DEPARTMENT OF BEHAVIOURAL SCIENCE AND MEDICAL ETHICS FACULTY OF MEDICINE DEPARTMENT OF BEHAVIOURAL SCIENCE AND MEDICAL ETHICS TOPIC: PSYCHOPATHOLOGY OF AGING AND ELDERLY FACILITATOR: DR. ISAAC LEMA

GROUP 21 MEMBERS: BALIYONOLELA ERICK MARTIN. LUPYANA L KINYAMAGOHA. NEEMA E. KUNYARANYARA. PETER HUMPHREY. PHILOMENA LYAMUYA. RASHID IDD RASHID. SHOMET MAKANGA MAIJEI. SOPHIA NGODOKI BONIFASI. USAMA MOHAMMED NASSOR.

Outline: INTRODUCTION DEFINITION OF TERMS SPECIFIC OBJECTIVES MAIN PRESENTATION SUMMARY CONCLUSION RECOMMENDATIONS REFERENCES

INTRODUCTION: Aging is a process that accumulates changes in organisms over time. Human aging process involves multidimensional changes on physical, psychological, cultural and social levels. At some point, these changes can be associated with problems and disorders. These provides information on various health and lifestyle subjects associated with aging and elderly.

DEFINITION OF TERMS: Aging is the accumulation of changes in a human being over time, encompassing physical, psychological and social changes. Psychopathology is the scientific study of mental disorders, including efforts to understanding their genetic , biological and social causes. Psychotherapy is a type of therapy used to treat emotional problems and mental health conditions. Depression is a serious medical condition in which a person feels very sad, hopeless, and unimportant and often is unable to live in a normal way. Delusion is a false idea or belief that is caused by mental illness.

DEFINITION OF TERMS cont..: Apathy (also called perfunctoriness) is a lack of feeling, emotion, interest, or concern. Hypochondriasis refers to worry about having a serious illness. Insomnia is an inability to sleep. Hypersomnia is an inability to awake. Delirium is a usually brief state of excitement and mental confusion often accompanied by hallucinations. Dementia is a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

SPECIFIC OBJECTIVES: To know the meaning of aging. To know the problems associated with aging and elderly. Neurocognitive disorders of aging and elderly. Prevention and treatment of Neurocognitive disorders.

Problems associated with aging and elderly:

Problems associated with aging and elderly: Physical decline and disabilities. Sensory and neurological deficits. Loss of loved ones. Myths against elderly. Social stresses such as stigmatizing attitudes towards elderly. Psychopathological disorders.

Psychopathological disorders associated with aging and elderly: Inability to adapt to life changes, stresses, losses, 15 % of elderly suffer at least moderately psychopathology disorders. The incidence is higher when the elderly is advanced aged, poor physical health, or unmarried. 30% of public mental health problem face elderly but only 2% of these elderly seek for medical attention.

Psychopathological disorders associated with aging and elderly: These psychopathological disorders are: FUNCTIONAL DISORDERS(Intact brain function): Delusion. Depression. Hypochondriasis. Apathy. Insomnia. ORGANIC DISORDERS(Impairment of brain function): Delirium. Dementia. Hypersomnia.

delusions DELUSION is the belief that is clearly false and that indicates and abnormality in the affected person’s content of thought.  A person with a delusion will hold firmly to the belief regardless of evidence to the contrary. Delusions are a symptom of either a medical, neurological, or mental disorder. Treatment: Psychotherapy and cognitive behavioral therapy(CBT).

DEPRESSION Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how elders feel, think and behave and can lead to a variety of emotional and physical problems. The elders may have trouble doing normal day-to-day activities and sometimes they may feel as if life isn't worth living. Treatment: Antidepressants and/or psychotherapy.

DEPRESSION CONT..: Depressed elder

HYPOCHONDRIASIS Hypochondriasis, also known as hypochondria, health anxiety or illness anxiety disorder, refers to worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence of an actual medical condition. Treatment: Cognitive-behavioral therapy (CBT).

apathy Apathy is a lack of feeling, emotion, interest, and concern. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical and/or physical life and the world. there is a great lack in large-scale clinical trials in the effort of finding specific treatment for apathy. Cholinesterase inhibitors used with individuals who have Alzheimer's have been seen to have positive responses from apathetic symptoms.

insomnia Insomnia is the feeling of inadequate or poor-quality sleep because of one or more of the following: trouble falling asleep (Initial Insomnia); trouble remaining asleep through the night (Middle Insomnia); waking up too early (Terminal Insomnia); or unrefreshing sleep for at least one month. Treatment: Relaxation training, stimulus control, sleep restriction, and cognitive behavioral therapy.

Hypersomnia Hypersomnia, or excessive sleepiness, is a condition in which a person has trouble staying awake during the day. This is due to brain function impairment. Elders who have hypersomnia can fall asleep at any time; for instance, at work or while they are driving.

DELIRIUM Delirium or Acute Confusional State or Acute Brain Syndrome Acute mental syndrome is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of your environment.  It is characterized by decreased ability to maintain attention to external stimuli, disorganized thinking and reduced level of consciousness. Because symptoms of delirium and dementia can be similar, the doctors or care givers has to make acute diagnosis before treating elders.

DEMENTIA Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills. It decreases cognitive function. Alzheimer’s disease accounts for 60% to 80% while Vascular dementia is the second most common dementia type which occurs due to stroke. Most common sign is forgetfulness.

DEMENTIA cont… Other common symptoms include: Emotional problems, Problems with language and Decrease in motivation. Mild cognitive impairment (MCI) may be precursor of serious late life memory disorders. Dementia occurs due to chemical and physical impairment of the brain.

DEMENTIA cont… Reversible Dementia can be due to: Vitamin deficiency. K+ deficiency. Hypo or hyperthyroid. Irreversible Dementia are: Alzheimer’s Disease. Multi-infarct Dementia. Vascular dementia.

Alzheimer’s disease Alzheimer's disease is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases. Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older.

Alzheimer’s disease There are three drugs involved in treatment of alzheimer’s disease:  donepezil (Aricept)  galantamine (Razadyne)  rivastigmine (Exelon). However these drugs just reduces the intensity of symptoms.

PHYSICAL AND CHEMICAL CHANGES TO THE BRAIN:

Multi-infarct dementia Multi-infarct dementia (MID) or Vascular dementia is a common cause of memory loss in the elderly and second most common form of dementia. MID is caused by multiple strokes (disruption of blood flow to the brain). Disruption of blood flow leads to damaged brain tissue. Some of these strokes may occur without noticeable clinical symptoms.

SUMMARY The psychopathology diseases that affect elders are delusion, depression, hypochondriasis, apathy, sleeping disturbance (insomnia and hypersomnia), delirium and dementia. They can cause permanent or temporary damage to the brain hence they can be reversible such as delusion, depression, apathy and hypochondriasis or irreversible such as Alzheimer's disease, delirium and vascular disease. The reversible psychopathological disorders can be treated by psychotherapy and sometime medications while irreversible are just reduced by medications.

CONCLUSION The causes of psychopathological disorders in aging and elderly are different depending on the disorders. Many function psychopathological disorders can be prevented while many organic psychological disorder can’t be prevented. Therefore, the elders should get all support from the family, friends and medical personnel. Also the government and NGOs must built elderly nursing homes to support and care for elders.

Elderly nursing home

RECOMMENDATION Doctors and nurses are suppose to offer support care, support and treatment to the elders because of their physical, social and psychopathological problems and disorders. Also there have to be careful consideration about memory and reasoning disorders when receiving medical information about the disease from elderly patients.

references: http://www.minddisorders.com/ http://www.wikipedia.org/

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