Psychological

Disorders
in
Psychological Disorders in
Late
LateLife
Life

By:Seemab
SeemabZahra
Zahra
By:

Prevalence:
How common are Psychological Disorders in
Late Life?

Current estimates indicate that person over 65 have the

lowest overall prevalence of mental disorders of all age
groups.
Prevalence rate for alcohol abuse or dependence rates are
less than 2%.
Even rates for depression and anxiety appear lower than in
younger population.
Most people 65 years of age and older are free from serious
psychopathology.

Medical Issues in Diagnosing

Psychological Disorders
Medical conditions are more common in elderly it is particular to rule
out the explanations for diagnosis
Medical problems such as thyroid problems, Addisons disease,
Cushings

disease,

hypoglycemia,

Parkinsons

anemia,

and

disease,

vitamin

Alzheimers

deficiencies

can

disease,
produce

symptoms that mimic schizophrenia,depression, or anxiety (Marengo

& Westermeyer, 1996).
Angina, congestive heart failure,and excessive caffeine consumption
may all cause a faster heart rate, which can be mistaken as a
symptom of anxiety (Fisher & Noll, 1996)

Contd
Contd
Age-related

deterioration

in

the

vestibular

system(inner-ear control of ones sense of balance)

can account for panic symptoms such as severe
dizziness(Raj, Corvea, & Dagon, 1993)
Antihypertensive

corticosteroids,

medication,
and

antiparkinsonism

hormones,
medications

may contribute to depression or anxiety (Spar &

LaRue, 1990).

Major

Researchers

Depressive
initially

Disorder:

believed that symptoms of

depression differed in late
life, but researchers have
identified

only

consistent

one

difference

cognitive symptoms (such

as

memory

confusion)

deficits
appear

pronounced

and
more
when

depression emerges in late

life

compared

adulthood.

to

earlier

Although depression is less

common among older adults
than younger ones, it accounts
for a very large proportion of
the
psychiatric
hospital
admissions among the aged.
(David Young-Wolff/PhotoEdit.)

Depression
Depression vs.
vs. Dementia
Dementia
The frequent presence of cognitive symptoms in late life
depression can make it hard to differentiate whether
memory problem is due to dementia or depression
Indeed, depression in older adults is often misdiagnosed
as

dementia

because

of

the

severe

cognitive

impairment.
Of

course,

people

can

have

both

dementia

and

depression. Cognitive difficulties in late life do predict

increases in depression over time (Vinkers et al., 2004).

Is it Depression or
Dementia?

Symptoms of
Depression

Symptoms of
Dementia

Mental decline is relatively rapid

Mental decline happens slowly

Knows the correct time, date, and

where he or she is

Confused and disoriented;

becomes lost in familiar locations

Difficulty concentrating

Difficulty with short-term memory

Difficulty concentrating

Writing, speaking, and motor

skills are impaired

Notices or worries about memory

problems

Doesnt notice memory problems

or seem to care

DSM-IV DIAGNOSTIC
CRITERIA
5 or more symptoms lasting >2 wk, change from
5 or more symptoms lasting >2 wk, change from
previous functioning:
previous functioning:
Depressed mood and/or loss of interest
Depressed mood and/or loss of interest
Altered sleep, loss of energy, appetite change or
Altered sleep, loss of energy, appetite change or
weight
loss,
feelings
of
weight
loss,
feelings
of
worthlessness/guilt,psychomotor changes, loss of
worthlessness/guilt,psychomotor changes, loss of
concentration and focus, recurrent thoughts of
concentration and focus, recurrent thoughts of
death
death

Etiology of Depression in Older Adults

As you grow older, you face significant life changes that can put
you at risk for depression. Causes and risk factors that contribute
to depression in older adults and the elderly include:

Health problems Illness and disability; chronic or severe pain;

cognitive decline; damage to body image due to surgery or
disease.

Loneliness and isolation Living alone; a dwindling social circle

due to deaths or relocation; decreased mobility due to illness or
loss of driving privileges.

Reduced sense of purpose Feelings of purposelessness or loss

of identity due to retirement or physical limitations on activities.

Fears Fear of death or dying; anxiety over financial problems or

Treatment of depression
There are several treatment options available for
depression.
They include :
Anti-depressant medication
Psychotherapy
Electroconvulsive therapy
Sometimes, a combination of these treatments
may be

Anti-Depressant
Anti-Depressant
Medication
Medication

Four groups of antidepressant medications have been used to

effectively treat depressive illness:

selective serotonin re-uptake inhibitors (SSRIs) and norepinephrine

and serotonin reuptake inhibitors (NSRIs),
and less commonly, tricyclics, monoamine oxidase inhibitors (MAOIs),
Medication adherence is especially important, but can present
challenges among forgetful individuals. It is important to note that all
medicines have side effects as well as benefits., and the selection of
the best treatment is often made based on tolerability of the side
effects.

Psychothera
Psychothera
py
py

Most depressed people find that support from family and friends,
involvement in self-help and support groups, and psychotherapy are
helpful.
Psychotherapy is especially beneficial for those who prefer not to take
medicine and who have mild to moderate symptoms. It also is helpful for
people who cannot take drugs because of side effects, interactions with
other medicines, or other medical illnesses.
Psychotherapy in older adults can address a broad range of functional and
social consequences of depression. Many doctors recommend the use of
psychotherapy in combination with antidepressant medicines.

Electroconvulsive
Electroconvulsivetherapy(ECT)
therapy(ECT)

ECT (also known as shock treatment) may

be very useful in the treatment of severe
depression in older adults.

For carefully selected people, ECT can be

a lifesaving intervention. For example, an
80 year old man who lives alone, has
been

depressed

for

months,

lost

60

pounds and has delusions about his body

as a kind of presentation that may
improve quickly with ECT.

ECT can impact memory so that is an

important consideration in comparing it to
other interventions.

Suicide
Suicide
Older

people

are

3x

more

likely

to

kill

themselves

than younger people

Depression

is

the

risk

factor.

Other

factors

include, physical illness, loss of loved ones, and dire financial

circumstances

Older

people

are

less

likely

to

communicate

their

intentions to commit suicide

One

treatment

program

to

reduce

depression

and suicidal rate among the elderly draws on the finding that
elderly people are more likely to visit primary care doctors than to
see specialty mental health providers