Week 4.3: Affective and common disorders in old age

Question 1

Explains the changes in birth and death rates over time, leading to population aging.

Answer 1

Demographic Transition Model

Question 2

The study of the distribution and determinants of health related
states or events, including disease.

And the application of this study to the control of disease and other health problems.

Answer 2

Epidemiology

Question 3

What is the current state of mental health in older adults?

Answer 3

Prevalence: Approximately 15% of adults over 60 suffer from a mental disorder.

Under-Identification: Mental health problems are often not recognized by healthcare professionals or the older adults themselves.

Stigma: Mental health stigma can prevent individuals from seeking help.

Question 4

The most common affective disorder in older adults.

Answer 4

Depression

Question 5

Does the early or late onset of depression have an effect on individuals?

Answer 5

Late-onset depression tends to recur more frequently and persist longer compared to depression in younger adults.

Question 6

Two or more symptoms of depression for at least two weeks, not severe enough for a full depression diagnosis.

Prevalence: More common than major depression in older adults, affecting 6-10% in primary care settings and 30% in medical and long-term care settings.

Answer 6

Subsyndromal Depression

Question 7

Both are associated with greater cognitive impairment

Answer 7

Increased Age and Depression Severity

Question 8

These cognitive domains are often impaired in depression

Answer 8

Attention and Processing Speed

Question 9

Refers to substances that block the action of acetylcholine, a neurotransmitter involved in transmitting signals in the nervous system.

Answer 9

Anticholinergic

Question 10

Bipolar disorder in individuals aged 60 and over.

Similar to early onset bipolar disorder but with generally less severe manic symptoms

Answer 10

Old Age Bipolar Disorder (OABD)

Question 11

What is the difference between morbidity and mortality?

Answer 11

Morbidity: Focuses on how common and severe a disease is within a population.
Mortality: Focuses on how many people die from the disease.

Question 12

Is common in older adults, leading to confusion, psychosis, and agitation due to underlying organic causes like infections.

Answer 12

Acute Delirium

Question 13

A sudden and severe change in mental state, characterized by confusion, disorientation, agitation, and hallucinations

Answer 13

Delirium

Question 14

The condition of waking up during the night to urinate more than once.

It can be caused by various factors, including excessive fluid intake before bedtime, sleep disorders, or underlying health conditions like bladder obstruction

Answer 14

Nocturia

Question 15

When do symptoms of primary psychiatric illnesses manifest?

Answer 15

Early Manifestation: Most primary psychiatric illnesses, other than cognitive disorders, manifest earlier in life.

First Episode After Age 40: Raises suspicion for an underlying medical problem

Question 16

Overlooked and Minimized: Often seen as a normal part of aging.

Risk Factor: Fundamental risk factor for developing mental disorders and increasing suicidal risk

Answer 16

Pain

Question 17

Critical for physical and emotional health of older adults

Answer 17

Sexual Functioning

Question 18

These are adverse mental health effects caused by medical treatments or medications

Answer 18

Iatrogenic Psychiatric Symptoms

Question 19

Both share common risk factors like smoking, hypertension, diabetes, and atherosclerosis.

These conditions can coexist because the underlying vascular issues (e.g., atherosclerosis) can affect both the heart and the brain

Answer 19

Cardiovascular Disease and Cerebrovascular Disease

Question 20

Observes and describes a patient’s current state of mind across various domains.

Diagnosis and Formulation: Combined with biographical and historical information to make an accurate diagnosis.

Answer 20

Mental State Examination (MSE) in Older Adults

Question 21

What are the common stressors in later life?

Answer 21

Loss of Capacities

Medical Comorbidities

Bereavement

Socioeconomic Changes

Question 22

What is the impact of later stressors in life?

Answer 22

Isolation and Loneliness

Psychological Distress

Caregiving

Question 22

Stereotyping, prejudice, and discrimination against people based on their age.

Can lead to marginalization, exclusion, and negative health outcomes for older adults.

Answer 22

Ageism

Question 23

What are the categories of risk in older adults?

Answer 23

Personal History: Includes forensic history, lack of supportive relationships, poor concordance with treatment, discontinuation or disengagement, impulsivity, and substance use.

Environmental and Social Risks: Includes risks such as fire, cluttering, falls, self-neglect, and environmental neglect.

Mental State Risks: Assess whether symptoms like psychotic symptoms (delusions, paranoia, command auditory hallucinations) pose a risk to self or others

Question 24

What are the types of risk in older adults?

Answer 24

Risk to Self: Includes self-harm, suicidal ideation, and behaviors that could lead to injury. Risk to Others: Includes violent behaviors, homicidal ideation, and emotional arousal that could lead to harm. Risk from Others: Includes potential abuse or exploitation from others

Question 25

Characterized by excessive worry, hyperarousal, and fear that is counterproductive and debilitating.

Answer 25

Anxiety Disorder

Question 26

A type of anxiety disorder characterized by persistent and excessive worry about various aspects of life. Often occurs alongside depression in older adults. Treatment: SSRIs, CBT, and Benziodiazepines

Answer 26

Generalized Anxiety Disorder

Question 27

A state of increased psychological and physiological tension, often associated with anxiety.

Answer 27

Hyperarousal

Question 28

What are the physical symptoms of hyperarousal?

Answer 28

Hypervigilance: Being constantly on the lookout for potential danger or threats. Startling Easily: Reacting strongly to sudden noises or movements. Heart Palpitations: Feeling like your heart is racing, pounding, or flip-flopping. Trembling or Shaking: Uncontrollable shaking or trembling. Sweating: Excessive sweating, often without physical exertion. Breathing Fast: Rapid breathing or feeling dizzy and lightheaded. Insomnia: Difficulty falling asleep, staying asleep, or experiencing restless sleep.

Question 29

What are the emotional symptoms of hyperarousal?

Answer 29

Heightened Sensitivity: Extreme sensitivity to sounds, smells, textures, or sights. Angry Outbursts: Sudden and intense anger or rage. Persistent Worry: Constantly thinking or worrying about things, even after situations have been resolved. Flashbacks: Vivid memories or flashbacks of traumatic situations from the past.

Question 30

The most common anxiety disorder in later life.

Answer 30

Phobias

Question 31

Characterized by sudden and repeated panic attacks.

Answer 31

Panic Disorder

Question 32

A condition characterized by unwanted and intrusive thoughts (obsessions) and repetitive behaviors (compulsions).

Answer 32

Obsessive-Compulsive Disorder

Question 33

A mental health condition triggered by experiencing or witnessing a traumatic event.

Answer 33

Post-Traumatic Stress Disorder (PTSD)

Question 34

Physical symptoms that can be caused or exacerbated by mental factors.

Answer 34

Somatic Symptoms

Question 35

Symptoms that indicate an absence of normal functions, such as lack of motivation or emotional expression.

Answer 35

Negative Symptoms

Question 36

Symptoms that indicate an excess or distortion of normal functions, such as hallucinations or delusions.

Answer 36

Positive Symptoms

Question 37

Is a significant health concern in older adults, with varying prevalence based on demographic factors.

Answer 37

Smoking

Question 38

Is a complex issue influenced by underreporting, comorbid conditions, and decreased tolerance.

Answer 38

Alcohol Misuse

Question 39

Is a syndrome, usually chronic or progressive, characterized by the deterioration of cognitive functions. This includes impairments in memory, thinking, behavior, and the ability to perform everyday activities.

Answer 39

Dementia

Question 40

Long-lasting and persistent.

Answer 40

Chronic

Question 41

Increasing in severity over time.

Answer 41

Progressive

Question 42

The most common type of dementia, accounting for up to two-thirds of cases.

Answer 42

Alzheimer's Disease

Question 43

Depression, psychosis, apathy, sleep disturbances, agitation, and aggression.

Answer 43

Behavioral and Psychological Symptoms of Dementia (BPSD)

Question 44

Accounts for approximately 10% to 15% of all dementia cases. A broader category of dementia caused by reduced blood flow to the brain, often due to strokes or other vascular conditions Symptoms vary depending on the affected brain area. Common symptoms include memory loss, confusion, difficulty with attention, and impaired judgment

Answer 44

Vascular Dementia

Question 45

A type of dementia that affects the subcortical regions of the brain, often leading to motor and cognitive impairments. Is considered a type of vascular dementia

Answer 45

Subcortical Dementia

Question 46

Represents several distinct dementia syndromes that primarily affect the frontal and temporal lobes of the brain.

Answer 46

Fronto-Temporal Dementia (FTD)

Question 47

What are the common sub-types of Fronto-Temporal Dementia (FTD)?

Answer 47

Behavioral Variant (bvFTD) Semantic Dementia Progressive Non-Fluent Aphasia (PNFA)

Question 48

Symptoms: Early onset, stronger familial loading, behavioral changes such as disinhibition, apathy, socially inappropriate behaviors, and executive dysfunction. Overlap with Extrapyramidal Disorders: May include symptoms similar to Parkinsonism.

Answer 48

Behavioral Variant Fronto-Temporal Dementia (bvFTD)

Question 49

Symptoms: Specific loss of word meaning and comprehension difficulties. Ex. A person might refer to a "dog" as an "animal" because they can no longer recall the specific word

Answer 49

Semantic Dementia

Question 50

Symptoms: Characterized by agrammatic and telegraphic speech

Answer 50

Progressive Non-Fluent Aphasia (PNFA)

Question 51

A stronger genetic component is often observed

Answer 51

Family Loading

Question 52

Lack of restraint manifested in disregard for social conventions, impulsivity, and poor risk assessment

Answer 52

Disinhibition

Question 52

Lack of interest, enthusiasm, or concern.

Answer 52

Apathy

Question 53

Movement disorders such as Parkinsonism, characterized by tremors, rigidity, and bradykinesia.

Answer 53

Extrapyramidal Disorders

Question 54

Speech that lacks grammatical structure, often seen in progressive non-fluent aphasia. Ex. Instead of "She is going to the store," they might say, "She go store."

Answer 54

Agrammatic Speech

Question 55

Speech that is concise and omits unnecessary words, resembling a telegram. Ex. "Joe hungry" instead of "Joe is hungry"

Answer 55

Telegraphic Speech

Question 56

Is the second most common form of dementia, accounting for about 5% of all dementia cases

Answer 56

Lewy-Body Dementia

Question 57

These are abnormal protein deposits (synuclein inclusions) found in the neocortex and brain stem, similar to those seen in Parkinson's disease

Answer 57

Lewy Bodies

Question 58

A group of movement abnormalities including tremor, rigidity, and bradykinesia (slowness of movement)

Answer 58

Parkinsonism

Question 59

Dysfunction in the autonomic nervous system, affecting involuntary bodily functions. Issues with regulating blood pressure, heart rate, and other autonomic functions

Answer 59

Autonomic Instability

Question 60

Abnormal protein deposits found in the brain.

Answer 60

Synuclein Inclusions

Question 60

A condition where individuals act out their dreams during REM sleep. Ex. Physical Movements Vocalizations Dream Recall

Answer 60

REM Sleep Behavior Disorder

Question 61

Dementia affects 30% to 50% of individuals with Parkinson's disease. Similar to Lewy body dementia, Parkinson's disease dementia also presents Lewy bodies, but these are more diffusely distributed in the cortical regions

Answer 61

Dementia in Parkinson's Disease

Question 62

Is a cholinesterase inhibitor that helps improve cognitive function by preventing the breakdown of acetylcholine, a neurotransmitter important for memory and learning. Recommended for treating dementia in Parkinson's disease, particularly in the initial stages

Answer 62

Rivastigmine

Question 63

his refers to how the body absorbs, distributes, metabolizes, and excretes a drug. In older adults, these processes can be significantly altered due to age-related changes in body composition and organ function.

Answer 63

Pharmacokinetics

Question 64

This refers to how the drug affects the body, including the mechanisms of action and the relationship between drug concentration and effect. Age-related changes can also alter drug sensitivity and response.

Answer 64

Pharmacodynamics

Question 65

The use of multiple medications increases the risk of drug interactions and drug-induced problems. This can lead to a higher chance of adverse effects

Answer 65

Polypharmacy

Question 66

What is the impact of Age-Related Changes on Pharmacokinetics in Older Adults?

Answer 66

1) Slower Absorption of medication 2) Increased Volume of Distribution 3) Metabolic Capacity 4) Impaired Renal Function

Question 67

This refers to the range between the effective dose and the toxic dose of a drug. Drugs with a narrow therapeutic index require careful management because small changes in dose can lead to toxicity or loss of therapeutic effect.

Answer 67

Therapeutic Index

Question 68

Related to the liver.

Answer 68

Hepatic

Question 69

Related to the kidneys.

Answer 69

Renal

Question 69

Is the process by which the body chemically alters a drug, usually in the liver, to make it easier to eliminate. Think of it as the body's way of breaking down a drug into smaller pieces so it can be removed from the body.

Answer 69

Drug Metabolism

Question 70

Is the process by which a drug spreads throughout the body's tissues and fluids after being absorbed. Imagine the drug traveling through the bloodstream to reach different parts of the body where it needs to work.

Answer 70

Drug Distribution

Question 71

What is the importance of physical assessment prior to prescribing medication?

Answer 71

These assessments help identify underlying medical conditions that can influence diagnosis and treatment options. Ex. Vital Signs Weight Blood Pressure Pain Severity

Question 72

What are the basic Principles for Prescribing Psychotropic Medication to Older Adults?

Answer 72

1) Start slow, go slow (minimal dose) 2) Keep pharmacological regimes simple (fewer medications) 3) Expect latency response (drugs take time to take effect) 4) Monitor for side effects 5) Conduct thorough assessments

Question 73

What are the basic Principles to avoid when Prescribing Psychotropic Medication to Older Adults?

Answer 73

1) Treating side effects with more medication 2) Dose augmentation 3) Antipsychotics in dementia 4) Medications with anticholinergic side effects 5) Very sedative medications 6) Drugs with long half-life

Question 74

Gradually adjust the dose of a medication.

Answer 74

Titrate

Question 75

The time it takes for the concentration of a drug in the blood to reduce by half.

Answer 75

Half-life

Question 76

Is the process of determining whether an individual has the ability to make specific decisions about their care, treatment, and finances. It is used to protect and empower individuals who may lack the mental capacity to make their own decisions.

Answer 76

Mental Capacity Assessment

Question 77

They are at increased risk of impaired decisional capacity due to age-related cognitive decline and other health conditions.

Answer 77

Older Adults

Question 78

Origin: Developed in the UK to provide a legal framework for decision-making for individuals over 16 years old who may lack mental capacity. Goals: To safeguard decision-making and ensure that decisions are made in the best interests of individuals who lack capacity

Answer 78

The Mental Capacity Act (MCA)

Question 79

When is capacity assessment needed?

Answer 79

It is required when there is an impairment of the mind or brain, and evidence shows that this impairment prevents the person from making a specific decision when needed

Question 80

What are the four main criteria to assess decisional capacity?

Answer 80

1) Understanding: The person must understand the information relevant to the decision. 2) Retention: The person must retain the information long enough to make the decision. 3) Use or Weigh Up Information: They need to consider the pros and cons of the decision. 4) Communication: This can be through speech, writing, or other means.

Question 81

What are the factors affecting decisional capacity?

Answer 81

1) Dementia and Other Mental Conditions 2) Emotional Factors 3) Specific Decision-Making Capacity (i.e., can make decisions on self-care but not finances) 4) Dynamic Nature of Capacity

Question 82

Factors such as paranoia or severe hopelessness can affect a person's ability to make decisions. The presence of these conditions does not automatically mean the person lacks capacity.

Answer 82

Emotional Factors

Question 83

False beliefs that one is being persecuted or targeted.

Answer 83

Paranoid Delusions

Question 84

A profound sense of despair and lack of hope for the future.

Answer 84

Severe Hopelessness

Question 85

Specialized medical care focused on providing relief from the symptoms and stress of a serious illness

Answer 85

Palliative Care