L12: disorders related to aging Flashcards
most common psych disorder in aging adults?
anxiety, then depression.
about 1/10 adults over 55yoa has diagnosable anxiety disorder
gender + anxiety disorder?
older women more likely affected than older men
2:1
most frequently occurring anxiety disorders in older adults?
generalized anxiety, phobic disorder
panic disorder is rare
agoraphobia in older adults?
recent origin + may involve loss of social support systems
depression + aging
- risk?
- prevalence?
- risk declines with age. many older adults encounter serious periods of depression.
- 8-20% experience some symptoms; 3% suffer from major depression
sleep problems + aging
- prevalence compared to depression?
- physiology?
insomnia more prevalent than depression.
- sleep problems reflect age-related changes in sleep physiology (sleep apnea, wake up earlier)
- may be feature of psych disorder or psychosocial issues/changes
previous DSM definition of neurocognitive disorder?
cog disorder are organic mental disorders.
organic = brain damage/dysfunction
all disorders have this feature..
primary deficit in neurocog disorder?
deficit in cog functioning.
- acquired, decline from previous function
what is dementia?
aka major neurocognitive disorder
what is delirium?
“from” “line” = straying from the line/norm in percpetion, cognition, behaviour
essential feature of delirium?
disturbance of attention, awareness that is accompanied by change in baseline cognition that cannot be explained by pre-existing, evolving neurocog disorder
delirium + disturbance in attention = reduced ability to?
direct, focus, sustain + shift attention.
= repeat Q, gets off topic + perseverates, easily distracted, reduced orientation to enviro
delirium development?
short (hours to days) m fluctuate over course of day + worsen in evening when orienting stimuli decrease
why does delirium happen?
physiological consequence of underlying medical condition, substance intox/withdrawal, medication, toxin exposure, combo.
accompanying changes in delirium?
memory + learning, disorientation, alteration in language, perceptual distortion, perceptual-motor distrubance
perceptual disturbances accompanying delirium include ?
illusions (misperceive object stimuli)
hallucinations (no objective stimulus)
delirium continuum?
normal -> delirium -> coma (lack of any response to external stimuli)
delirium + sleep-wake cycle?
distrubed s-w cycle
emotional disturbances in delirium?
- anxiety, fear, depression, irritability, anger, euphoria, apathy
- rapid, unpredictable shifts
prevalence of delirium?
highest among hospitalized older individuals.
- varies depending on characteristics, setting of care, sensitivit of detection method
- overall low prevalence:1-2%.
increases with age.
treatment/intervention of delirium?
- often have spontaneous recovery with or without treatment
- early recognition + intervention is helpful
- may progress if untreated = high mortality
risk factors for delirium?
functional impairment immobility history of falls low levels of activity use of drugs/meds with psychoactive properties
delirium in youth?
- assoc with high fever
- more in infant/early childhood than in middle childhood.
what is delirium tremens?
in chronic alcoholics that stop abruptly.
- terrorizing hallucinations from with drawal.
- treat with hospital, milkd tranquilizers + enviro support
treatment for delirium?
anti-psychotics, psychosocial interventions to help cope.
what are major + mild neurocog disorders?
cog disorders that include gradual deterioration of brain functioning tat impacts judgement, memory, language + other advanced cog processes.
specifiers of neurocog disorders?
- alzheimer’s
- frontotemporal lobar degeneration
- lewy body disease
- vascular disease
- traumatic brain injury
- substance/medication induced
- HIV infection
- prion disease
- parkinson’s disease
- Huntington’s
- other medical condition
- mutliple etiologies
- unspecified.
cognitive deficits assoc with dementia?
- aphasia
- apraxia
- agnosia
- disturbance in executive functioning
features of neurocog disorders?
- psychotic features are common
- paranoia, memory, perception
how does presentation of psychosis differ in earlier onset + older age onset?
in earlier life more disorganized speech + behaviour.
- in later life more hallucinations in any sensory modality.
depression common in what ncd?
early in course of alzheimers + parkinsons
elation common in what ncd?
in frontotemporal lobar degeneration.
mood symptoms + ncds?
increasingly recognized as significant feature in early stages of milk ncds.
agitation in ncd?
common in many ncds
- often in confusing, frustrating settings.
apathy in ncd?
in mild ncd, due to alzheimers + may be prominent in frontotemporal lobar degeneration.
apathy characterized by?
diminshed motivation + reduced goal-directed behaviour accompanied by decreased emotional responsiveness.
sleep disturbance as symptom of ncd?
insomnia, hypersomnia, circadian rhythm disturbance
behavioural symptoms of ncd?
wandering, disinhibition, hyperphasia (talking), hoarding
2 core features of neurocog disorders
- cognitive decline in one or more cognitive domains based on
1. concern by self, informant, clinician
2. performance falls below expected + declines over time.
what is cognitive concern?
elicited by careful questioning about specific symptoms that occur in individuals cognitive deficits.
mild cog concern? vs major cog concern?
milk: take longer to do task, compensatory strategy
major: only completed with assistance or completely abandoned.
psych testing + ncd
- neuropsych testing with performance comparison to same age, education, culture.
psych testing + major vs mild ncd?
major: performance is 2+ st.dev below norm
milkd: performance is 1-2 st.dev lower than norm.
cog concerns tested compared to prior performance - challenge?
challenging to compare high or low education + in individuals with alternate language/cultural background.
what is functional impairment
- impaired ability to do many tasks = interferes with independence sometimes, other times just takes longer to do things.
prevalence of neurocog disorders?
- depends on age/subtype
- 60+ yoa = prevalence increases steeply.
- approx 1-2% at age 65 + 30% by 85 yoa.
- sensitive to the definition we give.
rates of incidence of ncd?
more common as ppl age.
comparable against age + social class.
men have higher risk of vascular cause due to increase risk of stroke/heart attack.
women more likely to have alzheimers.
development + course of ncd?
- course varies across etiology, can be useful in differential diagnosis.
- alzheimers + frontotemporal lobar degeneration marked by incidious onset + gradual progression
- harder to recognize with age bc of medical illness + sensory deficits.
risk factors for ncds?
#1: AGE - female gender, potentially attributable to greater longevity in females
ncd due to alzheimers - onset + progression?
- presentation?
incidious onset, gradual progression of cog + behavioural symptoms.
- presentation as amnestic : problem with mem, learning, not getting new info
mild alzheimers?
impairment in learning + memory, sometimes accompanied by deficits in executive function.
major alzheimers?
visuoconstructional/perceptual-motor ability and language impaired. particularly when ncd is moderate to severe
- social cognition preserved until late
assoc features of alzheimers?
behavioural + psychological manifestation.
- as or more distressing than cog manifestations and frequently the reason that health care is sought.
- depression, apathy (mild)
- psychosis, irritability, agitation, combativeness, wandering (moderate to severe)
- later = gait disturbance, dysphagia, incontinence, seizures.
prevalence of alzheimers
7% of alzheimer’s diagnosed btw 65-74, 53% between ages of 75-84, 40% are 85 +yoa.
% of dementias that are alzheimers?
60-90% depending on diagnostic criteria.
development of ncd due to alzheimers
gradual, plateau, severe dementia to death
- mean duration after diagnosis = 10 years.
late-stage ncd due to alzheimers?
mute, bedmount.
- death due to aspiration.
risk factor for alzheimers
age.
- genetif polymorphism increases risk + decreases age of onset
* not validated biomarker
comorbidity of alzheimers?
cerebral vascular disease.
- many medical conditions in older age which complicate course, diagnosis, treatment
diagnosis of alzheimerS?
definitive done in autopsy.
- predict with 85% success rate, clinicians are good at detecting.
what is cerebral reserve hypothesis of alzheimers?
more prevalent in poorly educated.
- if losing IQ, more noticeable decline in less educated.
- higher education = more synapses = delayed signs.
causal factors of alzheimers?
plaques, steel-wool-like clumps form in brains of ppl with alzheimers disease.
- composed of material called beta amyloid = protein fragments.
treatment + prevention of alzheimers
- drugs: modest benefit, slow cog decline + boost cog fxn.
- hope for vaccine?
- lifestyle changes = exercise!
what is cerebrovascular accident?
stroke/brain damage from rupture/block of blood vessel supplying blood to brain. mini-strokes.
what is vascular ncd caused by?
blockage/damage to blood vessels that provide brain with O2 and other nutrients.
- acute, not slow progression.
- other paths utilized, but not as good.
prevalence of vascular ncd?
maybe around 4%? not many studies.
M more likely than W for sure tho.
onset of vascular ncd?
sudden - bc of stroke usually
features of vascular demenita?
similar to alzheimer’s
- impaired memory, language ability, agitation, emotional instability, loss of ability to care for own basic needs
general biological therapies for psychopathology?
- ect: used in depression, mood disorders, schizophrenia, adhd, anciety disorders. high success rates. may damage brain - impact memory
- psychopharmachology: psychoactive agents affects psych fxn. beneficial
what are antipsychotics
neuroleptics + major tranquilizers.
- first developed in 1950s to treat psychotic disorder (ie. schizophrenia)
- major side-effects known as extrapyramidal effects
what are extra-pyramidal effects of anti-psychotics?
movement disorders, parkinson-like symptom, neurologically-based restlessness.
what are anxiolytics?
alleviate symptoms of anxiety + muscle tension by reducing symp ns.
- barbuturates: tolerance develops quickly + toxic at high dose
- benzodiazepines: effective, addictive.
what are antidepressants?
drugs to treat depression :
maoi’s
tricyclics
ssris
side effects of antidepressants
dry mouth, blurred vision, nausea, headache, sexual side effects.
what are mood stabilizers?
- side effects?
lithium (bipolar disorder)
- nausea, dizzy, weight gain, therapeutic dose is idiosyncratic.
what are sitmulants?
treat adhd.
- 70% response rates, long-term condition, adherence may be issue.
limits on efficacy of psychopharmacology?
- effective, but none are effective for everyone.
- effect size is small
psychodynamic approach?
freud.
- help patient understand unconscious conflict = insight.
treatment
1. free association
2. grief interpretation
3. interpretation
4. analyis of resistance
5. analysis of transference.
neo-freud: face-to-face contact, client-therapist relationship. , interpersonal therapy (btw parent + child), ego analysis
humanistic-existential approach?
- focus on current experience, free will emphasized.
- karl rogers: client-centred therapy: unconditional (+) regard, empathy, genuinity.
- existential therapy: talk about things meaningful to client to help them grow + find meaning in life.
- gestalt is sub exist: talk about distortions leading to impairment.
- emotion-focused: clieant+ therapist = empathic relationship
cog/behavioural approach to treatment
operant, classical conditioning.
- assume behaviour is learned.
- behaviour reinforcement.
- behavioural activation (reward for participating)
- exposure therapy: immersed in feared object
- systematic desensitization: hierarchy of anxiety provoking stimuli
- assertiveness training
- cog restructuring: look at distorted thoughts + change
modalities of therapy?
individual: 1:1. most therapy
couple’s therapy: focus on relationship
family therapy: family system is “client”
group therapy: particular issues.
discuss couples therapy?
enhance partner satisfaction, behavioural, social learning.
- enhance communication, conflict resolution, emotion-focused,
discuss family therapy?
id how interactions contribute to problems.
- reframe the problem
- homework in treatment
- goal: enhance communication + negotiation styles within family
discuss group therapy
group of individuals with same issue come together.
- usually cog-behav is used
- benefit: no longer alone, more support, challenge each other on the issue, cost-effective
perspective of psychotherapist?
often say integrative - wont pick a side.
- psychologist =/= therapist, life coach. only psychologist is protected term.
- ask about training, what therapeutic method, confidentiality + finances.
who seeks psychotherapy?
- distress, wanting advice, assistance, coping with social roles, loss, etc.
- most likely female, university educated and/or young-middle aged adult.
duration of treatment (general)?
most ppl attend 10 or less sessions.
evaluating effects of psychotherapy
- effective?
show that it’s treating + not just “not causing harm”
eysenck’s review on psychotherapy?
narrative review, found that psychotherapy had no evident effect.
– positive result: spurred research in the area to show effectiveness of treatment
treatment efficacy vs treatment effectiveness
efficacy: evidence that treatment works when delivered in controlled study: maybe not generalizable
effectiveness: evidence that treatment works irl
what is a narrative study?
collect all data + subjectively decide what’s good vs bad.
take quantitative data + qualify it subjectively.
what are meta-analysis studies?
quantitatively review research
- statistically control for study quality.
- calculate effect size = (exp - control groups)/ (st.dev of control group +/- pooled sample)
meta-analysis study of psychotherapy effectiveness?
is effective, not related to duration or therapist years of experience (bc some are bad from start to finish)
- all psychotherapies = equivalent effects. differences are washed out.
- some studies show behavioural therpy is best.
effectiveness of psychotherapy on depression?
cog-behave + interpersonal techniques are effective
effectinveness of psychotherapy on childhood disorders (adhd, oppositional, conduct)?
use techniques to improve parenting skills is effective.
other disorders that psychotherapy is used?
sleep disorders, few axis ii- exception: borderline personality with dialectic behaviour
therapy for couple distress?
yes, behavioural marital/couple therapy works. emotionally focused.can reduce conflict
evidence-based practice?
- yay or nay?
- arguement against?
pressure for ev-based. reasonable + important
- but how to develop new, potentially better if can only use evidence-based?
- factors effective in treatment outcome =/= treatment, but therapist empathy, cohesion in group therapy, patient-therapist goal consensus.
- also rigid clinical practice guidelines =/= effective treatment delivery.
