Late-life psychiatric disorders

Full Answer Section

• Assessment Tools:
  • Geriatric Depression Scale (GDS): A self-report questionnaire specifically designed for older adults, focusing on psychological symptoms and minimizing somatic complaints.
  • Hamilton Rating Scale for Depression (HAM-D): A clinician-administered scale that assesses the severity of depressive symptoms.
  • Cornell Scale for Depression in Dementia (CSDD): Used to assess depression in individuals with cognitive impairment.
  • Thorough Medical History and Physical Examination: To rule out medical conditions that can mimic or contribute to depression (e.g., hypothyroidism, vitamin deficiencies).
  • Cognitive Screening: To assess for co-occurring cognitive impairment.
• Treatment Goals:
  • Reduce the severity and duration of depressive episodes.
  • Achieve remission of symptoms and return to baseline functioning.
  • Prevent relapse and recurrence.
  • Improve quality of life, social engagement, and functional independence.
  • Address co-occurring medical and psychiatric conditions.
  • Reduce the risk of suicide.
• Psychotherapy Considerations:
  • Cognitive Behavioral Therapy (CBT): Effective in addressing negative thought patterns and maladaptive behaviors contributing to depression. Adaptations for older adults may include slower pacing, more concrete examples, and addressing age-related concerns like loss and isolation.
  • Interpersonal Therapy (IPT): Focuses on improving interpersonal relationships and social functioning, which can be particularly ¹ helpful for older adults experiencing loss or social isolation.  
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  • Problem-Solving Therapy: A practical approach that teaches coping skills to manage stressors and solve daily problems, empowering older adults to regain a sense of control.
  • Life Review Therapy: Can help older adults find meaning and resolution in past experiences, fostering a sense of integrity and reducing feelings of despair.
  • Group Therapy: Provides social support, reduces isolation, and allows individuals to share experiences and coping strategies.

2. Anxiety Disorders (Generalized Anxiety Disorder, Panic Disorder, Social Anxiety)

• General Characteristics: Anxiety in older adults is often underrecognized. Symptoms can include excessive worry, restlessness, irritability, muscle tension, sleep disturbances, and difficulty concentrating. Older adults may present with more physical complaints (e.g., gastrointestinal issues, pain) related to anxiety. Late-onset anxiety may be associated with medical conditions, medication side effects, or life stressors like declining health or loss of loved ones. Co-occurrence with depression is common.
• Assessment Tools:
  • Geriatric Anxiety Inventory (GAI): A self-report measure specifically designed to assess anxiety symptoms in older adults.
  • Hamilton Anxiety Rating Scale (HAM-A): A clinician-administered scale assessing the severity of anxiety symptoms.
  • Penn State Worry Questionnaire (PSWQ): Measures the tendency towards excessive and uncontrollable worry.
  • Social Phobia Inventory (SPIN): Assesses symptoms of social anxiety.
  • Thorough Medical History and Physical Examination: To rule out medical causes of anxiety (e.g., hyperthyroidism, cardiac conditions).
  • Medication Review: To identify medications that may be contributing to anxiety.

Sample Answer

It's crucial to recognize the significant prevalence of mental health and substance use conditions in older adults. Addressing these issues with sensitivity and appropriate interventions is paramount for promoting well-being in later life. Here's a breakdown of the general characteristics, assessment tools, treatment goals, and psychotherapy considerations for the specified late-life psychiatric disorders:

1. Mood Disorders (Primarily Depression)

• General Characteristics: While sadness is a normal human emotion, geriatric depression is characterized by persistent sadness, loss of interest or pleasure (anhedonia), and often accompanied by physical symptoms like fatigue, changes in appetite and sleep, and unexplained pain. Older adults may present with more somatic complaints than overt sadness, making diagnosis challenging. Irritability, anxiety, and social withdrawal are also common. Late-onset depression (first episode after age 65) may be linked to cerebrovascular disease or other medical conditions. Suicide risk is a significant concern in this population.