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Transcript

GEY4612

Mental Health

Mental Illness

Good Mental Health

Studying mental health in adults focuses on context- Does the behavior interfere with daily functioning?

Adults and Mental Health

Where does one end and the other begin?

Characteristics of “mentally healthy” people (1980):

  • Positive attitude toward self
  • Accurate perception of reality
  • Autonomy and mastery of the environment
  • Personality balance
  • Growth and self-actualization

Defining Mental Health

  • Difficult to define
  • Expectations of behavior change over time, situation, and age
  • For older people, “abnormal” may be helpful in some cases
  • Psychopathology
  • The study of mental disorders
  • General term for any mental or behavioral disorder

Defining Mental Health

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Defining Mental Health

  • Viewing adults’ behavior from a lifespan perspective
    • Accounts for differences between younger and older people
    • Two patients, one old and one young:
      • Lack of sleep and energy
      • Changes in appetite
      • Feeling down
  • Would you evaluate them identically?

Life-Span Approach

Sociocultrual Forces & Life-Cycle Factors

Biological & Psychological Forces

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Life-Span Approach

  • Ethnicity
    • Describe feelings in different ways
    • What is/isn’t appropriate to share with strangers
  • Gender
    • Similar issues as ethnicity
    • Differences in prevalence and symptoms
      • Women experience depression twice as often as men
      • Men who are depressed more likely to commit suicide

Ethnicity and Gender

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Mental Health in Adulthood

  • One of the most common psychological problems in adults
    • The age of onset is 20s, the average age at diagnosis is 32
    • Women 2x as likely to be diagnosed
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Depression

Fact: depression rates decline over time

  • <5% of older adults living in the community
  • 13% of those requiring home health care
Older adults who have a high risk for depression
  • Chronic illness, nursing home residents, family caregivers

Myth: Most older adults are depressed

Depression

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  • Dysphoria
    • Feeling down or blue
      • Age differences in how dysphoria is expressed
  • Physical symptoms
    • Insomnia, changes in appetite, fatigue, headaches, pain
  • Diagnosis
    • Symptoms must be present for at least two weeks

Depression Symptoms

Depression Assessment

Most scales developed for younger adults include items assessing physical symptoms

  • Beck Depression Inventory
    • Feelings and physical symptoms
  • Scales that don’t ask about physical symptoms
    • Geriatric Depression Scale
    • Center for Epidemiologic Studies Depression Scale

Biological

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  • Interpretation of uncontrollable events; causes feelings of helplessness and hopelessness
  • Psychological effects of different types of losses
  • Genetics, brain changes, imbalance in neurotransmitters
  • Low levels of serotonin, norepinephrine, BDNF

Cognitive-Behavioral

Psychosical

What Causes Depression?

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Antidepressants

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Types of Treatments

Depression Treatment

Changes in situation may change your appraisal

Evaluate the event

Psychotherapy

BehaviorTherapy

Cognitive Behavior Therapy

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Categorize the event

Antidepressants

  • Selective serotonin reuptake inhibitors (SSRI)
    • Boost serotonin levels with fewest side effects
  • Tricyclic antidepressants
    • Most effective in younger and middle-aged people
  • Monoamine oxidase inhibitors (MAO)
    • Used only when other options don’t work

Psychotherapy

  • Can be used on its own for less severe depression, used with medication in severe depression
  • Behavior therapy: attempts to alter behavior, without necessarily addressing underlying causes
  • Cognitive behavioral therapy (CBT): attempts to change the way people think

Behavior Therapy

  • Behavior therapy
    • Assumes people don’t get enough reinforcement from their environment
    • Goal = increasing good things that happen to them
      • Increase activities and decrease negative thoughts
      • Family and friends instructed to reward positivity

Cognitive Behavioral Therapy (CBT)

  • Assumes people have negative beliefs about self
  • Recognize negative thoughts, then evaluate self, world, future, more realistically
    • Homework assignments reinforce new behaviors
  • Effective for most people, especially older adults
  • Differences in treatment based on age
    • Medication
      • Medication interactions
      • Dosage and efficacy different for adults at different ages
  • Psychotherapy
    • Adapted for unique needs of older adults
    • Education

Age and Treatment

  • Challenges with older adults
    • Getting them to seek treatment can be difficult
    • Believe that some symptoms are part of getting older
    • Mental health professionals under- or misdiagnose because of symptom overlap

Age and Treatment

  • Based on fear and uneasiness, interfere with social functioning, relationships, work
    • Severe anxiety for no apparent reason
    • Specific phobias about places/things
    • Obsessive-compulsive disorders
  • Prevalence
    • Affects >18% of adults, more common in women

Anxiety Disorders

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Anxiety Disorders

  • Symptoms
    • Some overlap with depression
    • Dry mouth, sweating, insomnia, hyperventilating, etc
  • Causes
    • Difficult to pinpoint a single cause, stressful events
    • For older adults – related to major negative life events and health

Anxiety Disorders

  • Treatment
    • Medication (anti-anxiety drugs)
      • Moderately effective, requires careful monitoring in older adults because of side effects
    • Psychotherapy
      • CBT, relaxation therapy, meditation
      • Effective
  • Bipolar disorder
    • Alternating between depression (lows) and activity (highs)
    • Exact causes unknown, but genes strongly implicated
      • If your twin has bipolar, you have a 70% chance of having it
    • Can be managed with medications (i.e., lithium)
    • Psychotherapy not as effective, but can help
  • Dysthymic disorder
    • Less severe, chronic form of depression
    • Diagnosis requires two-year history of depressed mood
  • Seasonal affective disorder
    • People with good mental health have depressive symptoms during winter
    • Ranges from 1.4% in FL to 10% in Alaska
    • Light therapy

Other Mood Disorders

  • Older adults are especially susceptible to delirium because they take more medications
    • Severity related to underlying physiological problem
    • Most cases can be cured (1/3 of cases preventable)
      • Treat physical problems/symptoms
      • Confusion and disorientation can be helped by interacting with a familiar person

Delirium – changes in consciousness and cognition, occurs rapidly

  • Difficulty with attention, memory, orientation, confusion
  • What causes delirium?
    • Medical conditions
      • Stroke, cardiovascular disease, etc.
    • Medication side effects
    • Substance intoxication or withdrawal

Other Mood Disorders

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  • Sociocultural forces
    • Social norms influence behavior and how we interpret it
    • Cultural differences
  • Life-cycle factors
    • Behavior affected by past life experiences
      • Middle-aged and older adults going back to school
      • Older adults hesitant to share personal info
  • Biological forces
    • Physical changes affect behavior and present as psychological problems
  • Psychological forces
    • Normative changes can mimic mental disorders
    • Personal relationships changing in older adults