CHAPTER TENCHAPTER TENClinical Assessment, Mental Health, and

Mental Disorders

Defining Mental Health– Characteristics of mentally healthy people:• Positive attitude toward self• Accurate perception of reality• Mastery of the environment• Autonomy• Personal balance • Growth and self-actualization

• When characteristics of mentally healthy people are absent, mental disorder becomes more likely

Defining Mental Health• Characteristics of

mental disorder include behaviors that• are harmful to oneself or

others• lower one’s well-being• are perceived as

distressing, disruptive, abnormal, or maladaptive

Defining Psychopathology– Biological forces

• Chronic disease, functional impairment, and other ailments can change behavior (e.g. memory loss from vitamin deficiencies, appetite loss from depression)

– Psychological forces• Normative changes can

mimic mental disorders (e.g. memory loss from stress)

Defining Psychopathology– Sociocultural forces

• Being paranoid may be adaptive in certain circumstances.

• Cultural differences must be taken into account.

– Life-Cycle Factors• Resistance to revealing personal

information might reflect upbringing rather than paranoia

• Sleeping patterns change with age; a decrease is part of normative aging and does not necessarily indicate depression or anxiety

Ethnicity, Aging, and Mental Health

• Sociocultural influence in assessing behavior– Older minorities may

have experienced:• Inadequate health

care• Environmental health

risks• Stress of prejudice and

discrimination

Ethnicity, Aging, and Mental Health

– Ethnic differences found:• Older Hispanic men

show higher rate of alcohol abuse than women.

• Older Hispanic women show higher rates of phobias and panic attacks than men.

Ethnicity, Aging, and Mental Health

– Ethnic differences found:• Native American men also have high rates of alcohol

abuse.• Older African-American men have lower rates of

depression than other ethnic groups.

Areas of Multidimensional Assessment• 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

Factors Influencing Assessment• Negative biases– Racial– Ethnic– Age stereotypes

• Positive biases– Women do not abuse alcohol.– Old people are not sexually active

Assessment and Therapy

• Mental status exams– Useful as a

quick screening of measures of mental competence• Mini-Mental

Status Exam (MMSE)

The Big 3

• Depression• Delirium• Dementia

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 adults living in the community show signs of depression.

– Cohort effect: most recent born have highest rates of depression.

Depression

• Depression: General Symptoms and Characteristics• Dysphoria—feeling “down” or “blue”• Accompanying physical symptoms

• Insomnia• Changes in appetite• Diffused pain• Trouble breathing• Headaches• Fatigue• Sensory loss

• Symptoms must last at least two weeks for clinical diagnosis• Other causes must be ruled out.• 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.

Causes of Depression–Sudden severe loss–Long-term, high-level stress• Research evidence of severe

depression links to neurotransmitter imbalance.– Serotonin– Norepinephrine

Treatment of Depression– Antidepressant medication– Electroconvulsive therapy– Psychotherapy • Behavior therapy attempts to alter current behavior

without necessarily addressing the underlying causes• Cognitive therapy attempts to alter the ways people

think

DeliriumDelirium is characterized by a

disturbance of consciousness and a change in cognition that develop over a short period of time

• Caused by:– Medical conditions

• Stroke• Cardiovascular disease• Metabolic condition

– Medication side effects, substance intoxication or withdrawal, exposure to toxins, or a combination

AlcoholismSubstance Abuse (e.g. alcoholism) involves– Craving– Impaired control– Physical dependence – Tolerance

• Elderly person’s drug of choice is alcohol.• Alcohol dependency drops significantly with age

Alcoholism/Substance Abuse• 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

Dementia• Dementia is characterized by cognitive and

behavioral deficits involving some sort of permanent damage to the brain.

• About one half of all people over the age of 85 are affected with some form of dementia.

• Many forms of dementia have been identified

Dementias• Vascular Dementia– Numerous small cerebral vascular accidents (strokes)

Dementias• Parkinson’s Disease– Characteristics• Slow walking• Difficulty getting into

or out of chairs• Slow hand tremors

– Drug treatments available (e.g. Levodopa raises the levels of dopamine in the brain)

Dementias

• Huntington's Disease– Involuntary flicking

movement of the arms and legs

– Hallucinations– Paranoia– Depression– Personality changes

Dementias• Alcohol Related

Dementia (Wernicke- Koraskoff’s syndrome)– Caused by a thiamine

deficiency– Symptoms include

weight loss, neurological problems, muscle weakness

Dementias

• AIDS Dementia Complex or ADC– Encephalitis, behavioral

changes, decline in cognitive function

– Progressive slowing of motor functions

Dementias• Alzheimer’s disease– The most common form of progressive,

degenerative, fatal dementia– Characterized by beta-amyloid deposits (plaques)

and death of brain cells

Alzheimer’s Disease• Symptoms and Diagnosis– Gradual changes in cognitive function including declines in:• memory• learning abilities• attention• judgment• word finding• communication• personal hygiene• self-care skills• orientation to time and space

– Inappropriate social behavior– Changes in personality

– Sundowning: symptoms are worse in the evening

Alzheimer’s Disease Treatment• Memory improvement drugs (e.g. Tacrine

“Cognex”, Donepezil “Aricept”)• Effective Behavioral Strategies– Rethink issues such a bathing, dressing, grooming– Strategies to prevent wandering – Incontinence– Remove items than may be harmful and jewelry that

might become lost

Alzheimer’s Disease Treatment• 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.