Mental health and Aging Vineeth - PowerPoint Presentation

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Mental health and Aging Vineeth - PPT Presentation

John MD MBA Case of a new onset Bipolar Disorder A 60yearold righthanded previously successful and psychiatrically healthy businessman was brought by his family to a university hospital neuropsychiatry service for consultation regarding behavioral and personality changes ID: 933862

onset depression medical dementia depression onset dementia medical late schizophrenia symptoms psychotic disorder disorders risk disease social delirium common

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Slide1

Mental health and Aging

Vineeth

John MD MBA

Slide2

Case of a new onset Bipolar Disorder

A 60-year-old, right-handed, previously successful and psychiatrically healthy businessman was brought by his family to a university hospital neuropsychiatry service for consultation regarding behavioral and personality changes.

When he was age 55 years, his customarily excellent financial and social judgment began to decline. Over the next 4 years, his attention to personal hygiene deteriorated, his business decisions became financially and ethically unsound, his range of social interests narrowed dramatically, and he developed an insatiable "sweet tooth."

One month before the neuropsychiatric consultation, he had received a diagnosis of late-onset bipolar disorder and had begun treatment with lithium carbonate. When his serum lithium level reached the therapeutic range, his cognitive, behavioral, and motor function declined precipitously, prompting the consultation for a second diagnostic opinion. Is this patient’s presentation consistent with late-onset bipolar disorder? What assessments are needed to clarify his diagnosis

Slide3

Case of a new onset Bipolar Disorder

In the year preceding the consultation, his ability to maintain sleep diminished, he began spending money recklessly and impulsively and became unable to appreciate the feelings and concerns of others, and his speech and behavior took on a

perseverative

quality. Concurrently, he developed unprovoked, brief, frequent, and excessively intense episodes of tearfulness and laughing. These episodes lasted minutes at most, after which he would return to his usual

euthymic

emotional state.

Slide4

Case of a new onset Bipolar Disorder

Slide5

Slide6

Late onset psychosis

Psychosis of Alzheimer's disease

Late onset Schizophrenia

Late life delusional disorder

Psychotic disorders secondary to General Medical Conditions

Slide7

Psychosis in AD

Increased risk of agitation

Increase in aggression

Poor self care

Disruptive behavior

Wandering

High rate of institutionalization

Slide8

Psychosis in AD

Between 30 to 50 % of AD patients have psychotic symptoms

Psychotic symptoms are more prevalent as the disease progresses but are more common in the middle stages.

Visual hallucinations are more common than auditory hallucinations.

Slide9

Common themes of delusions in AD

Stealing

Stranger in the house

Spying

Impersonating the spouse or loved one

Slide10

Psychosis in other dementias

Dementia of

Lewy

bodies -VH and Delusions

Parkinson's Disease - Delusions and hallucinations

Vascular Dementia

Slide11

Treatment of Psychotic Symptoms in Dementia

Low dose antipsychotics are the norm.

Careful balancing of the risks and benefits need to be performed.

Slide12

Delusions in Dementia

Hallucinations in Dementia

Agitation in Dementia

Depressed Mood in Dementia

Devanand

et al. Archives of General Psychiatry 1997;54(3) 257-63

Slide13

Agitation in Dementia

Treat reversible causes of agitation-UTI, medications, alterations in renal functions, pain and discomfort

Behavioral Interventions

Antipsychotic medications

Anticonvulsants

Acetyl Cholinesterase Inhibitors/

Memantine

SSRIs and antidepressant therapy

Slide14

Factors affecting Psychosocial interventions

Individual biography

Individual’s personality

Coexisting physical and mental health problems

Person’s social relationships

Physical environment in which the person is living

Community and cultural understandings of tolerance for confusion and frailty

Extent and location of the disease

Slide15

Psychotherapeutic Interventions

Behavior management training

Caregiver training

Scheduled toileting

Reminiscence therapy

Validation therapy

Supportive therapy

Reality orientation

Art therapy

Slide16

Slide17

Slide18

Late onset Schizophrenia

Schizophrenia is characterized by it's onset in youth and subsequent deterioration of functionality.

Schizophrenia after 45 years of age was considered late onset by APA DSM III R, 1987. International consensus panel chose 40 years as the cut off point.

No such distinction is elaborated in DSM IV TR version.

Slide19

What are the distinct features of late onset schizophrenia

Lack of negative symptoms

Lack of thought disorder

More paranoid schizophrenia subtype

Presence of the features of

neurodegeneration

–CVAs.