Gerontology (Fach) / Chapter11 (Lektion)

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• What is the difference between Mental Health and Psychopathology? 1) Mental Health describes either a level of cognitive and emotional well being or an absense of mental disorder. 2) Psychopathology is the study of mental illness, mental distress and maladaptive/ abnormal behavior. In sum, mental health service is everything that could help you with your mental health and you can also make use of a mental health service without having a psychiatric disorder. For instance, going to the therapist or going to a councelor after your husband has died is also a mental health service.
• Which disorders are mentioned in chapter 11 ??? DSM Axis I disorders. A number of mental disorders listed on Axis I have been diagnosed in adults of all ages but some of them are of greatest concern for the older age group 1) Depression 2) Anxiety Disorders 3) Hypochondrias 4) Paranoid Disorders 5) Alcoholism 6) Delirium 7) Dementia  
• Is the onset of these disorders really actually in old adulthood or has the disorder been there throughout young adulthood ? It varies depending on which disorder we are  talking about Depression: It varies.   Anxiety Disorders: Only 3% of anxiety disorders develop in old adulthood. Hypochondriasis: It is difficult to determine whether hypochondriasis reflects a longstanding personality dimension. However, the chapter mentions some hypotheses why older adults may take up the role of a Hypochondria. Paranoid Disorders: Some types related to Paranoid Disorders rather occur at other ages. For instance, the tough version paranoid schizophrenia or paranoid personality disorder. Onset of paranoia in old adulthood may often because of sensory and cognitive impairment as well as a defence against social isolation. Alcoholism: It varies. However, there is a gender difference in age of onset. Mens problems with alcohol are more longstanding whereas women may only turn to alcohol later in life.     Delirium: Dementia: Start in old adulthood    
• Sundown Syndrome Appearance or exacerbation (Verschlimmerung) of symptoms of confusion or agitation associated with the late afternoon, evening or nighttime hours - namely, after sunset !
• Whichone is one of the most common forms of disorder ? Depression
• Whichone is one of the most common forms of disorder ? Depression
• What are the Therapeutic Intervention mentioned in the chapter ? Environmental Design Sensory Retraining Therapy Behavior Therapy Reality Orientation Reminiscence Therapy Pet Therapy Supportive Therapy Insight-Oriented Therapy Psychodynamic Therapy Cognitive- Behavioral Therapy  
• What is Reminiscence Therapy ? Encourages older adults to think and talk about the past. They are encouraged to reevaluate and integrate their life experiences in order to alleviate feelings of depression and sadness and give them a sense of continuity and self worth. However, it is not suitable for older people who use the past to avoid thinking about present problems.
• What is said about using Reality Orientation and Reminiscence Therapy together ? Combining these two forms of therapy has a better effect than using each one individually
• How does Reality Orientation (RO) Therapy work ? The therapeutic approach intails that patients are reminded of the here and now.
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• Are the prevalence rates of older or younger adults higher ??? The proportion of the population that meets the criteria for mental disorders does not vary greatly with age.
• What is the prevalence of mental disorders among older adults ? Estimates lie between 18 % and 28 %. It is 22% when we count those older people with emotional dysfunction and cognitive impairments living in the community or being in hospital.
• Why is it difficult to compare the results from cross sectional studies on the proportion of older adults with mental disorders ?? The DSM was changes quite a few times. Therefore, diagnosis were made based on different criteria and are not really comparable.
• What are the emotional, body and cognitive symptoms of depression ? Psychological Symptoms: Sadness, Emptiness, Irritability, Withdrawl from interest, decreased feelings of pleasure, pessimissm, diminuished self-esteem, guilt, worthlessness, hopelessness, helplessness.     Bodily symptoms: Fatigue, loss of energy, sleep disturbance, bowel disturbance, weight changes,   Cognitive difficulties: Attention problems, Concentration, Memory, Slowing of speech, thought and decision making.  
• What are the two types of depressive disorder ? Major depressive disorder and milder depressive disorder.
• What does primary depression and secondary depression mean ? Primary depression occurs in the absense of physical disorders or drug side effects whereas secondary depression is a result of that.
• In older people bipolar disorder with very crazy manic- depressive mood swings is common. True or false ? F A L S E
• To which disorder does the Diathesis- Stress Model belong ?? Depression.
• What does diathesis means in german ? Neigung des Körpers zu einer bestimmten Krankheit oder zu einem bestimmten Symptom.
• What does Diathesis mean ? The individuals level of vulnerability.
• The prevelence numbers of depression given in the chapter are a bit akward. What do they say ??? When we look at the numbers of community living depressed people according to the DSM classification, it seems to be a small percentage. In fact, it seems that there is less depression in old people than in younger adults.   However, when we only pay attention to the occurence of some symptoms, then the picture looks different because 27 % of older adults report some symptoms.   Another study has estimated that 15% of community living people are depressed and 25 % of nursing home residents   Using the Epidemiological Studies Depression Scale, researchers found that  depression declines from older adulthood to late middle age but increases after the age of 75.  
• What are the risk factors for depression? Being woman Physical decline + medication is a greater risk for secondary depression Stressful life events / Loss of any kind Being a sole caregiver of a chronically ill family member Cerebrovascular Factors
• What can be said about the Diagnosis of depression ??? Since depression consists of various different aspects it is sometimes a bit tricky to diagnose. For that reason, depression may be overdiagnosed, underdiagnosed or mixed up with something else.  
• Depression in older adults can be overdiagnosed or underdiagnosed. Sometimes if depression is merely based on some physical symptoms it can be overdiagnosed. There is one scale that tries to avoid that problem. What is the name of that scale ? Geriatric Depression Screening scale
• Why is "differential diagnosis" mentioned in the chapter ??? Differential diagnosis means that the exact basis for a particular constellation of symptoms. In the chapter it says that a lot of physical as well as cognitive impairments that older adults may show anyway can lead to an overdiagnosis or underdiagnosis of depression.
• Which treatment possibilities are there for older adults ? Drug Therapy Electroconvulsive Therapy Psychological Therapies CBT
• What can be said with regard to suicide ?? Often related to mental disorders and particularly to severe depression Direct suicide is : fire arms + poison Less direct methods: Refusial to eat, take medicine, Older adults who make suicide attempts are more likely to get done with it than younger people. Older adults who do commit suicide were probably suffering from depression that was untreated or unrecognized Womens lower rate of suicide could be the result from more social relationships Gender Paradox of Suicide
• Dementia Is a syndrome of global cognitive decline that typically occurs for the first time in older adulthood.
• What are the numbers related to dementia ??? [65+]=    6 % to 8 % [85+]= 25 % to 30%
• What are the deficits that people with dementia have ? Memory, Language, Orientation, Abstract Thinking and reasoning, decision making, problem solving. Unlike in delirium, people maintain a normal level of consciousness until the late stage of the disorder.
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• How many types of dementia are there ? Dementia itself is a really big word . Herr Brouwer macht da die Unterscheidung zwischen 1) Cortical dementia 2) Subcortical dementia
• What is the difference between delirium and dementia ? As opposed to delirium, dementia is not temporary !
• Which two tests are mentioned in the chapter, whichone is the short one and which the long one ??? Mini- Mental State Examination (MMSE) -> longer 8-15 minuten     Mental Status Questionaire (MSQ) -> Short  
• What is the name of the test that is often used to assess dementia ? Orientation Questions Registration + Recall ( of 3 words) Attention + Calculation Spatial Ability Language ability   -> Lasts 8-15 Minutes
• According to the chapter, what are the two most common forms of dementia ? And which other third form was mentioned in the lecture ? Alzheimers disease Vascular Dementia Frontotemporal Dementia
• What does it mean that Alzheimers disease is made on a diagnosis by exclusion ? p.346 autopsy
• What are the signs of delirium ? Difficulty focussing attention (Especially with substained attention- to keep their attention focussed) Sudden onset Confusion Disorganized Thinking Incoherent Speech Altered level of consciousness Halluzinations Wake- Sleep circle is disturbed disorientation Memory impairment

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