CHAPTER 11 CHAPTER 11 Mental Health Issues and Treatments

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

 major psychiatric manual in US and Canada  Includes diagnostic criteria for major forms of psychological disorders  To meet criteria, client must have a fairly high degree of severity and symptoms must persist over period of time DSM-5 DSM-5 : Diagnostic and Statistical Manual Other countries use the International Classification of Diseases (ICD)

Major Depression Involves d ysphoria—feeling “down” or “blue” (sad mood, feelings of guilt and worthlessness, difficulty concentrating) 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.

Estimated 16.6% lifetime prevalence Average age of onset: 32 More common in females Twice as common in people under 60 than over 60 Highest in age group 7 Major Depressive Disorder However, many older adults report depressive symptoms (30% in clinic and hospital settings)

may not be correctly diagnosed Older adults may not be correctly diagnosed for major depressive disorder.  Health care professionals may not be trained in diagnosis of older adults  Older adults may not accurately report symptoms  Physicians spend too little time with them  Reimbursement rates lower than for medical  Attitudes toward depression in older adults  Medical and psychological symptoms may co-occur Health care workers should look for possible contributing psychosocial factors

Medical conditions can present significant risk factors for depression  Arthritis  Hip fracture  Diabetes  Metabolic syndrome  Hypertension  Tooth loss  Lack of vitamin D Depressive disorders may also cause further impairments in physical and cognitive functioning

Bipolar disorder Involves manic and depressive episodes 3.9% lifetime prevalence More than 50% of cases have onset before person reaches age 25 60% of all people with bipolar disorder can live symptom-free with treatment

Anxiety disorders Sense of dread about the future Go to great lengths to avoid anxiety-provoking situations Most highly prevalent of all psychological disorders except substance abuse 18.1% lifetime prevalence Prevalence rates are lower in people 60 and older Older women have higher rates than older men

Forms of anxiety disorder Generalized anxiety disorder Overall sense of uneasiness Prone to worrying Feelings of restlessness and tension 5.7% lifetime prevalence Panic disorder Involves panic attacks, or feeling that one is about to die May also involve agoraphobia 1.4% lifetime prevalence (panic attacks occur at a higher rate Specific phobia Irrational fear of particular object or situation Animals, natural environment, blood- injection-injury, engaging in specific activities 12.5% lifetime prevalence Social anxiety disorder Extreme anxiety about being watched by other people May become anxious at thought of eating in front of others 12% lifetime prevalence

Obsessive-Compulsive Disorder (OCD) Obsessions: repetitive thoughts, worries Compulsions: repetitive behaviors 1.6% lifetime prevalence;.7% among older adults

Trauma and stress-related disorders Symptoms include intrusion of distressing reminders, dissociative symptoms, avoidance of situations that remind one of the event, and hyperarousal Acute stress disorder Acute stress disorder involves symptoms for up to 1 month Post-traumatic stress disorder Post-traumatic stress disorder involves symptoms for >1 month 6.8% lifetime prevalence; older adults may suffer from late-onset stress symptomatology (LOSS) PTSD rates expected to increase as Vietnam vet population ages

Schizophrenia and other psychotic disorders Symptoms: Distorted perception of reality Impairment in thinking, behavior, expression of feelings (affect), and motivation Delusions, hallucinations, disorganized and incoherent speech, abnormal behavior Lack of behavior that is normally present 1% lifetime prevalence With treatment, 40% can recover from an acute episode

Alcoholism Substance 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

18 Alcohol dependence in older adults As many as 14% who receive medical attention in hospitals and ERs Prevalent in nursing homes and retirement communities Risks include increased injuries Alcohol also interacts badly with common meds Alcohol impairs cognition further in those with existing dementia.

Personality disorders Long-standing pattern of maladaptive inner experience and behavior 9% prevalence among general population Antisocial personality disorder Factor 1: disturbances in empathy, guilt and remorse Factor 2: unstable and impulsive behaviors Borderline personality disorder Extreme instability in sense of self and relationships with others Sexual impulsivity, fear of abandonment, suicide attempts, and difficulties regulating emotions  Psychopathy Immature less prevalent Mature more prevalent Improved coping with symptoms The maturation hypothesis proposes that older adults show lower prevalence of immature and higher prevalence of mature personality disorders

Estimated 14% of US adults 60+ Most frequent form is financial, at 5.2% Estimated 14% of US adults 60+ Most frequent form is financial, at 5.2% 5 Types of Elder abuse

Recommendations for reducing elder abuse Provide caregivers with better coping skills Provide adequate reimbursement and social support More funding of state Adult Protective Service agencies and better reporting Only 14 states have mandated reporting

Facts about suicide, or taking one’s own life U.S. suicides in 2010: Alcohol, anti-depressants, opiates were found in 33% 10 th leading cause of death, majority rd leading cause of death for year olds (20% of all deaths) Older adults often have only mild to moderate symptoms of depression Males 75+ have highest rates Between 43-76% of suicide victims had seen a health care provider within one month of their death

Professional Geropsychology: The application of gerontology to the treatment of older adults Selected items from the APA Geropsychology Guidelines Attitudes: Be aware of attitudes and beliefs about aging General Knowledge: Gain expertise in aging Clinical Issues: Understand psychopathology in older adults Assessment: Learn to use and interpret appropriate tools Service provision: Know about efficacy of interventions Education: Gain continuing education in geropsychology

Clinical interview Questions in face-to- face setting Somewhat flexible Mental status examination Assesses current state of mind Mini-Mental State Exam (MMSE) used to screen for dementia Functional abilities ADLs IADLs Specific symptom measures Geriatric Depression Scale Center for Epidemiological Studies Scale for Depression (CES-D) Assessment measures Psychological Assessment Formal evaluation of an individual’s cognitive, personality, and psychosocial functioning Should be tailored to older adults, including practical considerations Need to account for sensory, motor, and cognitive limitations

26 Treatment: Medical interventions TreatmentsConsiderations for older adults Antidepressants, antianxiety medications, neuroleptics Take precautions against drug interactions May have serious side effects including addiction Electroconvulsive therapy (ECT) May cause short-term memory loss

Psychodynamic Inner conflicts Attachment issues Life review Psychodynamic Inner conflicts Attachment issues Life review Cognitive- behavioral Change thoughts and behavior Cognitive- behavioral Change thoughts and behavior Behavioral Change reinforcements for behavior Behavioral Change reinforcements for behavior Cognitive Focus on dysfunctional thoughts Cognitive Focus on dysfunctional thoughts Interpersonal Cognitive methods and social skills Interpersonal Cognitive methods and social skills Integration Combination of approaches

Older adults seem protected against serious psychological distress