1. Assessment & Mental Disorders
Chapter 10
October 6, 2010

2. True / False
1. Mentally healthy people have positive attitudes,
accurate perceptions, autonomy, and personal
balance.
2. A good assessment would include medical,
psychological, and social functioning.
3. The “Big Three” are Dementia, Depression, and
Decubitus .
4. Depression is the most common mental disorder
in adults, but declines in frequency with age.
5. Dementia is a family of disorders.

3. True / False
• Alzheimer’s Disease is progressive and fatal.
• Major changes with dementia include memory loss,
emotional changes, and loss of motor function.
• The recommended treatment for Parkinson’s Disease
is Electroconvulsive Therapy (ECT)
• Anxiety Disorder symptoms may include chest
discomfort, sweating, difficulty breathing, and acute
memory loss.
• People with early-onset Schizophrenia often improve
over time as neurotransmitters become more
balanced.

4. Assessment & Mental Disorders
Chapter 10
October 6, 2010

5. Mental Health & the Adult Life Course
Learning Objectives
• How is mental health and psychopathology defined?
• What are the key dimensions used for categorizing
psychopathology?
• Why are ethnicity and aging important variables to
consider in understanding mental health?

6. Mental Health and the Adult Life Course
• What is the difference between mental health
and mental disorder?
Characteristics of mentally healthy people:
• Positive attitude toward self
• Accurate perception of reality
• Mastery of the environment
• Autonomy
• Personal balance
• Growth and self-actualization
• For older people, what would be considered
abnormal may be adaptive under some
circumstances.
– Isolation
– Passivity
– Aggressiveness

7. Mental Health and the Adult Life Course
Viewing adult’s behavior from a lifespan prospective
Psychological forces
• Normative changes can mimic mental disorders.
• Nature of personal relationships
Sociocultural forces
• Being paranoid may be adaptive in certain
circumstances.
• Cultural differences must be taken into account.
Life-Cycle Factors
• An older person who wishes to go back to school.
• Resistance to revealing personal information.
• Sleeping patterns

8. Distribution of Mental Disorders

9. Mental Health and the Adult Life Course
Sociocultural influence in assessing behavior
Older minorities may have experienced:
• Inadequate health care
• Environmental health risks
• Stress of prejudice and discrimination
Ethnic differences found:
• Older Hispanic men show higher rate of alcohol
abuse then women.
• Older Hispanic women show higher rates of phobias
and panic attacks than men.
• Native American men also have high rates of
alcohol abuse.
• Older African-American men have lower rates of
depression than other ethnic groups.

10. Development Issues in Assessment
Learning Objectives
• What key areas are included in a
multidimensional approach to assessment?
• What factors influence the assessment of adults?
• How are mental health issues assessed?
• What are some major considerations for therapy
across adulthood?

11. Development Issues in Assessment
Mental status exams
Useful as a quick screening of measures of mental
competence
• Mini-Mental Status Exam (MMSE)
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

12. Development Issues in Assessment
Factors Influencing Assessment
Negative biases
– Racial
– Ethnic
– Age stereotypes
Positive biases
– Women do not abuse alcohol.

13. Developmental Issues in Assessment
Assessment methods:
– Interview
– Self-report
– Report by others
– Psychophysiological
– Direct observation
– Performance-based assessment

14. Developmental Issues in Assessment
Developmental Issues in Therapy
Medical treatment
– Dosage may be different for older adults.
– “Start Slow; Go Slow”
Psychotherapy
– Different ages present different problems.

15. The Big Three:
Depression, Delirium, and Dementia
Learning Objectives
• What are the most common characteristics of
depression? How is depression diagnosed? What
causes depression? What is the relation between
suicide and age? How is depression treated?
• What is delirium? How is it assessed and treated?
• What is dementia? What are the major symptoms of
Alzheimer’s disease? How is it diagnosed? What
causes it? What are some other major forms of
dementia?

16. DEMENTIA OR DEPRESSION?

17. Dementia, Depression, & Delirium
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 adult living in the community
show signs of depression.
– For those receiving home health care, the rate is 13%.

18. Dementia, Depression, & Delirium
Depression
General Symptoms Depression
– Dysphoria—feeling “down” or “blue”
– Accompanying physical symptoms
• Insomnia
• Changes in appetite
• Diffused pain
• Trouble breathing
• Headaches
• Fatigue
• Sensory loss

19. Dementia, Depression, & Delirium
Depression
General Symptoms and Characteristics of Depression
1. Symptoms must last at least two weeks.
2. Other causes must be ruled out.
3. 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.

20. Dementia, Depression, & Delirium
Depression
Assessment Scales
– Beck Depression Inventory
– Geriatric Depression Scale
Diagnosis of depression should never be made on the basis of test
score alone.
Causes of Depression – two types
–Situational
–Organic

21. Dementia, Depression, & Delirium
Depression
Treatment of Depression
– Most forms of depression benefit from treatment
• Medication
– Prozac
– Paxil
– Zoloft
– Lexapro
• Electroconvulsive therapy
• Psychotherapy
– Behavior therapy
– Cognitive therapy
Most effective? A combination of medication and therapy.

22. Medication vs. Therapy
Most effective? A combination of medication and therapy.

23. Dementia, Depression, & Delirium
Delirium
Caused by:
– Medical conditions
• Stroke
• Cardiovascular disease
• Urinary Track Infection
• Dehydration
• Metabolic conditions
– Medication side effects, substance intoxication or
withdrawal, exposure to toxins, or a combination
Dementia
Affects over 5 million Americans
– About one half of all person over the age of 85 are
affected with some form of dementia.
– Could increase to 8 million in 2030 and triple to 2050
to 16 million

24. Dementia, Depression, & Delirium
Dementia
The family of Dementias
Alzheimer’s Disease
– Progressive
– Fatal
Characteristics of Alzheimer’s Disease
– Neurological Changes
~ Definitive diagnosis can only be done by autopsy
~ Rapid cell death
~ Neurofibrillary tangles
~ Amyloid plaques
Symptoms and Diagnosis
– Gradual changes in cognitive function: declines in memory,
to loss of remote memory, learning, attention, and
judgment; disorientation in time and place; difficulties in
word finding and communication; declines in personal
hygiene and self-care skills; inappropriate social behavior;
and changes in personality.

25. Dementia, Depression, & Delirium
Sundowning
• symptoms are worse in the evening
Intervention Strategies
• Memory improvement drugs
– Aricept
– Namenda
– Exelon
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.
• Effective Behavioral Strategies
– Include financial plans, rethinking issues such a bathing,
dressing, grooming
– Reduce wandering
– Incontinence
– Create safe environment

26. Dementia, Depression, & Delirium
Other Forms of Dementia
Vascular Dementia
• Numerous small cerebral vascular accidents
– Occurs with greater rapidity than Alzheimer’s
Parkinson’s Disease
• Characteristics
– Slow walking
– Difficulty getting into or out of chairs
– Slow hand tremors
– “ratcheting”
• Celebrities with Parkinson’s
– Muhammad Ali
– Michael J. Fox
• Treatment
– Levodopa: raises the levels of dopamine in the brain
– Sinemet: a combination of levodopa and carbidopa
– Stalevo: combination of Sinemet and entacapone

27. Dementia, Depression, & Delirium
Other Forms of Dementia
Huntington's Disease
• Involuntary flicking movement of the arms and legs
• Hallucinations, paranoia, depression, and clear personality changes
Alcohol Related Dementia
• Wernicke – Koraskoff’s syndrome
AIDS Dementia Complex (ADC)
• Encephalitis, behavioral changes, decline in cognitive function
• Progressive slowing of motor functions

28. Other Mental Disorders and Concerns
Learning Objectives
• What are the symptoms of anxiety disorders?
How are they treated?
• What are the characteristics of people with
psychotic disorders?
• What are the major issues involved with
substance abuse?

29. Other Mental Disorders
Anxiety Disorders
Treating Anxiety Disorders
• Medication
– Benzodiazepine (Valium and Librium)
– SSRIs (Prozac, Paxil, and others)
– Buspirone and beta-blockers
• Psychotherapy
– Relaxation training
– Substituting rational for irrational thought
– Gradual exposure to images or situations that generate anxiety

30. Other Mental Disorders
Schizophrenia
What is Schizophrenia?
• Onset occurs most often between ages 16 and 30
• Severe impairment of thought processes to include:
– Distorted perceptions (delusions)
– Loss of touch with reality
– A distorted sense of self
– Abnormal motor behavior
Treating Schizophrenia
• Anti psychotic medications
• Therapy to learn symptom management & coping skills
• Likely to have depression or anxiety as well

31. Other Mental Disorders
Substance Abuse
Elderly person’s drug of choice is alcohol
Alcoholism includes four symptoms:
• Craving
• Impaired control
• Physical dependence
• Tolerance
Alcohol dependency drops significantly with age
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

32. Alcohol Dependence by Age

33. QUESTIONS ?

34. Mental Health / Geriatric Report
1. Must be 3-4 (stapled pages) using 12 pt font
2. Must be in APA format
3. Must be original work in your own words unless data is
considered common knowledge or you provide the reference. If
you plagiarize (copy, lift, steal, use illegally), you will get an “F”.
4. Must have Title Page to include:
• Topic / Title
• Your name
• Your Student Number
• Date
5. Must include Reference Page to include at least 4 references
6. Topic must chosen from the list provided or approved by
instructor by 10/13/10
7. Due October 27, 2010 during class

35. Mental Health / Geriatric Report
Approved Topics for Report
• Nursing Homes Facilities (Alabama)
• Assisted Living Facilities (Alabama)
• Specialty Care Assisted Living Facilities (Alabama)
• Depression in the elderly
• Alcohol Abuse in the elderly
• Schizophrenia (include geriatric specific information)
• Bipolar Disorder (include geriatric specific information)
• Major Depression
• Obsessive-Compulsive Disorder (include geriatric specific information)

36. True / False
• TRUE Mentally healthy people have positive
attitudes, accurate perceptions, autonomy, and
personal balance.
• TRUE A good assessment would include medical,
psychosocial, and social functioning.
• FALSE The “Big Three” are Dementia, Depression,
and Decubitus .
• TRUE Depression is the most common mental
disorder in adults, but declines in frequency with
age.
• TRUE Dementia is a family of disorders.

37. True / False
• TRUE Alzheimer’s Disease is progressive and fatal.
• TRUE Major changes with dementia include memory
loss, emotional changes, and loss of motor function.
• FALSE The recommended treatment for Parkinson’s
Disease is Electroconvulsive Therapy (ECT)
• FALSE Anxiety Disorder symptoms may include chest
discomfort, sweating, difficulty breathing, and acute
memory loss.
• TRUE People with early-onset Schizophrenia often
improve over time as neurotransmitters become more
balanced.