CHAPTER TEN CHAPTER TEN Clinical 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

Delirium Delirium 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

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

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.