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Psych 357 Ch 11.docx

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PSYC 357
Dagmar Bernstein

Psych 357 Ch 11 (Mental health issues and treatment) • Psychological Disorders in adulthood: o Disorders significantly alter adaptation o Abnormal= feeling personal/subjective distress, being impaired in everyday life, causing risk to self/others and engaging in culturlally/socially unacceptable behaviour o Use of DSM-IV-TR (diagnosis and statistics manual)  Not developed with consideration of how diagnostic categories for psychological disorders might change over the adult years  5 axes: Axis I- clinical syndromes/disorders (collection of symptoms that together form a recognizable pattern of disturbance) • Includes mood disorders, dementia, anxiety disorders, substance related disorders, schizophrenia, sexual disorders, eating disorders, sleep disorders • Axis II- personality disorders where disturbances thought to reflect disturbance w/in basic personality structure of indiv • Axis III- medical conditions (ie diabetes as causal factor in depression) • Axis IV- psychosocial and contextual/environmental problems • Axis V- Overall rating of client functioning (suicidal 1-20 to superior 91- 100) o Major Axis I disorders in adulthood;  Mood disorders= abnormalities in experience of emotion • Depressive disorders= periods of sad mood (dysphoria) lasting varying amounts of time and varying in severity o 18.4% prevalence over adulthood in US, 1-5% at any given time (incidence) • Manic episode a feature of bipolar disorder= feel unusually “high”, elated, grandiose, expansive and highly energetic • At all ages rates of major depressive disorder and dysthymia is higher in women (2x), more likely when under 65 than over to experience o Women more likely to suffer depressive symptoms earlier, men more likely to develop them in later adulthood o Older adults less likely to report some more recognizable psychological symptoms (sad mood, guilt, thoughts of suicide) and more for somatic probs (insomnia, fatigue) • Late onset depression= mild or moderate depression taht first appears after the age of 60 o Risk factors= becoming a widow, having less high school educ, experiencing impairments in physical functioning, being heavy alcoholic o Often accompanied w/psychotic symptoms (hypochondriacal delusions, nihilistic beliefs, belief that self/other/world have ceased existing) o May occur in conjunction w/dementia esp in early stages • Health care pros not good at recognizing depression in older ppl b/c they don’t necessarily report their symptoms completely (also spend less time w/younger patients) • Psychological factors taht increase risk of depression: hearing or visual impairments, impaired physical functioning, probs w/memory and cognition, psychosocial issues (loneliness) and inability to use effective coping strategies • 12-20% prevalence rates of depression in hospitals/clinics, tooth loss also associated w/depression (often overlooked) • Depression related to higher morbidity- perhaps b/c immune dysfunction o Depression activates cytokines that eventually increase risk of cardiovascular disease, periodontal disease, frailty and functional decline • Prevalence of bipolar affective disorder far lower than MDD (1.6%)- lower in older adults and lower likelihood of older adult experiencing first ever manic episode o Generally onset of bipolar is in late adolescence/early adulthood (related to higher risk for cerebrovascular disease when it develops later in life) o Presence of white matter hyperintensities in indivs who dev bipolar for first time in late rlife reinforces ptl role of vascular contributions o Anxiety disorders: major symptom is excessive anxiety and brings focusing inward on unpleasant feelings that accompany anxiety (ie pounding heart)  Twice as much in women, predictive of other medical conditions (ie heart attack)  Symptoms can be produced at any age, or can exist along side medical condition  Generalized Anxiety Disorder (GAD): • Overall sense of uneasiness and concern but can’t id specific focus o Restlessness, muscle tension, sleep disturbance o May be triggered in late rlife by health concerns • Higher percentage of older adults experienced symptoms of GAD  Panic disorder= panic attacks (episodes where indiv experiences physical symptoms involving extreme shortness of breath, pounding heart and belief that death is imminent) • Unpredictable episodes, also often dev agoraphobia (fear of being stranded/trapped during a panic attack so stay home or away from certain places) • Agorapho ia less common among older adults, and unlike younger adults who may dev agoraphobia afte rpanic attack, more likely that this condition in older adults related to fear of harm/embarrassment  Specific phobia= irrational fear of object/situation • Most common form of AD in older adults, many types (common is blood- injury)  Social phobias= AD that applies to situations in which they must perform in front of others • Peak rates in 30s, women more than men, specific form for public speaking  Obsessive compulsive disorder= suffer from obsessions (repetitive thoughts) and compulsions (repetitive thoughts to dispel obsessions) • Dif than OC personality disorder (rigid and perfectionistic) • Rare in older adults?  Post traumatic stress disorder= prolonged effects of exposure to traumatic experience • Incapacitated by flashbacks or reminders of the event, intrustions of thoughts bout the disaster, hypersensitivity to events similar to the trauma and attempts to avoid these reminders o Associated w/being a veteran, heart disease associated w/PTSD (esp for men), also impaired memory o Anxiety may occur in conjunction w/depression so get Mixed Anxiety-Depressive disorder (recurrent/persistent dysphoria for at least 1 month w/at least 4 symptoms of anxiety disorders)  These ppl often less responsive to tx  Schizophrenia and other Psychotic Disorders: • Schizophrenia= hallucinations, delusions (false beliefs) as positive symptoms o Also negative symptoms= apathy, w/drawal, lack of emotional expression, altered speech/beahvior o Common symptom is disturbance in being in contact w/reality o Lifetime prevalent 1% w/peak in 30-44 age group and apparent decrease in older age group (reflects higher mortality)  For most ppl onsest before 40, and about 5 years earlier in women (more in older women than over men) o Initially known as Dementia Praecox and thought incurable, tho now know it’s highly variable in course  25% ppl w/disorder improve to complete remission, 10% remain chronically impaired  Negative symptoms become more prominent than positive in later adulthood, hopefully dev some impressive coping skills o Late onset schizophrenia= aka paraphrenia  Vs early onset more likely to involve paranoid symptoms, less severe cognitive impairment and respond better to meds  w/late onset form appear to function at higher level in yough than ppl w/early onset  Delirium, dementia and amnestic disorders • Alzheimers, dementia a term to apply to a change in cognitive functioning that occurs progressively over time • Symptoms= loss of memory and ability to use language (aphasia), apraxia (coordinated body movemtns), to recognize familiar objects, and to make rational judgments • Delirium= acute state w/disturbance in cognition and attention o Memory loss, disorientation, inability to use language o Mostly subsides w/in a few days but can persist longer, relatively frequent in acute care medical settings, uncommon w/in community residing older ppl o Often misdiagnosed • Amnesia= main symptom of profound memory loss, can’t
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