Transcript Psychology 3533 Understanding Human Sexuality

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
ADULT PSYCHOPATHOLOGY (Cont’d)
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.
ADULT PSYCHOPATHOLOGY (Cont’d)
Important personal variables:
• past history
• personality
• social supports
• SES
• locus of control (women, poor and elderly
more external)
• longevity (higher incidence)
ADULT PSYCHOPATHOLOGY (Cont’d)
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.
ADULT PSYCHOPATHOLOGY (Cont’d)
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.
ADULT PSYCHOPATHOLOGY (Cont’d)
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
ADULT PSYCHOPATHOLOGY (Cont’d)
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
ADULT PSYCHOPATHOLOGY (Cont’d)
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
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
• diabetes
• heart attack
• thyroid dysfunction
• malnutrition
• liver dysfunction
• trauma
• drugs
• tumors
• alcohol (Korsakoff
syndrome)
• infections
• surgery (anesthesia)
• electrolite imbalance
Some symptoms:
• agitation
• confusion
• changes in sensation and
• disorganized thinking
perception
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:
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Hallucinations:
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thought disorders, belief system
sensory perceptions not based on actual, real stimuli
Inappropriate Affect
• Managed with drugs
Depression:
Very high incidence all ages. Two types:
1. Unipolar: depression only, more common in
older adults.
2. Bipolar: alternating depression and mania, also
called manic-depression. More common in the
young.
Depression can also be:
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Reactive: acute, short duration, due to events,
responds to psychotherapy alone, support.
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Chronic: long term, resistant to psychotherapy,
often need physical therapies, e.g. drugs, ECT.
Drugs:
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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.
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Side effects of drugs leads to low
compliance. Also danger of drug
interactions (potentiate or decrease
effect when combined with other drugs)
often dangerous.
ECT:
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electroconvulsive therapy, “shock”,
memory deficits, brain damage possible.
Nobody knows how it works.
Psychoactive drugs for the elderly:
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Elderly need lower doses!!
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More problematic, as dosages have to
be more carefully adjusted, usually
downward. Also problem of interaction
with other drugs taken for other
problems. Polypharmacy.
Some Signs of Depression:
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dysphoria
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insomnia
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fatigue
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inability to enjoy things that were liked
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changes in appetite
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crying jags
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despair
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apathy
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pessimism
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differences between young and old: young
may cover it up better
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impaired daily functioning
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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:
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CV disease
brain disorders (Parkinson’s, MS,
dementias, etc.)
metabolic disturbances (e.g. diabetes,
thyroid)
cancer
post-operatory period
many drugs can cause depression and
suicide
Gender Issues:
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Gender: women socialized to self-blame,
more prone.
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Age: depletion syndrome of the elderly,
somewhat similar to depression. It
increases with age, depression proper
decreases.
Role of marital status:
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Before age 65: higher incidence for
single men and married women.
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After age 65: reverse
Gender Issues (Cont’d):
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Marriage improves men’s mental health. It
negatively affects women’s mental health. This
is reversed after age 65.
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Men more likely to show:
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‘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.
Gender Issues (Cont’d):
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Women more likely to show:
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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.
Psychotherapy for the elderly:
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Not common. Most therapists not trained
to deal with problems of the elderly.
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Higher tolerance for deviant behaviour.
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Therapists more interested in YAVIS:
(young, attractive, verbal, intelligent,
successful)
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Expense (private or public)
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Many elderly suspicious or reluctant
Organic Brain Disorders:
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Alzheimer’s
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Multi-infarct dementia
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Huntington’s chorea
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Parkinson's
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Lewy body dementia
Alzheimer’s Disease:
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Chronic, irreversible, degenerative
disease of brain.
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No known cause, some genetic markers
– iffy
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Type of dementia – brain syndrome
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Parts of brain involved:
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amygdala (emotions)
hippocampus (memory)
cerebral cortex (reason, judgment)
Alzheimer’s – Histological Changes
1. Amyloid plaques: clusters of protein bits
that accumulate, causing inflammation
and damaging neurons.
2. Neurofibrillary tangles: dendrites change
structure and disintegrate, leading the
neuron to wither and die.
Alzheimer’s
Affects
Amygdala
Hippocampus
Cortex
Personality
Appetites
Energy
Drives
ex: Irritable
Fussy
Memory
Works Backwards
Reasoning
Judgment
Decisions
Chronic, Irreversible
Death
Usual Cause: Pneumonia
8 mo. – 20 years
4 Phases:
1. Early Changes:
Irritability
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“Something Wrong”
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Memory
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Cover-Ups & Compensations
Hard to Assess
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Retrospective
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4 Phases (Cont’d):
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Memory Worse
Paranoia
Odd, Inappropriate Social Behavior
Needs Help (eg. banking, bills)
Personality Change
3.
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Unsafe to Leave Alone
Poor Concentration
Memory Gone
4.
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Terminal
No Coordination
Swallowing difficult or impossible
Agitation
Bed Ridden
Usual Course
Functionality
Time
Assessment methods:
1. Clinical interview (most common)
2. Self-report (reliability and validity?) e.g.
questionnaire
3. Other’s report (relatives, neighbours)
4. Psychophysiological (psychological
stimulus, physiological response) e.g.
fearful stimulus-situation and EEG or
heart rate
Assessment methods:
5. Direct observation in situ (e.g. nursing
home dining room)
6. Performance test (e.g. remembering list,
drawing a picture after looking at it for 10
seconds)
Critical areas:
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cognitive functioning
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social cognition
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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
Alzheimer’s (age 30-60)
Increased evidence of some prevention
factors:
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exercise
folate
low cholesterol
low blood pressure
MCI:
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mild cognitive impairment, different from
Alzheimer’s and different from normal agerelated memory decline.
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Drugs may prevent progression to Alzheimer’s
Multi-Infarct or Vascular Dementia:
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Reduced blood flow to brain areas, due
to either an arterial blockage (+85%) or a
hemorrhage (+15%)
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Either ‘regular’ stroke or ‘mini’ stroke.
The latter can go undetected, very brief
symptoms: transient ischemic attack
(episode) TIA
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E.g. brief fainting, acute brief headache
Huntington’s Chorea:
Autosomal disorder, dominant gene. Test
available. Expresses between ages 35 and
50. Physical and mental manifestations (see
text)
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involuntary movements of limbs
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difficulty with voluntary movement
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hallucinations
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paranoia
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mood swings
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eventually unable to care for self
Parkinson’s disease:
Characteristic: involuntary movements,
cannot control but also cannot move some
voluntary movements, rigidity.
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hallucinations
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paranoia
L-dopa (medication)
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depression
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mood swings
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eventually, cognitive decline
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genetic test available
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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:
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abnormal brain structures
progressive loss of memory, language,
reasoning
faster progression than Alzheimer’s
more ups and downs than Alzheimer’s in
early stages
psychotic symptoms as illness progresses
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