CHAPTER TEN CHAPTER TEN Clinical Assessment, Mental Health, and Mental Disorders.
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Transcript of CHAPTER TEN CHAPTER TEN Clinical Assessment, Mental Health, and Mental Disorders.
CHAPTER TENCHAPTER TENClinical Assessment, Mental Health, and
Mental Disorders
Defining Mental Health– Characteristics of mentally healthy people:• Positive attitude toward self• Accurate perception of reality• Mastery of the environment• Autonomy• Personal balance • Growth and self-actualization
• When characteristics of mentally healthy people are absent, mental disorder becomes more likely
Defining Mental Health• Characteristics of
mental disorder include behaviors that• are harmful to oneself or
others• lower one’s well-being• are perceived as
distressing, disruptive, abnormal, or maladaptive
Defining Psychopathology– Biological forces
• Chronic disease, functional impairment, and other ailments can change behavior (e.g. memory loss from vitamin deficiencies, appetite loss from depression)
– Psychological forces• Normative changes can
mimic mental disorders (e.g. memory loss from stress)
Defining Psychopathology– Sociocultural forces
• Being paranoid may be adaptive in certain circumstances.
• Cultural differences must be taken into account.
– Life-Cycle Factors• Resistance to revealing personal
information might reflect upbringing rather than paranoia
• Sleeping patterns change with age; a decrease is part of normative aging and does not necessarily indicate depression or anxiety
Ethnicity, Aging, and Mental Health
• Sociocultural influence in assessing behavior– Older minorities may
have experienced:• Inadequate health
care• Environmental health
risks• Stress of prejudice and
discrimination
Ethnicity, Aging, and Mental Health
– Ethnic differences found:• Older Hispanic men
show higher rate of alcohol abuse than women.
• Older Hispanic women show higher rates of phobias and panic attacks than men.
Ethnicity, Aging, and Mental Health
– Ethnic differences found:• Native American men also have high rates of alcohol
abuse.• Older African-American men have lower rates of
depression than other ethnic groups.
Areas of Multidimensional Assessment• Psychological functioning
assessed through:– Interviews– Observation– Test or questionnaires
• Three dimensions of social functioning:– Ties with social network– Content of interaction with
one’s social network– Number and quality of
interactions
Factors Influencing Assessment• Negative biases– Racial– Ethnic– Age stereotypes
• Positive biases– Women do not abuse alcohol.– Old people are not sexually active
Assessment and Therapy
• Mental status exams– Useful as a
quick screening of measures of mental competence• Mini-Mental
Status Exam (MMSE)
The Big 3
• Depression• Delirium• Dementia
Depression• Myth: most older adults
are depressed– Fact: rates of depression
decline from young adulthood to old age for healthy people.
– Less than 5% of older adults living in the community show signs of depression.
– Cohort effect: most recent born have highest rates of depression.
Depression
• Depression: General Symptoms and Characteristics• Dysphoria—feeling “down” or “blue”• Accompanying physical symptoms
• Insomnia• Changes in appetite• Diffused pain• Trouble breathing• Headaches• Fatigue• Sensory loss
• Symptoms must last at least two weeks for clinical diagnosis• Other causes must be ruled out.• Clinician must determine how symptoms are affecting daily
life.
• Older ethnic minorities show higher rates of depression.– Especially true for Chinese and Mexican Americans– One fourth of older Latinos show depressive
symptoms.• Gender and Depressive Symptoms– Women tend to be diagnosed with depression
more than men.
Causes of Depression–Sudden severe loss–Long-term, high-level stress• Research evidence of severe
depression links to neurotransmitter imbalance.– Serotonin– Norepinephrine
Treatment of Depression– Antidepressant medication– Electroconvulsive therapy– Psychotherapy • Behavior therapy attempts to alter current behavior
without necessarily addressing the underlying causes• Cognitive therapy attempts to alter the ways people
think
DeliriumDelirium is characterized by a
disturbance of consciousness and a change in cognition that develop over a short period of time
• Caused by:– Medical conditions
• Stroke• Cardiovascular disease• Metabolic condition
– Medication side effects, substance intoxication or withdrawal, exposure to toxins, or a combination
AlcoholismSubstance Abuse (e.g. alcoholism) involves– Craving– Impaired control– Physical dependence – Tolerance
• Elderly person’s drug of choice is alcohol.• Alcohol dependency drops significantly with age
Alcoholism/Substance Abuse• Middle age shows
effects of earlier alcoholism.– Disease of the
liver and pancreas
– Various types of cancer
– Cardiovascular disease
• Treatment focuses on three goals:– Stabilization– Reduction of
consumption– Treatment of
coexisting problems
Dementia• Dementia is characterized by cognitive and
behavioral deficits involving some sort of permanent damage to the brain.
• About one half of all people over the age of 85 are affected with some form of dementia.
• Many forms of dementia have been identified
Dementias• Vascular Dementia– Numerous small cerebral vascular accidents (strokes)
Dementias• Parkinson’s Disease– Characteristics• Slow walking• Difficulty getting into
or out of chairs• Slow hand tremors
– Drug treatments available (e.g. Levodopa raises the levels of dopamine in the brain)
Dementias
• Huntington's Disease– Involuntary flicking
movement of the arms and legs
– Hallucinations– Paranoia– Depression– Personality changes
Dementias• Alcohol Related
Dementia (Wernicke- Koraskoff’s syndrome)– Caused by a thiamine
deficiency– Symptoms include
weight loss, neurological problems, muscle weakness
Dementias
• AIDS Dementia Complex or ADC– Encephalitis, behavioral
changes, decline in cognitive function
– Progressive slowing of motor functions
Dementias• Alzheimer’s disease– The most common form of progressive,
degenerative, fatal dementia– Characterized by beta-amyloid deposits (plaques)
and death of brain cells
Alzheimer’s Disease• Symptoms and Diagnosis– Gradual changes in cognitive function including declines in:• memory• learning abilities• attention• judgment• word finding• communication• personal hygiene• self-care skills• orientation to time and space
– Inappropriate social behavior– Changes in personality
– Sundowning: symptoms are worse in the evening
Alzheimer’s Disease Treatment• Memory improvement drugs (e.g. Tacrine
“Cognex”, Donepezil “Aricept”)• Effective Behavioral Strategies– Rethink issues such a bathing, dressing, grooming– Strategies to prevent wandering – Incontinence– Remove items than may be harmful and jewelry that
might become lost
Alzheimer’s Disease Treatment• Caring for Patients with Dementia at Home– Over 23 million households provide an average of 21
hours of care per week in unpaid care for relatives.– Caregivers are at risk for depression.