PSYC361: Clinical assessments, mental health, and mental disorders

differences between mental health and mental disorder

• multicultural things to consider

• mental health definition needs to reflect appropriate age-related and socio-cultural criteria

• interpret behavior in context

Multidimensional life-span approach to psychopathology (4)

• biological approach: health problems increase with age and can provide clues about psychological difficulties

• psychological forces: normative changes can mimic mental disorders, nature of personal relationships

• sociocultural forces: social norms and cultural factors play a role in helping to define psychopathology

• Life-cycle factors: how a person behaves in influences by ones past experience

Types of assessments for older adults

• Clinical interviews

• psychophysiological tests (e.g., MRI)

• Performance based assessments (mini-mental status exam: does NOT tell you if you have dementia)

What factors influence assessment

• different level of education

• previous exposure

• text anxiety: environment in which the test is administered

• bias: racial/ethnicity, gender, age

Developmental issues in intervention

• Medical treatments

  • different dosages for older and younger adults

  • interaction with other medications

• Therapy for mental disorders

  • different ages may present different problems

  • Techniques must be adapted to the unique needs of older adults

Developmental changes in how medication works

• absorption: the time needed for medication to enter the bloodstream may increase

• distribution: once in the blood stream, the drug is distributed through the body

• metabolism: slower metabolism of medication means drug stays in body longer and can lead to anxiety

• excretion: medications are often not excreted as quickly and again this can lead to toxicity

Medication side effects

• polypharmacy: use of multiple medications

  • may produce dangerous interactions with food and mimic other conditions

• adherence to medication regimes

  • difficult with older patients

  • going to multiple doctors so accurate medication knowledge

What is depression and its symptoms

• Symptoms criteria

  • must last at least 2 weeks

  • others causes must be ruled out

  • must affect a person’s daily living

• depressed mood and loss of interest/pleasure

• reduced physical activity and loss of energy

Physical illnesses that cause depression

• Coronary artery disease: neurological disorders, stroke, AD, PD

• Metabolic disturbances

• Cancer

Assessment scales for depression (2)

• Beck depression inventory (BDI)

  • commonly used with adults and more accurate for older woman

  • questions focus on feelings and physical symptoms

• geriatric depression scale

  • doesn’t include physical symptoms

  • format is easier for older adults

Causes for depression later in life: neurological factors

• genetic predisposition

• early-onset depression

• Imbalance of neurotransmitters:

  • low serotonin: result from high levels of stress

  • low levels of norepinephrine

  • low levels of BDNF

Treatments for depression (4)

• Medication: MAO inhibitors (may produce dangerous interactions with food)- serotonin, dopamine, and norepinephrine reuptake inhibitors

• Behavior therapy: increase good, decrease bad

• Cognitive therapy: changing how you think

• Brain stimulation

What are anxiety disorders

• Generalized anxiety disorder

• Panic disorder

• Phobia

• Agoraphobia: fear of being in situations where escape is difficutl

• Social anxiety disorder

• Separation anxiety disorder

What is alcohol use disorder and its treatment

• drinking pattern that results in significance and recurring consequences that reflect loss of reliable control over alcohol use

• mild, moderate, severe

• Higher in men than women (widowed men)

• Treatment

  • stabilization and reduction of consumption

  • social interventions

What is late onset depression most linked to?

neurotransmitter imbalance

What group is rate of depression the highest in

• most prevalent in 20-30s

• frequent in widowers men

• greater risk: older adults, diabetes, cancer, CVD, PD, nursing home residents, family care providers

Anxiety disorders in older adults

• associated with relocation, stress, isolation, fear of losing control

• anxiety in older adults due to underlying health problems

• psychotherapy is the treatment of choice for older adults