PSYX 233: Mental Health 3-10 November
PSYX 233: Mental Health 3-10 November PSYX 233 - 01
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PSYX 233 - 01
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This 9 page Class Notes was uploaded by Rachel Notetaker on Friday November 6, 2015. The Class Notes belongs to PSYX 233 - 01 at University of Montana taught by Christa Marie Neuman (P) in Fall 2015. Since its upload, it has received 21 views. For similar materials see Fund of Psychology of Aging in Psychlogy at University of Montana.
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Date Created: 11/06/15
Clinical Assessment, Mental Health, and Mental Disorders Mental health: o The only people who use the DSM V are American psychiatrists/psychologists o Treat the person, not the diagnosis You’re not schizophrenic, you are a person with schizophrenia Characteristics of mentally healthy people o Positive attitude for self o Accurate perception of reality o Mastery of the environment o Autonomy (more of a western value) o Personal balance o Growth and self-actualization (Maslow’s hierarchy of needs) The four D’s of diagnosis o Distress How do the symptoms affect the person? How is it distressing for caregivers/people around them? o Deviance Does the behavior differ greatly from the mainstream norms? o Danger Is someone who is severely depressed thinking of taking their life? Will the person act unsafely towards other people? o Disfunction For older people, what would be considered abnormal may be adaptive under some circumstances o Isolation o Aggressiveness o Passivitiy Multidimensional life-span approach to psychopathology o Psychological forces Normative changes can mimic mental disorders Toddler throwing tantrums v teens throwing tantrums Nature of personal relationships Clearly change over the lifespan o Sociocultural forces Being paranoid may be adaptive in certain circumstances Someone thinking the mafia is after them is different in NYC compared to Montana Cultural differences must be taken into account Someone with normal development until a certain age Religion is a cultural norm o Life-cycle forces An older person who wishes to go back to school Resistance to revealing personal information Sleeping patterns Hypersomnia, hyposomnia, insomnia Mental health and the adult life course o Alcohol dependence/abuse, major depression, any anxiety disorder all decrease in the “60 years and up age group” Highest for “30-44 years” age group Ethnicity, gender, aging, and mental health o Sociocultural influence in assessing behavior o Older minorities may have experienced: Inadequate health care Environmental health risks Stress of prejudice and discrimination o Ethnic differences found: Older Hispanic and Native American men show higher rates of alcohol abuse Older Native American men have the lowest rates of suicide Older Hispanic women show higher rates of phobias and panic attacks Older African-American men have lower rates of depression than other ethnic groups Developmental issues in assessment and therapy o Areas of multidimensional assessment Mental status exams Useful as a quick screening of measures of mental competnee o Family history, mood, sleeping and eating patterns, current relationships and social support, observations of behavior o Mini-mental status exam (MMSE) Psychological functioning assessed through o Interviews o Observation o Test or questionnaires Three dimensions of social functioning o Ties with social network o Content of interaction with one’s social network o Number and quality of interactions Factors influencing assessment You want descriptive observation, not interpretive observations Negative biases o Racial o Ethnic o Age stereotypes Positive biases o Women do not abuse alcohol Assessment methods Primary methods: o Interview o Self-report o Report by others o Psychophysiological o Direct observational o Performance-based assessment Developmental issues in therapy Medical treatment: dosage may be different for older adults o Ingestion v injection is also an option Psychotherapy: different ages present different problems The big three: depression, delirium, and dementia o Depression Aaron’s Becks theory of depression Negative theory of self, of the world, and of the future Theory of self: self-concept (one’s thought about themselves), automatic thoughts (black and white opinions of what others think about you), core beliefs (statement grown out of conflict, opinion based on baggage and interaction with others), schemas (an unconscious certain way of seeing things, how you interpret situations) 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 For those receiving home health care, the rate of depression is 13% Cohort effect: most recent born have highest rates of depression o Generations can be more depressed as a whole Prevalence of depression throughout the years has decreased General symptoms include Dysphoria (feeling “down” or “blue”) o Lack of energy o Don’t feel like doing much (getting out of bed, talking to people) o Not a physical symptom Physical symptoms o Insomnia o Changes in appetite o Diffused pain o Trouble breathing (only for older populations) o Headaches o Fatigue o Sensory loss (only for most severe form of depression) Symptoms must last at least two weeks for depression to be diagnosed Other causes must be ruled out first (there’s often cross-over in symptoms) Clinician must determine how symptoms affect daily life o Are the harmful to oneself or others? Ethnic differences 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 Assessment Scales Beck depression inventory Geriatric depression scale Center for epidemiological studies- depression scale o Study types of treatment and diagnosis Causes of depression Biological: genetics, brain changes, neurotransmitters o Low level of serotonin o Selective Serotonin Reuptake Inhibitors (SSRI) Cognitive-behavioral: internal belief systems are affected by experiencing unpredictable and uncontrollable events Physical: not all causes, but strong correlates o Coronary artery disease Hypertension, myocardial infarction, congestive heart failure, etc. o Neurological disorders Cerebrovascular accidents, Alzheimer’s, Parkinson’s, Binswanger’s, multiple sclerosis, etc. o Metabolic disturbances Diabetes, hypo/hyperthyroidism, Addison’s, autoimmune thyroiditis, etc. o Cancer Pancreatic, breast, lung, colonic, and ovarian carcinoma, lymphoma, etc. Treatments Empirically Supported Treatments: those shown through scientific research o Cognitive Behavioral Theory Act despite the way you feel Act your way into how you should feel Medication: sometimes deals with all neurotransmitters, research is going towards more specificity o Selective Serotonin Reuptake Inhibitors (SSRI) o Norepinephrine reuptake inhibitors (SNRI) o Norepinephrine and dopamine reuptake inhibitors (NDRI) o Combined reuptake inhibitors and receptor blockers o Tetracyclic antidepressants o Monoamine oxidate inhibitors (MAOI) Can cause high blood pressure, not suggested for the elderly Electroconvulsive therapy (ECT) o Not a lot of side effects, except short term memory loss o Targets specific areas of the brain Psychotherapy o Behavior therapy o Cognitive therapy o Delirium Not a diagnosis, but a description More short term than dementia Most cases can be cured Disturbance of consciousness that develops rapidly Due to Medical conditions Medication side effects Substance intoxication or withdrawal Exposure to toxins Combination of any of these o Dementia Affects over 37 million globally Doesn’t affect most of older adults About a dozen identified forms of dementia Alzheimer’s Progressive, degenerative, and fatal Neurological changes Rapid cell death Neurofibrillary tangles Plaques consisting of a core of beta-amyloid, surrounded by degenerated fragments of dying or dead neurons Symptoms/diagnosis Gradual changes in cognitive function Declines in personal hygiene or self-care skills Inappropriate social behavior Changes in personality Sundowning: symptoms are worse in the evening Cause: Autosomal dominant inheritance patterns o Involved one gene from either one’s mother or father in order to cause to condition Beta-amyloid cascade hypothesis o Process by which beta-amyloid creates neuritic plagues that in turn lead to tangle that cause neuronal death Intervention strategies: Memory improvement drugs Behavioral strategies are more effective than drugs o Spaced retrieval: involved using implicit-internal memory intervention Caring for patients with dementia: Caregivers at risk for depression Effective behavioral strategies o Financial plans o Rethinking issues such as bathing, dressing, grooming o Strategies to prevent wandering o Incontinence o Removing items that may be harmful and jewelry that might become lost Vascular dementia Numerous small cerebral vascular accidents o Occurs with greater rapidity than Alzheimer’s Parkinson’s disease Slow walking, difficulty getting into/out of chairs, slow hand tremors Treatment o Levodopa: raises levels of dopamine in the brain o Sinemet: combination of levodopa and carbidopa o Stalevo: Combination of sinemet and entacapone Huntington’s disease Involuntary flicking movement of arms and legs Hallucination, paranoia, depression, clear personality changes Alcohol-related dementia Wernicke-Korsakoff’s syndrome Key symptom is confabulation o Fabricated, distorted, or misinterpreted memories AIDS dementia complex (ADC) Encephalitis, behavioral changes, decline in cognitive function Progressive slowing of motor function Anxiety disorders o Symptoms and diagnosis Physical changes that interfere with functioning Anxiety in older adults may be appropriate to the situation or are due to underlying health problems o Treatment Medication Benzodiazepine (Valium, Librium) SSRIs (Prozac, Paxil, etc.) Buspirone, beta-blockers Psychotherapy Cognitive behavioral Relaxation training Psychotic disorders o Schizophrenia Severe impairment of the thought process Delusions Onset occurs most often between ages 16 and 30 Natural course of the disorder is improvement over the adult lifespan Treatment Emphasis on medication Difficult to treat with psychotherapy Comprehensive and integrated program can be effective Substance abuse o Elderly person’s “drug of choice” is alcoholism Four symptoms of alcoholism Craving Impaired control Physical dependence Tolerance Middle age shows effects of earlier alcoholism Disease of the liver and pancreas Various types of cancer Cardiovascular disease Three goals of treatment Stabilization Reduction of consumption Treatment of coexisting problems
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