of neuritic plaques both in normal aging; and in Alzheimer’s disease
* Prescence is related to severity of the disease
Neurofibrillary Fibers
neurofibers become twistsed and interfere with the transmission of nutrients/information
* Number of tangles is directly related to the severity of symtpoms
Where does Rapid Cell Death occur the most in Alzheimer’s disease?
Hippocampus, The Prefrontal Cortex, and the Basal Forebrain
Sundowning
the phenomenon when people with Alzheimer’s disease show an increase in symptoms later in the day
Beta-Amyloid Cascade Hypothesis
refers to the process by which beta-amyloid deposits create neuritic plaques
* Leads to neurofibrillary tangles, causes neuronal death
Spaced Retrieval
a behavioral, implicit - internal memory intervention used in early-and middle-stage dementia
* can be used to train nonmemory behaviors
Vascular Dementia
a form of dementia caused by a series of small strokes
* many have sudden onset
* most have history of cardiovascular or cerebrovasular disease
* Death occurs 2-3 years after onset
* 10%-15% of Dementia Cases
Lewy Bodies
Abnormal accumulation of Alpha-Synuclein Protein inside neurons
* Fluctuating cognition with significant variations in attention and alertness
* Recurring complex visual hallucinations
* Spontateous feature of Parkinson’s Disease
Parkinson’s Disease
Caused by a deteroriation of neurons that produce the neurotransmitter dopamine
* known primarily for characteristic motor symptoms are easily observable
* very slow walking, difficulty getting into and out of chairs, slight hand tremor
Huntington’s Disease
a fatal autosomal dominant disorder that usually begins ages 30-45
* manifests through involuntary flicking movements of the arms and legs, inability to sustain a motor act, prominent psychiatric disturbances, clear personality change
* onset of symptoms is gradual
* progressive is ultimately lose the ability to care for themselves physically and mentally
Alcohol-Related Dementia
Chronic alcohol use may result in cognitive decline, ranging from limited forms of amnesia or mild cognitive impairment to dementia
* Causes damage to Thalamus and Hypothalamus
Confabulation
when the person to make up apparently believable, but completely fictitious stories that cover the gaps in memory
AIDs Dementia Complex (ADC)
Occurs primarily in person with more advanced HIV infection
* inflammation of the glial cells may cause damange to brain and spinal cord
* confusion and forgetfulness, behavioral changes
* Progressive weakness, loss of sensation of arms and legs
Psychoses
involves losing touch with reality and the disintegration of the personality
* Delusions - belief systems not based on reality
* Hallucinations - distortions in perception
Schizophrenia
characterized by the severe impairment of thought processes
* content and style of thinking
* distorted perceptions
* loss of touch w/ reality
* abnormal motor behavior
* inappropriate emotionally
Alcohol Use Disorder (AUD)
a drinking pattern that results in significnat and recurrent consequences that reflect loss of relaible control over alcohol use
How is Dysphoria perceived in older adults?
- Older adults may not talk about their feelings at all
- May label feelings as pessimistic or helplessness
- Shows signs of apathy, subdued self-deprication, expressionless
- Common to withdraw, isolate, confine self to bed, and not tkae care of bodily functions
How is Depression Measured in Older Adults?
- Short Geriatric Depression Scale (GDS)
- Center for Epidemiological Studies - Depression (CES-D)
Why is the Beck Depression Inventory (BDI) not reliable for older adults?
Questions consist of bodily questions that could be confused with normtive aging processes
Medications to treat Depression
- Selective Serotonin/Norepinephrine Inhibitors (SSRI, SNRI)
- Norepinephrine & Dopamine (NDRI)
Electroconvulsive Therapy (ECT)
a form of treamtent for severe, long-duration depression; for those not responsive to medication
What can cause Delirium?
Can be caused by any of a number of medical conditions
* Dehydration, medication side effects, substance/intonxication, sleep deprivation, fever
* Older adults are particularly suspcetible
* 1/3 of cases are preventable
What are the 2 genes associated with Early Onset of Alzheimer’s Disease?
APOE 2 - gene that prevents the development of dementia
APOE 4 - plays a role in the development of neuritic plaque
What are the major symptom areas of Alzheimer’s Disease?
- Memory loss that interferes with daily life
- Difficulty in dealing with everyday problems
- Difficulty completing familiar tasks
- Confusion w/time or place
- Trouble understanding visual images
- New Problems w/ words
- Misplacing things/retracing steps
- Poor judgement
- Withdrawals from work or social
- Changes in mood/personality
What is the model of the Beta-Amyloid Cascade Hypothesis?
Neuritic Plaques»_space;> Neurofibrillary Tangles»_space;> Neuronal Death»_space;> Alzheimer’s
What interventions exist for Dementia?
- Medications that block effect of beta-amyloid and tau proteins
- Behavioral Strategies - have more effect
Differential Reinforcement of Incompatible Behavior (DRI)
a person is rewarded for doing desired behavior, but not rewarded for doing undesirable behavior
What did the Nun Study Uncover about how to build Resiliency against Dementia?
Many participants had the neuropathology for Dementia, but never exhibited behavioral/clinicial dementia
* Higher cognitive reserve
* May be influenced by education/engagement, exercise, medi-diet, or lifestyles
What influences the development of Parkinson’s?
A-snynuclein aggregates around the Substania Nigra
* dopamine in the systsem eventually die, creates issues in which proteins fold
* Involves the Gut Microbiome
Characteristics of Anxiety
Increased blood pressure, heart rate, dry mouth, sweating, dizziness, headache, chest pain, insomnia
Treatments for Anxiety
Medication, CBT, relaxation training
How does Substance Use change in Older Adults?
Less recreational - more OTC, prescription meds, alcohol
* Craving»_space;> impaired control»_space;> physical dependence»_space;> increased tolerance
What are the Ethnic/Gender Differences with AUD?
- 2-6x more likely for men, widowers after 75
- Native American have higher likelihood than European Americans
What are the 2 patterns of onset for Alcohol Use Disorder?
- Early onset in young adulthood or middle age with lifelong problems - 2/3 of prevelance
- Late onset proble drinking
* less medical problems due to less exposure
* more affluent, more women, more likely to start use after stressful event
Treatment of AUD involves what?
- Stabilization & Education of Substance Consumption
- Treatment of Coexisting problem
- Arrangement of appropriate social interventions
