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Psychology (860)
PSY 606 (26)
Chapter 16

Chapter 16 notes

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PSY 606
Thomas Hart

Ch 16 – Aging and Psychological Disorders • signs of aging in women are not valued in society • ageism  discrimination against any person based on chronological age • the Canadian CLSA has provided a wealth of basic info about healthy aging, health care use, & risk factors for diseases and disabilities. It’s goal includes  preventive intervention & cost- efficient treatments • the “Big Boom”  impact that baby boomers of Canada will have on country’s health system as they move into their senior years in less than a decade • family physicians of Ontario feel less prepared to identify older patients with psychological problems than younger patients • physicians are much less likely to refer older patient for treatment, & psychotherapy is less effective for older patients • three groups of ppl older than 65 yrs of age: 1. young-old group  65-74 2. old-old group  75-84 3. oldest-old group  85+ • ppl tend to become less alike as they grow older • three kinds of effects are important to define in any age related discussion: 1. age effect  consequences of being a given chronological age 2. cohort effect  consequence of being born in a given year & having grown up during particular time period with its own unique pressures; a cohort effect exists if these ppl have some factors that distinguishes them from those who turned 65 or older at an earlier age 3. time-of-management  confounds that arise coz events at an exact point in time can have specific effect on variable being studied over time; ex: assessing post-traumatic stress disorder in Holocaust survivors • cross-sectional studies  compares different age groups at same moment in time on variable of interest; allow us to make statements only about age effect • longitudinal studies  periodically retest a selected cohort using the same measure over number of years; allow us to make statements only about cohort effect • conclusions drawn from longitudinal studies are restricted to cohort chosen • another problem with longitudinal studies is that participants often drop out as studies proceed creating a bias known as selective mortality  the least-able people are most likely to drop out leaving a nonrepresentative group  thus overly optimistic stats • the DSM-IV criteria for older adults are basically same as those for younger adults • accurate assessment of elderly people for purposes of establishing diagnoses & conducting research requires assessment measures tailored to elderly people • the Modified Mini-Mental State Exam (MMSE) is a brief measure of an ind cognitive state assessing orientation, memory, attention, ability to name, follow verbal & written commands, • write sentence spontaneously, & copy a complex polygon • a Clock Test is a simple measure to detect Alzheimer and dementia  it is reliable & valid though results vary depending on scoring system used • the Geriatric Depression Scale (GDS) is true-false self-report designed to assess depression & suicide possibilities in elderly • the elderly people with mental disorder suffer “double jeopardy” since they suffer the stigmas associated with being old and being mentally ill • older adults who belong to groups that provide strong and meaningful roles for them seem to have an easier time adjusting to growing old • maladaptive personality trait & inadequate coping skills that person brings into old age plays a role in any psychological disorder • persons over age 65 have lowest overall rates of mental disorder of all age groups • cognitive impairment is the primary problem which underlies many others (i.e. depression) • majority of 65 yrs and older are actually free from serious pychopathology  10-20% are not Dementia • it is gradual deterioration of intellectual abilities to the point that social & occupational functions are impaired • difficulty remembering things, especially recent events, is most prominent symptom • patients may leave tasks unfinished, not remember their children’s names, stay unhygienic, may wander off and get lost even in familiar settings, poor judgment, impulsive, coarse language, inappropriate jokes, shoplift, depressed, flat affect, & sporadic emotional outbursts • have language disturbances, vague pattern of speech, although the motor system is intact they may have difficulty carrying out motor activities (brushing teeth, or dressing) • episodes delirium (a state of great mental confusion) may also occur • is progressive, static or remitting, depending on the cause • prevalence increases with advancing age (same goes for Alzheimer’s disease) Causes: • dementias are classified into 3 types  Alzheimer’s disease, frontal-temporal, & frontal- subcortical dementias • Alzheimer’s Disease − it accounts for 50% of dementias in older people − we are facing “looming global epidemic” − promoting mental & physical exercise would result in 10% reduction in prevalence − brain tissue deteriorates irreversibly − women with Alzheimer live longer than men but more women than men die due to it − patients blame others for personal failings & may have delusions of being persecuted − patients are wholly unaware of the extent of their memory decline − main physiological change in brain is an atrophy of cerebral cortex, entorhinal cortex, hippocampus, frontal & temporal & parietal lobes − have enlarged ventricles − plaques (small round remnants of lost neuron & b-amyloid) & neurofibrillary tangles − hippocampus & medial temporal lobes has reduced volume − cerebellum, spinal cord, & motor & sensory areas of cortex are less affected − about 25% of patients also have brain deterioration similar to that of Parkinson’ disease − anticholinergic drugs (those that reduce Ach) can produce memory impairments − have fewer Ach terminals in the brain & levels of acetycholine is also low − has genetic basis − among early-onset (before age 60) cases, which account for 5% of cases, the inheritance pattern suggests the operation of single dominant gene − people with Down syndrome often develop Alzheimer if survive long enough  thus chromosome 12 is studied which makes protein b-amyloid − chromosome 12 is the reason behind early onset − dominant genes causing disease have also been found on chromosome 1 & 14 − majority of late-onset cases of Alzheimer’s disease exhibit a gene on chromosome 19 − this allele increases the risk regardless of age, gender, and education level − env is likely to play a role in most Alzheimer’s cases − heritability is quite high and equal for both genders − head injury, & depression is risk factor for developing the disease − non-steroidal anti-inflammatory, such as aspirin, or nicotine reduce the risk of it − remaining active at cognitive level may buffer/protect − cognitive activity preserve cognitive function; cognitive activity helps crystallized intelligence more than fluid intelligence; there is support for cognitive reserve hypothesis − cognitive reserve hypothesis  high education levels delay the onset of dementia − being bilingual acts as a protective barrier against Alzheimer • Frontal-Temporal Dementias − accounts for 10-15% of the cases − typically begins in late 50s − marked by extreme behavioural and personality changes − patients become to apathetic or at times may express overactivity, impulsivity & euphoria − is not closely linked to los of cholinergic neurons − serotonin neurons are most affected; deficiency in frontal and temporal lobe − the Pick’s disease is one cause of this disease (Pick’ disease is degenerative disorder • Frontal-Subcortical Dementias − both cognition & motor activity are affected − types of frontal-subcortical dementias: o the Huntington’s chorea is caused by single dominant gene located on chromosome 4 and is diagnosed by genetic testing o the Parkinson’s disease is marked by muscle tremors, muscular rigidity, & akinesia can lead to dementia o the vascular dementia is second most common type; it is diagnosed when a patient with dementia has neurological signs, such as weakness in an arm or when brain scans show evidence of cerebrovascular disease; most commonly patient had a series of strokes in which clot formed impairing circulation and
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