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239 - final > L12: disorders related to aging > Flashcards

L12: disorders related to aging Flashcards

1
Q

most common psych disorder in aging adults?

A

anxiety, then depression.

about 1/10 adults over 55yoa has diagnosable anxiety disorder

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2
Q

gender + anxiety disorder?

A

older women more likely affected than older men

2:1

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3
Q

most frequently occurring anxiety disorders in older adults?

A

generalized anxiety, phobic disorder

panic disorder is rare

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4
Q

agoraphobia in older adults?

A

recent origin + may involve loss of social support systems

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5
Q

depression + aging

  • risk?
  • prevalence?
A
  • risk declines with age. many older adults encounter serious periods of depression.
  • 8-20% experience some symptoms; 3% suffer from major depression
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6
Q

sleep problems + aging

  • prevalence compared to depression?
  • physiology?
A

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
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7
Q

previous DSM definition of neurocognitive disorder?

A

cog disorder are organic mental disorders.

organic = brain damage/dysfunction

all disorders have this feature..

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8
Q

primary deficit in neurocog disorder?

A

deficit in cog functioning.

- acquired, decline from previous function

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9
Q

what is dementia?

A

aka major neurocognitive disorder

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10
Q

what is delirium?

A

“from” “line” = straying from the line/norm in percpetion, cognition, behaviour

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11
Q

essential feature of delirium?

A

disturbance of attention, awareness that is accompanied by change in baseline cognition that cannot be explained by pre-existing, evolving neurocog disorder

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12
Q

delirium + disturbance in attention = reduced ability to?

A

direct, focus, sustain + shift attention.

= repeat Q, gets off topic + perseverates, easily distracted, reduced orientation to enviro

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13
Q

delirium development?

A

short (hours to days) m fluctuate over course of day + worsen in evening when orienting stimuli decrease

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14
Q

why does delirium happen?

A

physiological consequence of underlying medical condition, substance intox/withdrawal, medication, toxin exposure, combo.

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15
Q

accompanying changes in delirium?

A

memory + learning, disorientation, alteration in language, perceptual distortion, perceptual-motor distrubance

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16
Q

perceptual disturbances accompanying delirium include ?

A

illusions (misperceive object stimuli)

hallucinations (no objective stimulus)

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17
Q

delirium continuum?

A

normal -> delirium -> coma (lack of any response to external stimuli)

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18
Q

delirium + sleep-wake cycle?

A

distrubed s-w cycle

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19
Q

emotional disturbances in delirium?

A
  • anxiety, fear, depression, irritability, anger, euphoria, apathy
  • rapid, unpredictable shifts
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20
Q

prevalence of delirium?

A

highest among hospitalized older individuals.
- varies depending on characteristics, setting of care, sensitivit of detection method

  • overall low prevalence:1-2%.
    increases with age.
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21
Q

treatment/intervention of delirium?

A
  • often have spontaneous recovery with or without treatment
  • early recognition + intervention is helpful
  • may progress if untreated = high mortality
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22
Q

risk factors for delirium?

A 
functional impairment
immobility
history of falls
low levels of activity
use of drugs/meds with psychoactive properties
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23
Q

delirium in youth?

A
  • assoc with high fever

- more in infant/early childhood than in middle childhood.

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24
Q

what is delirium tremens?

A

in chronic alcoholics that stop abruptly.

  • terrorizing hallucinations from with drawal.
  • treat with hospital, milkd tranquilizers + enviro support
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25
Q

treatment for delirium?

A

anti-psychotics, psychosocial interventions to help cope.

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26
Q

what are major + mild neurocog disorders?

A

cog disorders that include gradual deterioration of brain functioning tat impacts judgement, memory, language + other advanced cog processes.

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27
Q

specifiers of neurocog disorders?

A
  • 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.
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28
Q

cognitive deficits assoc with dementia?

A
  • aphasia
  • apraxia
  • agnosia
  • disturbance in executive functioning
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29
Q

features of neurocog disorders?

A
  • psychotic features are common

- paranoia, memory, perception

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30
Q

how does presentation of psychosis differ in earlier onset + older age onset?

A

in earlier life more disorganized speech + behaviour.

- in later life more hallucinations in any sensory modality.

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31
Q

depression common in what ncd?

A

early in course of alzheimers + parkinsons

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32
Q

elation common in what ncd?

A

in frontotemporal lobar degeneration.

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33
Q

mood symptoms + ncds?

A

increasingly recognized as significant feature in early stages of milk ncds.

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34
Q

agitation in ncd?

A

common in many ncds

- often in confusing, frustrating settings.

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35
Q

apathy in ncd?

A

in mild ncd, due to alzheimers + may be prominent in frontotemporal lobar degeneration.

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36
Q

apathy characterized by?

A

diminshed motivation + reduced goal-directed behaviour accompanied by decreased emotional responsiveness.

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37
Q

sleep disturbance as symptom of ncd?

A

insomnia, hypersomnia, circadian rhythm disturbance

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38
Q

behavioural symptoms of ncd?

A

wandering, disinhibition, hyperphasia (talking), hoarding

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39
Q

2 core features of neurocog disorders

A
  • cognitive decline in one or more cognitive domains based on
    1. concern by self, informant, clinician
    2. performance falls below expected + declines over time.
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40
Q

what is cognitive concern?

A

elicited by careful questioning about specific symptoms that occur in individuals cognitive deficits.

41
Q

mild cog concern? vs major cog concern?

A

milk: take longer to do task, compensatory strategy
major: only completed with assistance or completely abandoned.

42
Q

psych testing + ncd

A
  • neuropsych testing with performance comparison to same age, education, culture.
43
Q

psych testing + major vs mild ncd?

A

major: performance is 2+ st.dev below norm
milkd: performance is 1-2 st.dev lower than norm.

44
Q

cog concerns tested compared to prior performance - challenge?

A

challenging to compare high or low education + in individuals with alternate language/cultural background.

45
Q

what is functional impairment

A
  • impaired ability to do many tasks = interferes with independence sometimes, other times just takes longer to do things.
46
Q

prevalence of neurocog disorders?

A
  • 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.
47
Q

rates of incidence of ncd?

A

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.

48
Q

development + course of ncd?

A
  • 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.
49
Q

risk factors for ncds?

A 
#1: AGE
- female gender, potentially attributable to greater longevity in females
50
Q

ncd due to alzheimers - onset + progression?

- presentation?

A

incidious onset, gradual progression of cog + behavioural symptoms.
- presentation as amnestic : problem with mem, learning, not getting new info

51
Q

mild alzheimers?

A

impairment in learning + memory, sometimes accompanied by deficits in executive function.

52
Q

major alzheimers?

A

visuoconstructional/perceptual-motor ability and language impaired. particularly when ncd is moderate to severe
- social cognition preserved until late

53
Q

assoc features of alzheimers?

A

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.
54
Q

prevalence of alzheimers

A

7% of alzheimer’s diagnosed btw 65-74, 53% between ages of 75-84, 40% are 85 +yoa.

55
Q

% of dementias that are alzheimers?

A

60-90% depending on diagnostic criteria.

56
Q

development of ncd due to alzheimers

A

gradual, plateau, severe dementia to death

- mean duration after diagnosis = 10 years.

57
Q

late-stage ncd due to alzheimers?

A

mute, bedmount.

  • death due to aspiration.
58
Q

risk factor for alzheimers

A

age.
- genetif polymorphism increases risk + decreases age of onset
* not validated biomarker

59
Q

comorbidity of alzheimers?

A

cerebral vascular disease.

- many medical conditions in older age which complicate course, diagnosis, treatment

60
Q

diagnosis of alzheimerS?

A

definitive done in autopsy.

- predict with 85% success rate, clinicians are good at detecting.

61
Q

what is cerebral reserve hypothesis of alzheimers?

A

more prevalent in poorly educated.

  • if losing IQ, more noticeable decline in less educated.
  • higher education = more synapses = delayed signs.
62
Q

causal factors of alzheimers?

A

plaques, steel-wool-like clumps form in brains of ppl with alzheimers disease.
- composed of material called beta amyloid = protein fragments.

63
Q

treatment + prevention of alzheimers

A
  • drugs: modest benefit, slow cog decline + boost cog fxn.
  • hope for vaccine?
  • lifestyle changes = exercise!
64
Q

what is cerebrovascular accident?

A

stroke/brain damage from rupture/block of blood vessel supplying blood to brain. mini-strokes.

65
Q

what is vascular ncd caused by?

A

blockage/damage to blood vessels that provide brain with O2 and other nutrients.

  • acute, not slow progression.
  • other paths utilized, but not as good.
66
Q

prevalence of vascular ncd?

A

maybe around 4%? not many studies.

M more likely than W for sure tho.

67
Q

onset of vascular ncd?

A

sudden - bc of stroke usually

68
Q

features of vascular demenita?

A

similar to alzheimer’s

- impaired memory, language ability, agitation, emotional instability, loss of ability to care for own basic needs

69
Q

general biological therapies for psychopathology?

A
  • 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
70
Q

what are antipsychotics

A

neuroleptics + major tranquilizers.

  • first developed in 1950s to treat psychotic disorder (ie. schizophrenia)
  • major side-effects known as extrapyramidal effects
71
Q

what are extra-pyramidal effects of anti-psychotics?

A

movement disorders, parkinson-like symptom, neurologically-based restlessness.

72
Q

what are anxiolytics?

A

alleviate symptoms of anxiety + muscle tension by reducing symp ns.

  • barbuturates: tolerance develops quickly + toxic at high dose
  • benzodiazepines: effective, addictive.
73
Q

what are antidepressants?

A

drugs to treat depression :
maoi’s
tricyclics
ssris

74
Q

side effects of antidepressants

A

dry mouth, blurred vision, nausea, headache, sexual side effects.

75
Q

what are mood stabilizers?

- side effects?

A

lithium (bipolar disorder)

- nausea, dizzy, weight gain, therapeutic dose is idiosyncratic.

76
Q

what are sitmulants?

A

treat adhd.

- 70% response rates, long-term condition, adherence may be issue.

77
Q

limits on efficacy of psychopharmacology?

A
  • effective, but none are effective for everyone.

- effect size is small

78
Q

psychodynamic approach?

A

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

79
Q

humanistic-existential approach?

A
  • 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
80
Q

cog/behavioural approach to treatment

A

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
81
Q

modalities of therapy?

A

individual: 1:1. most therapy
couple’s therapy: focus on relationship
family therapy: family system is “client”
group therapy: particular issues.

82
Q

discuss couples therapy?

A

enhance partner satisfaction, behavioural, social learning.

- enhance communication, conflict resolution, emotion-focused,

83
Q

discuss family therapy?

A

id how interactions contribute to problems.

  • reframe the problem
  • homework in treatment
  • goal: enhance communication + negotiation styles within family
84
Q

discuss group therapy

A

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
85
Q

perspective of psychotherapist?

A

often say integrative - wont pick a side.

  • psychologist =/= therapist, life coach. only psychologist is protected term.
  • ask about training, what therapeutic method, confidentiality + finances.
86
Q

who seeks psychotherapy?

A
  • distress, wanting advice, assistance, coping with social roles, loss, etc.
  • most likely female, university educated and/or young-middle aged adult.
87
Q

duration of treatment (general)?

A

most ppl attend 10 or less sessions.

88
Q

evaluating effects of psychotherapy

- effective?

A

show that it’s treating + not just “not causing harm”

89
Q

eysenck’s review on psychotherapy?

A

narrative review, found that psychotherapy had no evident effect.
– positive result: spurred research in the area to show effectiveness of treatment

90
Q

treatment efficacy vs treatment effectiveness

A

efficacy: evidence that treatment works when delivered in controlled study: maybe not generalizable
effectiveness: evidence that treatment works irl

91
Q

what is a narrative study?

A

collect all data + subjectively decide what’s good vs bad.

take quantitative data + qualify it subjectively.

92
Q

what are meta-analysis studies?

A

quantitatively review research

  • statistically control for study quality.
  • calculate effect size = (exp - control groups)/ (st.dev of control group +/- pooled sample)
93
Q

meta-analysis study of psychotherapy effectiveness?

A

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.
94
Q

effectiveness of psychotherapy on depression?

A

cog-behave + interpersonal techniques are effective

95
Q

effectinveness of psychotherapy on childhood disorders (adhd, oppositional, conduct)?

A

use techniques to improve parenting skills is effective.

96
Q

other disorders that psychotherapy is used?

A

sleep disorders, few axis ii- exception: borderline personality with dialectic behaviour

97
Q

therapy for couple distress?

A

yes, behavioural marital/couple therapy works. emotionally focused.can reduce conflict

98
Q

evidence-based practice?

  • yay or nay?
  • arguement against?
A

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.

239 - final (5 decks)

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