Week 4: Mood and Affect

Question 1

it is true that older adults are the least likely to use services for mental health

Answer 1

yes sadly…

Question 2

true of false: 1 of 3 Canadian have a mental illness sometime in their life

Answer 2

true

Question 3

what does mood mean?

Answer 3

this is defined as the way a person feels

Question 4

what does affect mean?

Answer 4

defined as the observable response a person has to his or her own feelings

Question 5

can mood and affect be associated with the risk of suicide?

Answer 5

yes

Question 6

please explain the scope of mood and affect.

Answer 6

low range of mood and affect: melancholy (flat affect), depression (medical diagnosis), corresponding decline in functional ability

Normal range: euthymia, optimal functional ability

Elevated range: mania(medical diagnosis) corresponding decline in functional ability

Question 7

what is the definition of mental health?

Answer 7

WHO states “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Question 8

true or false: this is a diagnosable mental illness: “characterized by a combination of abnormal thoughts, perceptions, emotions, behavior and relationship with others. Mental disorders include depression, bipolar disorder, schizophrenia and other psychoses, dementia and developmental disorders including autism”

Answer 8

true

Question 9

please describe these terms describing mood:
Euthymia, melancholy, depression and mania

Answer 9

euthymia: normal and healthy fluctuations of mood (normal experiences of sadness)
Melancholy: undiagnosed mood state characterized by sadness, despair and decreased
functional ability
Depression: diagnosed mood state
Mania: diagnosed mood state: a euphoric or agitated affective state

Question 10

what are some interacting components of affect during normal (Euthymic) Mood

Answer 10

Cognition, Mood and Energy
Cognition: Normal information processing (thoughts are occurring at a normal rate) stay within the euthymic range and curve upwards with low mood and energy and downward with mania
Mood: Generally follows the curve of energy
Energy: Generally follows the curve of mood

Question 11

true of false: suicide in older adults tend to be less lethal than in younger adults

Answer 11

false; more lethal

Question 12

true or false: Suicide rate for white “oldest” men is higher than the general population

Answer 12

true

Question 13

big difference between mood and affect

Answer 13

mood - feeling inside, would not know until we ask

affect - something we can see

Question 14

true or false: risk of suicide is an aspect of untreated mental health disorder

Answer 14

true

Question 15

select all that are true:
- The impact of an event depends on the persons experience through their lifetime
- Most adults cope well with early life challenges
- Trauma in the life course impacts the way people experience life events and increases risk for mental health disorders (e.g. generational trauma of indigenous people)

Answer 15

true except second one; late

Question 16

what are some psychosocial challenges the older adult faces?

Answer 16

ageist stereotypes
retirement
death of friends
widowhood
relocation
chronic illness
grief associated with adjustment to each other

Question 17

what are some risk factors: medications and alcohol

Answer 17

depression - adverse effect of some meds
- poly pharmacy increases risk for adverse meds affects including depression
-withdrawal of meds cause depressive symptoms
depression can lead to alcohol abuse

Question 18

true of false: alcohol can cause depression - age related changes increase risk for the older client adult to experience the adverse effects of alcohol

Answer 18

true

Question 19

what are some factors that impact the experience of mental health?

Answer 19

life course
culture
sexual orientation
past trauma

Question 20

true or false: contributing factors in later life are medical conditions and medications

Answer 20

true

Question 21

main difference between melancholy and depression

Answer 21

melancholy - undiagnosed
depression: diagnosed

Question 22

what is this an example of: “During those bad times, I didn’t get along with my family at all. I didn’t know if they felt I was not doing a good job, like maybe they weren’t sympathetic enough, but I think they just didn’t know how people can feel when these things happen to you…being retired, being sick….I didn’t get along with them for a long time. I had to, but I didn’t. Just like that. That was tough. “

Answer 22

depression

Question 23

what are some risk factors of depression for older adults

Answer 23

Four occurrences in the population:
Older adults who have had depression in their younger adulthood
Older adults who become depressed in later life
People with dementia
People with medical conditions

financial worries
genetic predispositions
social isolation/loneliness

Question 24

what are some more sings of melancholy and depression within function

Answer 24

Functional Impairment
Decline in individual’s performance to perform functions they could do when not depressed (ADL’s, IADL’s and executive function)

persistent mood disturbance - longer than 2 weeks

disturbed vegetative function - somatic symptoms: fatigue, decreased energy, increased or decreased appetite, weight, sleep disturbances, and psychomotor agitation

Question 25

true or false: Suicidal ideation and psychotic features are associated with more severe depression

Answer 25

true

Question 26

what something that can be noticed within the function assesement for mental status

Answer 26

change in ADLs and IADLS and executive function

Question 27

what falls under mental status exam (MSE)

Answer 27

Appearance Speech Emotion (mood and affect)- see screening tools Perception Thought Insight and judgement Cognition – see screening tools

Question 28

what are some mental health assessments ?

Answer 28

* Geriatric Depression Scale (GDS) * Cornell scale for depression in dementia * Assessment of recent changes in functional status * Careful observation of affect

Question 29

what is grief?

Answer 29

associated with any loss, mourning

Question 30

how is energy expressed in a depressive disorder?

Answer 30

fatigue decreased energy sleep disturbance psychomotor agitation dependence, poor grooming, decreased ability to manage ADL's

Question 31

how are cognitive changes expressed through depression?

Answer 31

decreased concetration suicidal thoughts or actions

Question 32

how is mood expressed through depression?

Answer 32

Loss of pleasure in usual activities Feelings of worthlessness or guilt Expressed despair, sadness, or irritable

Question 33

what are some mental health disturbances that can be seen in depression?

Answer 33

paranoia, delusions, psychotic features (can be other mental disorders too)

Question 34

what are some risk factors for psychotic features?

Answer 34

social isolation, sensory deficits, physical illness, cognitive impairment and polypharmacy

Question 35

can paranoia indicate a medical emergency?

Answer 35

yes

Question 36

what are some risk factors to paranoia?

Answer 36

meds, vision and hearing loss

Question 37

true or false: older adult with memory impairment need to be evaluated for depression

Answer 37

true

Question 38

true or false: Suicide in older adults tends to be more lethal than in younger adults

Answer 38

true

Question 39

true or false: Suicide rate for white “oldest” men is higher than the general population

Answer 39

true

Question 40

true of false: depressive disorders - low suicide risk in older adult

Answer 40

false; high

Question 41

What biopsychosocial factors are associated with melancholy/depression?

Answer 41

older clients with: depression in younger life, depressed in later life, people with dementia and medical conditions social isolation/loneliness financial worries genetic predisposition

Question 42

under Cornell scale, what are the suicidal warning signs? (11 identified)

Answer 42

* History of depression * Trouble sleeping * Feelings of hopelessness, helplessness, anxiousness or worthlessness, * Loss of interest in things they once cared about * See no reason for living or lost sense of purpose in life * Switching suddenly from deep sadness to calmness or happiness * Feelings of being trapped * Overwhelming feelings or inability to cope * Experienced trauma or past suicide attempt

Question 43

true or false: Depression and the Older adult with dementia can result in responsive behaviors

Answer 43

true

Question 44

what is responsive behaviour?

Answer 44

person-entered term recognizing how behaviours uncomfortable for us indicate an unmet need in the older adult

Question 45

true or false: Some behaviors that are called responsive behaviors are acceptable to engage in ADL’s and wandering

Answer 45

false; they are resistance to engage

Question 46

how to assess signs and symptoms of major depression in persons with dementia

Answer 46

*Mood-related signs *Behavioral disturbance *Physical signs *Cyclic function *Ideational disturbances

Question 47

differentiating delirium, depression, and dementia what are the onset characteristics for delirium, depression , and dementia ?

Answer 47

delirium= sudden, abrupt depression= recent, may relate to life change dementia= insidious, slow ( over the years), often unrecognized until deficits are obvious

Question 48

what are some pharmacotherapy used to improve affects of ex. dementia?

Answer 48

SSRI's (selective serotonin reuptake inhibitors) - increase risk for hyponatremia -adverse side effects: nausea, dizziness, hyponatremia Cyclic Anti-depressants: adverse effects on cardiovascular system anti-cholinergic effect: blurred vision, urinary retention, cognition impairments

Question 49

what is the guideline for nursing interventions? PPPMOSE

Answer 49

provide - therapeutic relationship and referrals to other health care professionals promote - health through physical activity and nutrition provide - education and counselling Maximize - person’s sense of meaning control and autonomy Optimize - pain control and relaxation therapy Support - strengths, capabilities and hope Ensure - safety

Question 50

what are some interventions to improve an older adults experience with melancholy/depression?

Answer 50

* Reduce risk * Pharmacotherapy * Psycho-social * Nursing interventions * Providing interpersonal support * Evidence based geriatric nursing protocols for best practice

Question 51

state whether or not this is true: Evidence that older adults with high levels of spirituality and depression maintained meaning of life.

Answer 51

true

Question 52

Spirituality has a protective factor against loss of meaning of life and this was associated with less depressive symptoms.

Answer 52

yes

Question 54

name the characteristics over the course over 24 hours for delirium, depression, and dementia

Answer 54

delirium = fluctuating, often worse at night depression- fairly stable, may be worse in the morning dementia= fairly stable, may change with stress

Question 55

name the characteristics over conciousness in differentiating delirium, depression, and dementia

Answer 55

disturbed= delirum clear= depression clear = dementia

Question 56

what are the alert level of a patient with dementia, delirium, and depression

Answer 56

dementia= generally normal depression= normal delirium= increased, decreased, or variable

Question 57

what are the pyschomotor activity for delirium, depression and dementia

Answer 57

increased, decreased, or mixed variable, agitated, or slowed down normal, may have apraxia, agnosia

Question 58

what is the duration for delirium, depression, and dementia

Answer 58

hours to weeks variable, agiated, or slowed down years

Question 59

what is the attention characteristics for delirium, depression, and dementia

Answer 59

disordered, fluctuates little impairment generally normal but may have trouble focusing

Question 60

what is the orientation for delirium, depression and dementia

Answer 60

usually imapired, fluactuate usually normal : may not have any answer 'i dont know ' to questions or may not answer often impaired

Question 61

in the category 'thinking' , what are differentiating for delirium, depression, and dementia

Answer 61

disorganized, rambling, illogical, or incoherent may be slow; hopelessness, helpness difficulty finding words, preservation impoverished thoughts, difficulty with abstraction, delusions ins severe cases

Question 62

what is the perception between delirium, depression and dementia

Answer 62

disturbed, illusions, hallucinations and misperceptions misperception usually absent intact, hallucinations in severe cases

Question 63

what is the affect between delirium, depression, and dementia

Answer 63

variable but may look disturbed, frightened flat slowed response, may be labile