Week 5 Mental Health and Disorders (3012PSY) PDF

Week 5: Mental 3012PSY Health and Disorders Learning Outcomes 1. Understand the incidence of mental illness in older adults 2. Describe why mental illness is an important topic in ageing  Identify key groups of vulnerable older adults 3. Describe key ways ageing...

Week 5: Mental 3012PSY Health and Disorders Learning Outcomes 1. Understand the incidence of mental illness in older adults 2. Describe why mental illness is an important topic in ageing  Identify key groups of vulnerable older adults 3. Describe key ways ageing may interfere with diagnosis 4. Describe the aetiology, treatment, and outcomes of the 3 D’s  Have an in-depth understanding of the mechanisms, progression and outcomes of Alzheimer's disease  Be able to differentiate the 3 D’s 2 Definitions… What is mental health? What is a mental disorder? What is psychopathology?  Solmi, M., Radua, J., Olivola, M. et al. Age at onset of mental Solmi et al., (2022): disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Global onset of the first mental disorder occurs: Psychiatry 27, 281–295 (2022). https://doi.org/10.1038/s41380- Before age 14 in one-third of individuals (34.6%) 021-01161-7 At age I8 in almost half (48.4%) And before age 25 in over half (62.5%) With median age at onset of 18 across all mental disorders Median age of onset for specific disorders was: Separation anxiety & phobias, ASD, ADHD: 8-13 years Eating disorders, OCD: 17-22 years Schizophrenia, personality and alcohol use disorders: 25-27 years PTSD, GAD, depressive disorder, bipolar disorder: 30-35 years  Are older adults more or less menta lly health y than young Mini-Lecture 2: Mental 3012PSY Health & Older Adults  Mental Illness and Ageing 10–15% of older Australians in the community experience anxiety or depression 1 in 5 reported moderate levels of psychological distress 10% reported high or very high levels of psychological distress This is substantially higher for: Those in hospital Those with dementia Older adults who are carers Australian Institute of Health and Welfare 2015. Australia’s welfare 2015. Australia’s welfare series no. 12. Cat. no. AUS 189. Canberra: AIHW. https://www.aihw.gov.au/reports/older-people/older-australians/contents/health/ health-disability-status#Mental%20health  Mental Illness and Aged Care Risk factor - living in residential care In 2019, of those living in res aged care: 87% - diagnosed with at least one mental health or behavioural condition 49% had a diagnosis of depression https://www.aihw.gov.au/reports/older-people/older-australians/contents/ health/health-disability-status#Mental%20health  Mental Illness and Ageing Older adults with a mental illness tend to: 1. Have a lifetime of chronic or relapsing mental illness 2. Recent onset of mental illness as the result of a significant stressor Which means that mental illness in older age tends to be more chronic in nature https://www.aihw.gov.au/getmedia/0ec5c782-8ef0-4c4a-a7af- e25a3beb59d7/aw15-6-4-mental-health-of-older-australians.pdf.aspx https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in- australia/suicide-deaths-over-time  Normative changes can mimic mental disorders Clinical presentation may be different, making detection more difficult Depression Delirium Dementia  Depression Generally, less prevalent… 1. More likely in subgroups of older people 2. Less likely to be detected Summary of main symptoms (DSM-5-TR): 1. Depressed mood Major Depressive Disorder 2. Loss of interest or pleasure in activities 3. Significant weight loss or weight gain (or Diagnosis (DSM-5-TR): changes in appetite) Must have  5 or more symptoms 4. Slowed down thoughts and reductions in during a 2-week period movement 5. Fatigue or loss of energy At least one  1) depressed mood or 6. Feelings of worthlessness or excessive 2) loss of interest or pleasure guilt 7. Reduced concentration or indecisiveness 8. Recurrent suicidal ideation or a plan for suicide or a suicide attempt Causes Biological  Genetics  Neurotransmitters (serotonin, brain derived neurotrophic factor BDNF, norepinephrine) Psychosocial  Stress, loss and internal belief systems Treatment Medication – e.g., SSRIs - work to modify neurotransmitters in the brain Psychotherapy – e.g., CBT - modify one’s unhelpful thoughts and behaviour Used separately or in combination Depression and Suicide Depression is the leading trigger for suicide in older adults Often linked to – bereavement, and declines in physical health and independence (De Leo, 2022) An important problem – especially prevalent for older men Undiagnosed and untreated depression in the primary care setting plays a large role in suicide Contact with primary health care in the final month before end of life is common in older adults. Delirium Disturbance of consciousness that develops rapidly. The ability to focus is impaired and fluctuates 10-18% of older adults have delirium when admitted in hospital (Australian Commission on Safety and Quality in Healthcare) Confusion Assessment Method (CAM) 1. Acute onset and fluctuating course 2. Inattention 3. Disorganized thinking 4. Altered consciousness (hyperalert, lethargic, or stupor) Causes Medical Illness – stroke, CVD, metabolic, hypotension, urosepsis, pneumonia Pharmacological Medication side effects, changes in medication affects, interactions between medications Substance use Toxins Tends to be multiple factors Treatment Can be treated by targeting the cause – e.g., stopping certain medications. Can also be prevented. Potentially modifiable Non-modifiable risk risk factors factors  Sensory impairment (hearing  Dementia or cognitive or vision) impairment  Immobilisation (catheters or  Advancing age (>65 years) restraints)  History of delirium, stroke,  Medications neurological disease  Illness (e.g., infection, anemia,  Multiple comorbidities dehydration, poor nutrition, fracture or trauma)  Terminal illness  Surgery  Pain  Sustained sleep deprivation  Dementia  Affects more than 55 million people worldwide  Nearly 10 million new cases each year  60% of cases live in low-and middle-income countries  Dementia is a family of diseases characterised by cognitive and behavioural deficits involving permanent damage to the brain  Women are disproportionately affected by dementia https://www.who.int/news-room/fact-sheets/detail/ dementia  Dementia In 2023, 411k living with dementia in Aus Risk factor – age Dementia rates higher in older age groups In 2024 - estimated 29,000 people with younger onset dementia Dementia prevalence rates for First Nations people – approx. 3-5 times higher than rate for Australia overall Dementia is the second leading cause of death Alzheimer’s Symptoms – gradual changes in 10 areas: 1. Memory loss 2. Difficulty with everyday problems 3. Difficulty completing familiar tasks 4. Confusion with time and place 5. Difficulties understanding visual images 6. Problems with words 7. Misplacing things 8. Poor judgement 9. Withdrawal from usual activities 10. Changes in mood and personality  Alzheimer’s Disease Continuum https://www.alz.org/media/Documents/alzheimers-facts-and- figures.pdf Alzheimer’s Beginning stages: - Vague symptoms Symptoms become progressively worse - Emotional problems - Wandering - Sundowning  Advanced stages: - Loss of mobility - Incontinence  Alzheimer’s 1. Progressive 2. Degenerative – rapid cell death, tangles, neuritic plaques, inflammation in the brain. 3. Fatal Risk factors 1. Most evidence – age, genetics 2. Modifiable risk factors – physical activity, smoking, education, staying socially and mentally active, blood pressure and diet 3. Some evidence (evidence still growing) – sleep, air pollution, and critical illness in older adults Alzheimer’s Association. 2024 Alzheimer’s Disease Facts and Figures. Alzheimer's Dement Treatment  Firstly, have to identify:  Barriers to diagnosis from medical point of view  Negative attitudes  Fear  Deal with co-morbidities?  Epilepsy  Falls  Delirium  Frailty  Malnutrition  Dental disease  Visual impairment  Sleep disorders  Incontinence  Treatment There is no cure, but… Medications: 1. Used to slow disease progression 2. Temporarily reduce symptoms Behavioural strategies: 1. Memory – e.g., spaced retrieval 2. Changes in behaviour: identifying and modifying triggers of behaviour, avoid correction, slow and calm speech, regular routines, redirection, identify and respond to the emotion, allow rest breaks, and security objects. https://www.dementia.org.au/living-dementia/mood-and- behaviour-changes#what-you-can-do https://www.alz.org/alzheimers-dementia/treatments  CAREGIVING https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/carers-and- care-needs-of-people-with-dementia Caregiving Caregiving can take major physical, emotional, and financial costs – they are at high risk for depression Carer support and education is key for prevention Dementia  Vascular Dementia  Lewy Body Dementia  Parkinson’s Disease  Huntington's Disease  Alcohol-Related Dementia