Mood disorders in specific populations

Question 1

What are the trends of old age population and what are the ramifications?

Answer 1

Old age population set to double by 2050: 12-22% 3.5 times quicker than general pop

Demands on: Health Care Pension and Social Care

Need for age friendly environment and larger workforce

Aged proved family and volunteer help

Question 2

What is the demographic transition model?

Answer 2

Developed by Warren Thompson.

Shows interplay between fertility and mortality and shows how industrialisation changes it.

Question 3

Where will the majority of over 55 year olds be in 2050?

Answer 3

In LMIC.

Question 4

How prevalent is mental disorders amongst over 60s?

Answer 4

15%

6. 6 % Daly
7. 4 % YLDs

Question 5

What is the most common disorder in over 60s and how significant is it?

Answer 5

Depression

15-25%

Uni polar is 7%

Subsyndromal: Primary care 6-10% long term 30%

Still under diagnosed

Question 6

How are older adults mentally assessed?

Answer 6

Via Mental state Exam
and Physical examination (especially if mental disorder is after 40) include blood and urine, MRI and ECG.

Considerations:
Delirium
suicidal ideation (high suicide completion)

Question 7

How prevalent are anxiety disorders in older population?

Answer 7

Lower than younger adults

BUT commonly Comorbidity with depression in 30-70% of the time.

Question 8

Why should there be consideration in administering benzodiazepines in the elderly?

Answer 8

Due to risk of falls, cognitive impairment and dependency (Most likely in substance abuse disorder)

SSRis better choice

Question 9

What are the most common anxiety order in the older generation?

Answer 9

Phobias
OCD
panic disorders less common

Question 10

What are the most common cognitive disorder in the older pop?

Answer 10

Dementia:

currently 50 million projected to 82 mill in 2030 and 156 mil in 2050

Alzhiemers is the most common type 2/3rds. Treatment with Acetylcholinestarese and Psychosocial interventions

Dementia Lewy Bodies: Highly sensitive to motor side effects of anti psychotics. Treatment with Acetylcholinestarese

Parkinsons Dementia is type of Lewy bodies dementia: rivastigmine treatment

Vascular Dementia: 10-15% linked to CV issues. limited treatment options

FrontoTemporal Dementia 5-15% limited treatment options

Question 11

What are the considerations when using pharmacological interventions in the elderly?

Answer 11

-Increased Comorbidity illness

-Increased side effects: Antipsychotics-Stroke, Parkinsonism, and tardive dyskinesia
Antidepressants- bleeding, weight gain

-Delayed response

Question 12

Why might dosage reduction be important in the elderly?

Answer 12

Increased volume of certain tissue (fat)

Decreased absorption

Slower excretion due to renal activity reduction

metabolism remains the same

Question 13

What principles follow the “Start low and go slow” mantra?

Answer 13

Lowest dose possible first

Tolerance and response: Latency

Side effects: More likely in elder

Review routinely: Physicals et

Question 14

What protects elderly patients from having their diminished capacity being taken advantage of?

Answer 14

Mental capacity act 2005 (all above 16)

Can patient…

1: Understand info
2: Retain it
3: Weigh up info
4: Communicate info?

This is fluid, therefore continual assessment.

Question 15

What are some future considerations for policy makers to improve mental health of the elderly?

Answer 15

Increasing training for health care

Enhancing prevention and management of chronic illness

Designing policy

Building age friendly systems and environments