Test Bank Mental Health Psychopathology and Therapy Ch.11

CHAPTER 11

MENTAL HEALTH, PSYCHOPATHOLOGY, AND THERAPY

CHAPTER SUMMARY

Chapter 11 is divided into three sections – mental health, psychopathology, and therapy in older adulthood. The first section points out that a high proportion of older adults report being happy and satisfied with their lives and the rate of mental disorders does not seem to be any higher in older adulthood than it is in young adulthood. However, it is important to recognize that some older adults do need mental health services, and a minority of older adults have diagnosable psychiatric disorders. Estimates on the rate of mental disorders in older adulthood vary, but the rate projected rate for the 21st century is higher than it has been for older adults in the past.

Some statistics are provided on the estimated proportion of older adults with mental health problems that warrant professional services, along with some possible explanations for why mental health resources fall short of their estimated need.

The second section of the chapter opens with a brief description of the Diagnostic and Statistical Manual (DSM-IV), which is used to classify mental disorders. This is followed by a description of the mental health problems most prevalent in the older adult age group.

Depression is not a part of normal aging, but among the most frequent emotional disorders. Depression is both underdiagnosed and overdiagnosed in the older population. The nature and prevalence of primary and secondary depression are discussed, as are the risk factors for depression in older adulthood. There is a discussion of the diathesis-stress model, which is one model for predicting the likelihood a particular individual will suffer from a mental disorder such as depression. Differential diagnosis of depression in older adulthood is not always clear-cut because the symptoms of depression can co-exist with age-related changes, physical illness, and dementia. Scales that screen for depression should be tailored to the older population and several types of therapy for depression are described. Treatment interventions include drug therapy (antidepressant medication), ECT, and psychological therapy, with cognitive-behavioral therapy showing particular promise. The act of suicide, the voluntary termination of one’s life, is a behavior rather than a mental disorder but often it is the end result of untreated depression. Older European American men are at the highest risk for completed suicide.

Compared to depression, anxiety disorders have received less attention in the older adult population but they often co-exist with depression. Often, anxiety disorders begin early in life, but a small percent have an onset in older adulthood. Based on studies of identical twins in the United States and other countries, researchers think that genetic factors play a role in symptoms of both anxiety and depression, but so do environmental influences. The symptoms of hypochondriasis, a somatoform disorder, can also overlap with depression. Paranoid disorders often entail faulty interpretation of events and suspicion and distrust of others when there is no realistic basis. In older adulthood, paranoid disorders are often associated with sensory impairment, but they can also be associated with depression, social isolation, or decline in cognitive functioning. Alcoholism is a substance abuse disorder more common in the older adult group than is readily apparent. Frequently it is diagnosed only when older adults are treated in hospitals or emergency rooms for other health problems such as falls.

Delirium falls into the category of cognitive disorders and is an acute physiological brain dysfunction characterized by confusion, disorganized thinking and perceptions, and disturbances of consciousness. Often delirium occurs when older adults are hospitalized after surgery, in response to intoxication from alcohol, or as a by-product of infectious disorders or malnutrition. If the root cause is treated, delirium is usually reversible.

Dementia is a cognitive disorder that typically occurs for the first time in older adulthood and is characterized by deficits in memory, language, orientation, thinking, reasoning, and problem-solving. Dementia is not an inevitable consequence of aging, but it does become more prevalent with increasing age. Several screening tests have been developed for making an initial determination of possible dementia, although no two patients have exactly the same symptom patterns.

Alzheimer’s disease (AD) is the most common form of dementia and vascular dementia (VaD) is the second most common form. AD is an irreversible progressive brain disorder associated with the death of brain cells and connections between them. AD has insidious onset, so initially it can be difficult to differentiate it from a milder form of memory impairment (MCI). However, there is a steady downhill course, and, in the final phase, mental and physical functions are severely impaired. AD can last for many years and it is more common in older women than in older men. Interestingly, some people, whose brains upon autopsy show clear evidence of dementia such as AD, did not show clear behavioral manifestations of dementia when they were alive. This has given rise to the Cognitive Reserve Hypothesis, which proposes that some brains have more cognitive, or neural, reserve, possibly because of a higher initial level of cognitive ability, more education, or lifestyles that featured greater amounts of physical or cognitive activity. There is a great deal of ongoing research to determine the possible causes of AD so that it can be prevented or so its downhill course can be arrested. VaD is associated with disorders of the cerebrovascular system (strokes, hypertension, and diabetes) and focal destruction of brain tissue. It comes on more abruptly than AD does, and it is characterized by a more stepwise and fluctuating course as compared to the steady downhill course of AD. VaD is more common in men than women. Dementia with Lewy bodies (DLB) used to be considered rare but now is thought to be the third or even second most common type of dementia, Lewy bodies are abnormal microscopic protein deposits found inside nerve cells and identified with certainty only with post-mortem histology. They can occur in the brain stem as well as the cortex, so they are capable of disrupting both motor and cognitive functioning.

The third section in the chapter describes therapeutic interventions that have been effective in treating older adults with mental disorders. These must be uniquely tailored to the problem being treated as well as to the individual’s capability and motivation. Environmental design and sensory retraining are useful for institutionalized older adults who may have limited cognitive capability. Behavioral interventions have been successful in modifying behaviors that interfere with an older adult’s quality of life. Other interventions include reality orientation, reminiscence therapy, pet therapy, cognitive-behavioral therapy, individual therapy, and family-oriented therapy.

SUGGESTED WEBSITES

Depression and Older Adults

www.nimh.nih.gov

This is the website of the National Institute of Mental Health. Click on “Publications” and then on “Older Adults.” Here you will find a variety of facts about signs of depression in older adulthood, as well as ways depression can be treated in the older age group.

National Mental Health Association

www.nmha.org

This is the home page of the National Mental Health Association, which is a nonprofit public education and advocacy organization. If you do a search for older adults, you will see a list links covering a variety of topics. One link is to a fact sheet with 10 tips for improving the mental health of older adults. There is also information on taking care of an aging parent.

Alzheimer’s Disease Education and Referral Center

www.nia.nih.gov/Alzheimers/

This website is maintained by the National Institute on Aging and provides information on the potential causes, symptoms, treatment, and research on Alzheimer’s disease.

Alzheimer’s Association

www.alz.org

This website provides information on what Alzheimer’s disease is, and what caregivers can do for Alzheimer’s patients, as well as ongoing research on Alzheimer’s disease.

American Psychological Assocation

http://www.apa.org/topics/alzheimers/index.aspx

This website, maintained by the American Psychological Association, provides a description of Alzheimer’s disease symptoms, recommendations on how to preserve brain function, including memory, and how to find help when Alzheimer’s disease is suspected. It also lists links to recent news articles on Alzheimer’s disease.

MULTIPLE-CHOICE QUESTIONS

Select the best answer from the options provided.

1. What is the best estimate of the percent of older adults (65+) who live both in the community and in institutional settings who meet the criteria for some type of mental disorder?

a. 5%

b. 13%

c. 20%

d. 45%

2. In the future, it is expected that ______ older adults will need mental health services.

a. fewer

b. the same number of

c. more

3. Today’s cohort of older adults makes full use of the mental health services that are available in the community.

a. True

b. False

4. DSM-IV is a ______________.

a. classification system for mental disorders

b. type of therapy often used to treat depression

c. type of mental disorder commonly seen in older adults

d. type of imaging that has been used to scan the brain to detect dementia

5. Depression ______________.

a. is just a part of normal aging

b. is never accompanied by cognitive difficulties

c. can be associated with bodily symptoms such as fatigue

d. is more often bipolar than unipolar in older adults

6. According to the diathesis-stress model, which of the following combinations would render a person most vulnerable to suffering from depression?

a. High diathesis; high stress

b. Low diathesis; low stress

c. High diathesis; low stress

d. Low diathesis; low stress

7. The diathesis-stress model has been used to understand why mental disorders such as depression occur. Of the following statements, which is closest to what this model proposes?

a. Depression is attributable to a biochemical imbalance that runs in families.

b. Depression is attributable to the stressful events that take place in a person’s life.

c. Some people have a stronger predisposition than others do for developing depression, but the disorder is triggered by stress.

d. Depression can be traced to a person’s dietary habits and metabolism.

8. Risk factor(s) for depression in older adults under the age of 80 is (are) _______,

a. being female

b. having a chronic illness

c. stressful life events involving loss

d. All of the above

9. In a two-year study following European American and African American caregivers of a family member diagnosed with dementia, it was found that over time, __________.

a. physical symptoms worsened in the African American caregivers but not in the European American caregivers

b. both groups had increased life satisfaction and improved physical well-being

c. compared to African American caregivers, European American caregivers experienced greater feelings of stress

d. African American caregivers experienced greater feelings of stress over time, but European American caregivers experienced more physical symptoms

10. Because some symptoms of depression are similar to symptoms of physical illnesses that are common in older adulthood, depression is often ______ in older adults.

a. underdiagnosed

b. overdiagnosed

c. accurately diagnosed

11. Older adults with a high level of education and income are more vulnerable to experiencing depression than those with less education and lower income.

a. True

b. False

12. The term “differential diagnosis” refers to _________________.

a. planning different treatment strategies for young and older adult patients

b. determining the exact basis for a set of symptoms

c. being more ready to detect dementia the first time an older adult forgets something

d. being cautious about detecting a physical problem when an older adult complains

13. Which of the following has the highest risk for completed (not just attempted) suicide?

a. Older European American men

b. Older European American women

c. Older African American women

d. Older Asian American men

14. One of the most frequent and also most treatable mental disorders in older adulthood is ____________.

a. Alzheimer’s disease

b. depression

c. vascular dementia

d. All of the above are equally easy to treat.

15. Older adults with hypochondriasis ___________________.

a. rarely have any other mental disorders such as depression

b. usually deny having any physical health problems

c. may have had it when they were younger

d. are treated most effectively by being reassured about their health

16. In older adults, paranoid thinking is often associated with a ______________.

a. decline in cognitive functioning

b. defense against social losses

c. defense against feelings of failure

d. All of the above

17. Older adults with diagnosed alcohol problems _______________.

a. are more likely to be women than men

b. are vulnerable to health problems and accidents

c. have these problems because they live alone

d. All of the above

18. As a general rule, older adults are_____ to alcohol compared to younger adults and therefore the effects of alcohol persist for a _____ in older adults than in younger adults.

a. more sensitive. longer time

b. more sensitive; shorter time

c. less sensitive; longer time

d. less sensitive; shorter time

19. Delirium is ____________________.

a. a permanent and irreversible type of dementia

b. a common type of anxiety disorder that is difficult to treat

c. rarely seen in the frail elderly

d. an acute brain dysfunction that can result from a medical condition or malnutrition

20. Sundown syndrome refers to ___________________.

a. symptoms of confusion older adults often experience in the late afternoon and evening

b. older adults’ need for alcoholic beverages before the dinner hour

c. feelings of sadness and depression older adults experience as the sun sets

d. older adults’ preference for taking walks outside when the sun is setting

21. Dementia ______________________.

a. is never seen in anyone under the age of 75

b. is a normal part of the aging process

c. always comes on suddenly and usually results in death within a year of diagnosis

d. is associated with a significant degree of cognitive impairment

22. Which type of dementia is most associated with both cognitive difficulties and motor disorders?

a. Alzheimer’s disease (AD)

b. Dementia with Lewy Bodies (DLB)

c. Vascular dementia (VaD)

d. All of the above are equally likely to be associated with both cognitive difficulties and motor disorders.

23. Dementia with Lewy Bodies (DLB)______________.

a. is extremely rare nowadays so it is not even considered when diagnosing older adults

b. is typically associated with motor symptoms similar to those seen in Parkinson’s disease

c. is not associated with any cognitive symptoms

d. can be completely cured if diagnosed early enough

24. Alzheimer’s disease (AD) ____________________.

a. has a sudden onset

b. leads to death shortly after it is diagnosed

c. is the most common form of dementia

d. is associated at the outset with a lack of conscious awareness of the immediate environment

25. Individuals with mild cognitive impairment (MCI) ___________.

a. are more forgetful than most people their age

b. definitely meet the criteria for Alzheimer’s disease (AD)

c. cannot carry on with any normal activities of daily living

d. are less likely to develop AD later on than are individuals who do not experience any memory problems at an earlier point in time

26. As far as we know now, which of the following is most likely to be a risk factor for Alzheimer’s disease?

a. Increasing age

b. Being male

c. Being highly educated

d. Getting a lot of physical exercise

27. The role of the APOE epsilon4 allele is being studied in relation to _____________.

a. Vascular dementia (VaD)

b. Alzheimer’s disease

c. Multi-infarct dementia (MID)

d. Depression

28. Vascular dementia (VaD) ________________.

a. is the most common form of dementia in the older adult age group

b. is more common in women than it is in men

c. is associated with more focal destruction of brain tissue than is Alzheimer’s disease

d. comes on more gradually than Alzheimer’s disease does

29. Multi-infarct dementia (MID) is __________________.

a. usually associated with multiple strokes or hypertension

b. the result of a slow-acting virus

c. genetically determined by the APOE epsilon4 allele

d. never found in the same patients who have Alzheimer’s disease

30. Which type of therapy technique is best suited for institutionalized older adults with severe physical and cognitive limitations?

a. Reminiscence therapy

b. Cognitive-behavioral therapy

c. Psychodynamic therapy

d. Sensory retraining therapy

31. Behavior therapy would be most appropriate for older adults who need _____.

a. training to re-acquire and maintain self-feeding skills

b. encouragement to think about their past lives

c. exercises to stimulate their kinesthetic and proprioceptive receptors

d. a person in whom they can confide their deepest feelings

32. One study tested how effective a combination of reminiscence therapy and reality orientation therapy, or either one by itself, would be in improving the cognitive and behavioral functioning of nursing home residents. Which resulted in the greatest benefit?

a. Reminiscence therapy alone.

b. Reality orientation alone.

c. A combination of both therapies, but with reality orientation therapy coming first.

d. A combination of both therapies, but with reminiscence therapy coming first.

33. When pets are introduced into nursing home settings, there have been reports that the morale of the residents improves tremendously. This is a clear reason for concluding that pets are the cause of this improvement.

a. True

b. False

34. Which type of therapy has been helpful for physically healthy, educated older adults who suffer from depression?

a. Cognitive-behavioral therapy

b. Sensory retraining therapy

c. Reality orientation therapy

d. Reminiscence therapy

35. The term boomerang kids refers to _____________________.

a. children who are born to parents in their late middle-age years

b. children who are brought up by their grandparents

c. adult children who leave their parents’ home but return some years later

d. older adults w ho engage in sports and games like they did as children

SHORT ANSWER QUESTIONS

1. Why is the number of older adults in need of mental health services expected to increase in the future?

2. What are some reasons that could explain why today’s older adults may not seek mental health services?

3. Use the diathesis-stress model to discuss why an individual who was depressed in middle-adulthood might be happier and less depressed in older adulthood.

4. Briefly define depression and explain why it is sometimes underdiagnosed in older adults.

5. The suicide rate is lower among older women than it is among older men. Can you give a reason that might explain this gender difference?

6. What is hypochondriasis and how should it be treated?

7. What is delirium and when is it most likely to occur?

8. What do Alzheimer’s disease (AD) and vascular dementia (VaD) have in common and how do they differ?

9. What is the cognitive reserve hypothesis and what does it try to explain?

10. Briefly describe reality orientation (RO) therapy and reminiscence therapy. For what type of problem would each be suitable?

11. What is cognitive-behavioral therapy? For what kind of problem would it most likely be helpful and which type of older adult is most likely to benefit from this type of therapy?