Psychopathology

Question 1

Structure of the DSM-5

Answer 1

• there are multiple diagnostic categories
• each diagnostic category includes:
• Diagnostic criteria
  – Onset
  – Prognosis
  – Risk factors
  – Comorbidity

Question 1

Depression in younger vs older adults

Answer 1

• traditionally recognized “psychological” symptoms of depression, such as dysphoria (sad mood), guilt, low self‐esteem, and suicidal thoughts, are less likely to be acknowledged by older adults
• “Depression without sadness”
• may look like withdrawal, apathy (lack of feeling or emotion), lack of vigour (physical strength)

Question 2

Persistent depressive disorder (PDD)

Answer 2

• Previously called ‘dysthymia’
• chronic depression characterized by a long-lasting depressed mood that lasts for at least 2 years
• May occur with or without MDD episodes

Question 3

bereavement disqualifier DSM-5

Answer 3

• a diagnosis of Major Depressive Disorder (MDD) could not be made during the first two months following the death of a loved one
• Differentiation between ‘typical’ mourning and true depression
• removed this bereavement exclusion to allow for a more nuanced approach

Question 4

Definition of Generalized Anxiety Disorder

Answer 4

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
• individual finds it difficult to control the worry
• anxiety and worry are associated with 3 (or more) of the 6 symptoms

Question 5

6 symptoms of Generalized Anxiety DIsorder

Answer 5

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

Question 6

Onset and Course of Generalized Anxiety Disorder

Answer 6

• Onset of GAD rarely occurs prior to adolescence
• Median age for diagnosis is age 30
• in population, level of anxiety is relatively constant throughout the lifespan
• content of worries changes

Question 7

Generalized anxiety in older adults

Answer 7

• Anxiety disorders are more
  prevalent in adults over 65
  than are depressive disorders or cognitive impairment
• content of worries differs from what younger adults experience
• Older adults use a disproportionate amount of anti-anxiety medications
• Anxiety contributes to disability

Question 8

Separation anxiety disorder in older adults

Question 9

What are the 3 intervention groups that the participants were divided into? Wetherell et al (2003)

Answer 9

1. Group CBT
   - group-based strategy facilitation and cognitive restructuring
2. DIscussion group (DG)
   - topic-based discussion of worries
3. Waitlist
   - offered CBT after study conclusion

Question 10

What did Wetherell et al (2003) investigate?

Answer 10

effectiveness of anxiety interventions in older adults

Question 11

Procedure: Wetherell et al (2003)

Answer 11

• randomly divided into the 3 interventions
• administered questionnaires on anxiety and depression 3 times (pre-test, post-test, and 6 months follow up)

Question 12

Results: Wetherell et al (2003)

Answer 12

• CBT and discussion groups equally as effective
• both more effective than waitlist
• CBT better than DG in reducing percent of day worrying, but not significant in 6-month follow-up
  Conclusion: for this demographic of older adults, discussion groups may be just as effective in reducing anxiety symptoms as more formal CBT groups

Question 13

What are the 6 neurocognitive domains?

Answer 13

1. Perceptual-motor function
2. Language
3. Learning and memory
4. Executive function
5. Complex attention
6. Social cognition

Question 14

Neurocognitive disorders in the DSM-5

Answer 14

• Major neurocognitive decline (dementia)
• Minor neurocognitive decline
• Delirium (attentional disorder)
• Minor neurocognitive decline is new in the DSM

Question 15

Major neurocognitive decline (syndrome)

Answer 15

• significant decline in 1 or more of the 6 domains
• interference with independence in everyday activities (ADLs and IADLs)
• once syndrome is identified, a specific etiological (causal) specification can be made

Question 16

syndromal classification

Answer 16

• system classifies diseases or disorders based on observable symptoms and signs (the syndrome), regardless of their underlying cause
• descriptive rather than explanatory

Question 17

etiological classification

Answer 17

• classifies diseases or disorders based on their underlying cause (etiology)
• Focuses on why a condition occurs rather than how it presents

Question 18

Interventions for major neurocognitive decline

Answer 18

• psychosocial interventions can be used
• person-centered approaches (therapy)
• physical activity approaches
• caregiver training
• social enhancement (ie. music, animals, games)

Question 19

What did Marchant et al (2021) do?

Answer 19

• examined 70 year old adults experiencing subjective cognitive decline
• tested the effect of mindfulness-based intervention vs health self-management program on anxiety symptoms

Question 20

Findings in Marchant et al. (2021)

Answer 20

• no significant difference in the effect of Mindfulness-based intervention vs. health self management program on anxiety symptoms at all 3 time points: baseline, post-intervention, and follow-up)
• health self management had slightly lower STAI scores at all 3 time points

Question 21

Challenges in psychological
diagnosis in older adults

Answer 21

• Normalization of psychopathology in older
  adults
• Confusion between typical
  and atypical aging
• Lack of awareness/education
• Stigma
• disorders themselves may prevent seeking treatment