GEY4612_M6_mental_health

GEY4612

Mental Health

Adults and Mental Health

Where does one end and the other begin?

Good Mental Health

Mental Illness

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

Defining Mental Health

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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Life-Span Approach

• 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

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Sociocultrual Forces & Life-Cycle Factors

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Biological & Psychological Forces

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Ethnicity and Gender

• 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

Mental Health in Adulthood

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Depression

• 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

Myth: Most older adults are depressed

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

Depression Symptoms

• 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

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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

What Causes Depression?

Cognitive-Behavioral

Biological

Psychosical

• Interpretation of uncontrollable events; causes feelings of helplessness and hopelessness

• Genetics, brain changes, imbalance in neurotransmitters
• Low levels of serotonin, norepinephrine, BDNF

• Psychological effects of different types of losses

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Psychotherapy

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Antidepressants

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Behavior Therapy

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Cognitive Behavior Therapy

Depression Treatment

Categorize the event

Evaluate the event

Changes in situation may change your appraisal

Types of Treatments

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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

Age and Treatment

• 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

Anxiety Disorders

• 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

• 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 majornegative life events and health

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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

Other Mood Disorders

• 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

• 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

Other Mood Disorders

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

• 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

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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