MENTAL ILLNESS

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MENTAL ILLNESS

• ADULT PSYCHOPATHOLOGY
• Definitions of mental health vs. illness vary
• culture great variability
• SES (a rich man is eccentric, a poor one is mad)
• age more acceptance of odd behaviours in the
  elderly
• gender different cultural expectations, less
  tolerance of deviance in women

2

• ADULT PSYCHOPATHOLOGY (Contd)
• Ideal vs. real mental health (e.g. text)
• Difference between stress and coping mechanisms,
  which can sometimes be maladaptive, and full
  blown mental illness.
• Change is always stressful, individual variation
  in optimal levels of stress.
• Summation of stresses as we age depletion of
  coping resources vs. development of better coping
  strategies.

3

• ADULT PSYCHOPATHOLOGY (Contd)
• Important personal variables
• past history
• personality
• social supports
• SES
• locus of control (women, poor and elderly more
  external)
• longevity (higher incidence)

4

• ADULT PSYCHOPATHOLOGY (Contd)
• Bottom line criterion for mental illness
• inability to function
• Importance of label, stigma
• Relative influence of nature vs. nurture
• (heredity/environment)
• the higher the genetic predisposition, the fewer
  environmental insults needed to produce mental
  illness.

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• ADULT PSYCHOPATHOLOGY (Contd)
• Most common model of mental illness
• medical model
• Medical model
• a series of culturally unacceptable behaviours is
  packaged into a diagnostic category.
• DSM
• no uniform, testable criteria.

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• ADULT PSYCHOPATHOLOGY (Contd)
• Each category has
• Symptoms (mix of behavioural and physical)
• Underlying cause (etiology)
• Treatment (can be just palliative or geared to
  eradicate the cause)
• Approaches
• biological
• psychological
• combination of both

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• ADULT PSYCHOPATHOLOGY (Contd)
• Biological approach
• organic causes (brain)
• treatment drugs, ECT, surgery
• Psychological approach
• causes stress, emotions, personality, childhood
  experiences, poor coping strategies
• treatment psychotherapy (rare for the elderly)
• Combination approach
• causes both organic and environmental
• treatment usually drugs and some level of
  psychotherapy

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• ADULT PSYCHOPATHOLOGY (Contd)
• Etiology of mental illness
• organic, e.g. Alzheimer's
• functional or psychic, e.g. phobias
• organic environment, e.g. most
• problems in living (Szasz)
• Treatments
• drugs
• ECT
• psychotherapies
• out vs. inpatient

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Brain disorders (delirium in text covers only
acute disorders) can be acute or chronic. Acute
rapid onset, reversible with treatment. Chronic
slow and gradual onset, degenerative,
irreversible. Acute Brain Disorders Many
possible causes

• stroke
• heart attack
• malnutrition
• trauma
• tumors
• infections
• electrolite imbalance

• diabetes
• thyroid dysfunction
• liver dysfunction
• drugs
• alcohol (Korsakoff syndrome)
• surgery (anesthesia)

• agitation
• changes in sensation and perception

• Some symptoms
• confusion
• disorganized thinking

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Unfortunately, the reversible illnesses are
treated as irreversible in the elderly, therefore
depriving them of a possible cure.

• Chronic Brain Disorders
• Schizophrenia
• onset between ages 13 and 30, chronic
• Delusions
• thought disorders, belief system
• Hallucinations
• sensory perceptions not based on actual, real
  stimuli
• Inappropriate Affect
• Managed with drugs

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• Depression
• Very high incidence all ages. Two types
• Unipolar depression only, more common in older
  adults.
• Bipolar alternating depression and mania, also
  called manic-depression. More common in the
  young.
• Depression can also be
• Reactive acute, short duration, due to events,
  responds to psychotherapy alone, support.
• Chronic long term, resistant to psychotherapy,
  often need physical therapies, e.g. drugs, ECT.

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• Drugs
• tricyclics, MAO inhibitors, lithium (for bipolar,
  very toxic to liver and kidneys, increases blood
  pressure), SSRIs selective serotonin reuptake
  inhibitors, e.g. Prozac, Zoloft, Paxil, etc.
• Side effects of drugs leads to low compliance.
  Also danger of drug interactions (potentiate or
  decrease effect when combined with other drugs)
  often dangerous.

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• ECT
• electroconvulsive therapy, shock, memory
  deficits, brain damage possible. Nobody knows how
  it works.
• Psychoactive drugs for the elderly
• Elderly need lower doses!!
• More problematic, as dosages have to be more
  carefully adjusted, usually downward. Also
  problem of interaction with other drugs taken for
  other problems. Polypharmacy.

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• Some Signs of Depression
• dysphoria
• insomnia
• fatigue
• inability to enjoy things that were liked
• changes in appetite
• crying jags
• despair
• apathy
• pessimism
• differences between young and old young may
  cover it up better
• impaired daily functioning
• negative thoughts, suicidal ideation

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• People with chronic illnesses very vulnerable to
  depression
• Some diseases of middle/old age can also cause
  depression
• CV disease
• brain disorders (Parkinsons, MS, dementias,
  etc.)
• metabolic disturbances (e.g. diabetes, thyroid)
• cancer
• post-operatory period
• many drugs can cause depression and suicide

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• Gender Issues
• Gender women socialized to self-blame, more
  prone.
• Age depletion syndrome of the elderly, somewhat
  similar to depression. It increases with age,
  depression proper decreases.
• Role of marital status
• Before age 65 higher incidence for single men
  and married women.
• After age 65 reverse

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• Gender Issues (Contd)
• Marriage improves mens mental health. It
  negatively affects womens mental health. This is
  reversed after age 65.
• Men more likely to show
• acting out
• alcoholism
• drug abuse
• criminal behaviour
• reluctance to seek help
• but, because of social male stereotypes, more
  tolerance for the above and less likely to be
  labelled and stigmatized.

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• Gender Issues (Contd)
• Women more likely to show
• anxiety
• depression
• self-blaming
• intense emotional expression
• Women more likely to acknowledge problems and
  seek help, and more likely to be labelled,
  stigmatized and given psychotropic medication.
  Influence of feminine stereotypes, powerlessness.

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• Psychotherapy for the elderly
• Not common. Most therapists not trained to deal
  with problems of the elderly.
• Higher tolerance for deviant behaviour.
• Therapists more interested in YAVIS (young,
  attractive, verbal, intelligent, successful)
• Expense (private or public)
• Many elderly suspicious or reluctant

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• Organic Brain Disorders
• Alzheimers
• Multi-infarct dementia
• Huntingtons chorea
• Parkinson's
• Lewy body dementia

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• Alzheimers Disease
• Chronic, irreversible, degenerative disease of
  brain.
• No known cause, some genetic markers iffy
• Type of dementia brain syndrome
• Parts of brain involved
• amygdala (emotions)
• hippocampus (memory)
• cerebral cortex (reason, judgment)

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• Alzheimers Histological Changes
• Amyloid plaques clusters of protein bits that
  accumulate, causing inflammation and damaging
  neurons.
• Neurofibrillary tangles dendrites change
  structure and disintegrate, leading the neuron to
  wither and die.

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Alzheimers Affects Amygdala Hippocampus Cortex
Personality Memory Reasoning Appetites Works
Back- Judgment Energy wards Decisions Drive
s ex Irritable Fussy Chronic,
Irreversible Death Usual Cause
Pneumonia 8 mo. 20 years
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• 4 Phases
• Early Changes
• Irritability
• Something Wrong
• Memory
• Cover-Ups Compensations
• Hard to Assess
• Retrospective

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• 4 Phases (Contd)
• 2.
• Memory Worse
• Paranoia
• Odd, Inappropriate Social Behavior
• Needs Help (eg. banking, bills)
• Personality Change
• 3.
• Unsafe to Leave Alone
• Poor Concentration
• Memory Gone
• 4.
• Terminal
• No Coordination
• Swallowing difficult or impossible
• Agitation
• Bed Ridden

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Usual Course
Functionality
Time
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• Assessment methods
• Clinical interview (most common)
• Self-report (reliability and validity?) e.g.
  questionnaire
• Others report (relatives, neighbours)
• Psychophysiological (psychological stimulus,
  physiological response) e.g. fearful
  stimulus-situation and EEG or heart rate

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• Assessment methods
• Direct observation in situ (e.g. nursing home
  dining room)
• Performance test (e.g. remembering list, drawing
  a picture after looking at it for 10 seconds)

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• Critical areas
• cognitive functioning
• social cognition
• personality
• Must be preceded by medical exam to rule
• out diseases or medication effects, and
• assessment of nutritional status.

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• Genetics important only in early onset of
  Alzheimers (age 30-60)
• Increased evidence of some prevention factors
• exercise
• folate
• low cholesterol
• low blood pressure
• MCI
• mild cognitive impairment, different from
  Alzheimers and different from normal age-related
  memory decline.
• Drugs may prevent progression to Alzheimers

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• Multi-Infarct or Vascular Dementia
• Reduced blood flow to brain areas, due to either
  an arterial blockage (85) or a hemorrhage
  (15)
• Either regular stroke or mini stroke. The
  latter can go undetected, very brief symptoms
  transient ischemic attack (episode) TIA
• E.g. brief fainting, acute brief headache

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• Huntingtons Chorea
• Autosomal disorder, dominant gene. Test
  available. Expresses between ages 35 and 50.
  Physical and mental manifestations (see text)
• involuntary movements of limbs
• difficulty with voluntary movement
• hallucinations
• paranoia
• mood swings
• eventually unable to care for self

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• Parkinsons disease
• Characteristic involuntary movements, cannot
  control but also cannot move some voluntary
  movements, rigidity.
• hallucinations
• paranoia
• depression
• mood swings
• eventually, cognitive decline
• genetic test available

L-dopa (medication)
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• Neurons in the substantia nigra in the midbrain
  do not produce enough dopamine, an important
  neurotransmitter.
• Initially physical symptoms only. Eventually, up
  to 40 develop dementia, could be due to the
  illness or to the drugs given. L-dopa, a
  synthetic dopamine, causes hallucinations and
  other psychotic symptoms at certain dosages.

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• Lewy Body Dementia
• abnormal brain structures
• progressive loss of memory, language, reasoning
• faster progression than Alzheimers
• more ups and downs than Alzheimers in early
  stages
• psychotic symptoms as illness progresses

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• Substance abuse
• In young adults, mostly by choice, though some by
  prescription medications.
• In middle-aged (particularly women) and old
  adults, by prescribed medications (tranquilizers,
  pain-killers, etc.)
• Very widespread in our society
• Males alcohol most common
• Females sedatives, hypnotics, psychotropic drugs
  most common