Lecture 8 Mental health Flashcards
What is mental health? What is psychopathology? What characteristics do mentally healthy people typically have?
Unclear:What is mental health and psychopathology is- it’s easier to say what it is not.
Mentally healthy people have the following characteristics (they have gaappe!!! (who doesn’t love gaappe?))
1. Positive self attitudes (self estime)
2. Accurate perception of reality (no hallucinations)
3. Mastery of environment (ability to function with day to day tasks)
4. Autonomy
5. Personality balance (no wild mood swings, shifts in personality)
6. Growth and self actualization
What is the problem with our view of mental health?
- They are largely western based, not always inclusive of other cultures
According to Hechanova & Wealdle what are the 5 main components of diverse cultures that have implications for mental health?
Five main cultural components that need to be taken into account (SPECs)
1. Emotional expression: some cultures believe that talking about pain creates more pain (less inclined to do talk based therapy)
- Shame: some cultures believe talking about problems brings shame to the family or individual, to the individual.
- Power & relationship: is one culture dominating the other? Be mindful of balances.
- Collectivism: focuses on group as unit of analysis instead of individual.
- Spirituality and religion: can affect what is viewed as a symptom and coping strategies
ex. hallucinations
What are the three main mental health factors?
- Biological:
- neurological changes, disease and physical limitations can change behaviour.
- Mental health problems can increase with age and memory gets worse
- genetic factors (ex. Alzheimer’s and dementia)
- Underlying physical problems can cause psychological ones (same thing reversed)
ex. memory loss can be due to vitamin deficiencies - Psychological
- Changes in memory, intelligence, and relationships across adulthood can mimic or mask mental disorders in older adults
- Relationships, especially with family and friends, greatly influence how symptoms are interpreted. - Sociocultural
-Ask if the behaviour is normative for the culture before asking if it’s mental health related - Life cycle (book added)
- How people behave is strongly influenced by their past experiences.
Multidimensional Assessment:
Why is it important?
Who is it done by?
How does it work?
Why:
Race, gender and sexuality… have negatively influenced diagnoses and research in the past. This is why a multidimensional approach is important!
Who:
*Done by a team of different professionals (physician, psychiatrist, therapist, nurse/doctor, social workers…) this helps create a more holistic view of someone’s wellness
What:
*Focusing on multiple aspects of someone’s life rather than just diagnosing from the DSM
*Screening (used to see if someone qualifies for further support) vs. diagnosis
ex. bcap- tells you if a parent is at risk for abusing a child.
- doesn’t say if parent is abusing child already
- helps you catch abuse early on
*Ideally it would be a combination of performance tests and daily life functioning
What drives bias in assessment?
- Stereotypes!
- Positive vs. negative bias
Positive bias occurs when individuals or systems favour positive attributes or outcomes, often leading to overly optimistic interpretations.
ex. A belief that older adults are often “eccentric” may mitigate against accurate assessment of abilities.
Negative bias occurs when individuals or systems focus on negative aspects, often overestimating risks or problems
ex. someone holds an identity based stereotype and might diagnose something that a person doesn’t actually have
- environment can also work against accurate assessments
Physical health issues
- if people are experiencing physical and mental health issues, people tend to overlook the mental
It’s important to use many methods to assess. Why? What are the 6 different methods and when are they useful?
Different methods can:
- give more information
- fill in information gaps
- can learn in different context
ex. family report and observation on daily life tasks of older individual
Different methods
1. clinical interview (provide direct information in responses to questions and non-verbal info)
2. self-report (easy cheep BUT less reliable)
3. report by others (clients can be unable or unreliable to tell the full story on their own)
4. psychophysiological and neuroimaging assessment (measures the body’s reaction to certain stimuli)
5. direct observation
6. performance-based (give clients specific tasks to preform)
Depression (gasp)
What are risk factors?
Who has more depression?
Dispel a stereotype:
The belief that “all older adults are depressed” is an ageist stereotype. Depression declines by more than half from young adulthood to old age
*Risk factors: people with chronic health conditions or pain or nursing home residents
*Higher for women, variable by race/ethnicity
Why? (according to Jess)
- Role of gender socialization
- Role of internalization (girls are socialized to internalize problems and to express emotion through sadness)
- Men often socialized to repress
✨ Anxiety✨
What are the types of disorders?
Latter life symptoms?
Treatment?
Types of disorders
1. generalized anxiety disorder (persistent and excessive worry)
- Panic disorders
- recurrent panic attacks that can have triggers or can not
- Both physical and psychological distress (can manifest as hyperventilation or chest pains heart attack vibes)) - Phobias
- Persistent fear of something that’s not generally harmful.
ex. Agoraphobia fear of being in a situation you can’t escape - Social anxiety disorder
- significant unease or discomfort within social interactions - Separation anxiety disorder (not just with little kids)
- Anxious about being separated, scared they will be left or loved one will be hurt
*Again, women more likely than men
*In some cases, anxiety is reasonable, so may be difficult to work through
ex. someone is afraid of scorpions, and they have a phobia of them and see them often
- When an anxiety is getting in the way of daily life, then that’s an issue
- can be caused by a series of negative life experiences
*Most common later-life symptoms
- stress impairment frequent uncontrolled worry muscle tension and sleep issues
*Treatments: therapy is preferred to medication (behavioural or relaxation therapy)
Triggers for Alcohol abuse in old age.
Potential dangers?
What effects alcohol abuse?
Effects:
Alcohol abuse rates much higher for men
*Longer term heavy drinking = worse outcomes
*Drinking norms differ by country (age drinking is legalized)
Triggers:
- Retirement loosing a spouse chronic pain having to leave their house.
Issues:
*May lead to issues with medications (they can interact poorly)
*Older adults more at risk for alcohol abuse due to normative biological changes (takes less alcohol to feel effects and stays in blood longer)
- their tolerance gets lower
What is delirium?
What causes it? How is it treated?
-Rapid-onset confusion and reduced awareness of environment
Cognitive changes:attention difficulties memory troubles difficulty orienting rambling/incoherent speech…
Causes: medication side effects, stroke, dehydration sleep deprivation
About 1/3 of cases are preventable, almost all cases are reversible and treatable once the cause is found, though in some cases there can be permanent brain damage or even fatality
symptoms in older adults worse
Alzheimers disease
The most common form of progressive, degenerative, and fatal dementia, accounting for 60-80% of dementia cases
*More prevalent in women and older adults (risk goes up the older you get, and women live longer than men)
*Symptoms: memory lose, difficulty with daily life problem and familiar tasks, confusion with time or place, misplacing things, poor judgment, imaging processing, social withdrawal changes in mood and personality
- Symptoms worse in evening
*In advanced stages, causes incontinence and immobility
*Assessment is extensive: you want to rule out other disorders first because Alzheimer’s is none treatable- last resort
Neurological Causes of Alzheimer’s
- Rapid cell death: dramatic brain shrinkage in hippocampus (responsible for memory), cortex and basal forebrain
- Neurofibrillary tangles:
- Neurofibers get tangled up because there’s too much phosphate binding with the proteins
-These tangles interfere with the transmission of the nutrients and information and kill the neurons - Neuritic plaques
- Proteins called beta amyloid proteins that clump up with neuron detritus (neuron junk)
- clump up on and around neurons.
- similar to heart attack where plaque builds up in arteries
- neurons get clogged up and information can’t pass through
Neuro changes are similar to
normative aging, but more rapid and
more dramatic
Genetic Causes of Alzheimer’s
Early onset (before 65) often related to gene mutations responsible for beta-amyloid protein production
*Later onset (after 65) often related to 9 different genes which are responsible for different processes
*One chromosomal trait related to neuritic plaques
*Beta-amyloid deposits could be linked to infection and inflammation- brains not as efficient at flushing out waste
Alzheimer’s Treatment
Currently there is no cure, no prevention, no treatment, only care and alleviation of symptoms
Mostly behavioural interventions
ex calendars or spaced retrieval (gradually taught to remember things with spaced intervals)
Most effective when paired with broad social support & service provider support
Other types of demensia
Vascular dementia: caused by numerous small strokes
- faster progression than alzymers
Lewy body dementia: caused by protien acumulation and neuron death
- and
Parkinson’s Huntington’s : movement disorder can progress into dementia
Huntington’s: involuntary movement hallucinations, a hereditary neurodegenerative disorder characterized by motor dysfunction, cognitive decline, and psychiatric symptoms, typically manifesting in mid-adulthood.
Medication and brain implants can help
*Alcohol-related dementia: drinking stops progression stops
*HIV-associated neurocognitive disorders: caused by brain infection
*Symptoms of depression (blues clues)
specific to aging adults.
*Pacing or fidgeting
*Difficulty sleeping
*Social withdrawal
Why do older people experience depression?
What are the treatments?
What are the issues and how to surpass?
Why:
- Genetics accounts for 40-50% of the risk of depression in adults
* Higher rates of depression in people whose relatives also diagnosed
- genetic and intergenerational trauma
* Age-related changes in brain structure
* changes in neurotransmitter functioning and imbalance in neurotransmitter levels such as low levels of serotonin and norepinephrine, and the action of brain-derived neurotrophic factor (BDNF)
*Stressful life events; bereavement and chronic health conditions
Treatments:
-medications, culturally sensitive therapy (behavioural; changes behaviour focuses on rewards, while cognitive changes the way people think), and lifestyle changes (great in combination of other treatments)
Issues?
- The ways medications work change with age. - Medications administered to treat mental health disorders must be monitored very carefully, especially with older adults.
- Psychotherapy for older adults requires tailored techniques, leading to a positive geriatric approach and geriology which focused on recovery, successful aging, neuroplasticity, and fostering traits like resilience, social engagement, and wisdom.
What is dementia?
A cluster of diseases characterized by cognitive and behavioral deficits involving some form of permanent damage to the brain.
What is vascular dementia?
Dementia caused by a series of small strokes (cvas)
What is spaced retrieval?
A behavioural, implicit-internal memory intervention used in early and middle staged dementia
gradually taught to remember things with spaced intervals
Lewy Body dementia
- 3ed most common type
Symptoms: - Recurring hallucinations
- lose of thinking abilities
- Balance problems
- delusions and paranoia
Diagnosis has to do with timing of symptom occurrence
- cognitive symptoms develop a year after physical ones
Parkinson’s disease
- Known for motor symptoms
- Slow movement, muscle stiffness, hand tremors…
But can develop into a form of dementia
Incurable but symptoms can be alleviated with some meds
Neurostimulator also helps (device implanted in brain)
Some people with this disease develop severe cognitive impairment and eventually dementia
Huntington’s disease
- Begins between 30 and 45
- Involuntary flicks of arm and leg
- Inability to sustain motor activity
- hallucinations
- personality change
- Suicide 10 times more likely than average
- It’s like having Parkinson’s and Alzheimer together
Alcohol-Related dementia
- Consistent alcohol use disorders can cause dementia
Two aspects to condition: - Wernicke’s encephalopathy is a degenerative brain disorder caused by the lack of thiamine (vitamin B1)
- Korsakoff syndrome is a memory disorder that also results from vitamin B1 deficiency and is associated with alcohol use disorder.
- person often makes up fictive but believable stories that cover gaps in memory (confabulation)
- Symptoms can often stop progressing when drinking stops
- But the damage already done is permanent
HIV-Associated Neurocognitive Disorders
HIV infections spreads through brain cause dementia
- More infection= worse dementia
- Treatment : antiretroviral therapy
