Depression Depression among Older among Older Adults Adults Pre va - - PowerPoint PPT Presentation
Depression Depression among Older among Older Adults Adults Pre va le nc e & I nte rve ntio n Stra te g ie s Definition Definition De pre ssio n is a c o mple x syndro me c o mple x c ha ra c te rize d b y mo o d disturb a nc e plus
Pre va le nc e & I nte rve ntio n Stra te g ie s
De pre ssio n is a c o mple x syndro me c o mple x c ha ra c te rize d b y mo o d disturb a nc e plus va rie ty o f c o g nitive , psyc ho lo g ic a l, a nd ve g e ta tive disturb a nc e s
npa tie nt se tting
y c linic and inpt. psyc hiatr y
a te -life de pre ssio n: se c o nda ry to va sc ula r e tio lo g y
Simon GE, et al. N Engl J Med. 1999;341(18):1329-1335.
In primary care, physical symptoms are often the chief complaint in depressed patients
N = 1146 Primary care patients with major depression
In a New England Journal of Medicine study, 69% of diagnosed depressed patients reported unexplained physical symptoms as their chief compliant1
a no rma l pa rt o f a g ing
65 ha ve de pre ssive illne ss
inc re a se s the risk o f de ve lo ping de pre ssio n
e a ds to e a rly re la pse a nd c hro nic ity
se rio us illne sse s
tre a te d
a re the hig he st o f a ny a g e g ro up.
re c e ive a de q ua te a ntide pre ssa nt tre a tme nt
he dire c t a nd indire c t c o sts – $43 b illio n e a c h ye a r
a te life de pre ssio n is pa rtic ula rly c o stly b e c a use o f the e xc e ss disa b ility tha t it c a use s a nd its de le te rio us inte ra c tio n with physic a l he a lth
llne ss:
stro ke
a c k o f a suppo rtive so c ia l ne two rk
ra uma tic e xpe rie nc e s
e a r o f de a th
rustra tio n with me mo ry lo ss
de te rio ra tio n
V-T R c rite ria
pre se nt fo r a t le a st two we e ks
func tio ning
lo w/ de pre sse d mo o d is a must fe a ture
inc re a se d
me mo ry
rrita b ility
a c k o f inte re st in pe rso na l c a re (skipping me a ls, fo rg e tting me dic a tio ns, ne g le c ting pe rso na l hyg ie ne )
nc re a se d use o f a lc o ho l o r o the r drug s
c o mmo n tha n ma jo r de pre ssio n
se rvic e s
func tio ning
tre atme nts!
mpo rta nt, E a sy to miss
ire a rms a t ho me
a prima ry c a re physic ia n ve ry c lo se to the time o f the suic ide
suic ide
20% o f the 30,000 suic ide s/ yr
suic ide , yo ung e r pa tie nts ma ke 100 to 200 a tte mpts pe r c o mple tio n
(rates per 100,000) (rates per 100,000)
LA Co Dept of Public Health, Injury & Violence Prevention Program (Ma
S- Ma le Se x A- Ag e (yo ung / e lde rly) D- De pre ssio n P- Pre vio us a tte mpts E- E
T OH
R- Re a lity te sting (I
mpa ire d)
S- So c ia l suppo rt (la c k o f) O- Org a nize d pla n N- No spo use S- Sic kne ss
Cho o se the b e st a nswe r fo r ho w yo u ha ve fe lt o ve r the pa st we e k:
S / NO
S / NO
S / NO
S / NO
S / NO
S / NO
S / NO
S / NO
YE S / NO
YE S / NO
S / NO
S / NO
S / NO
S / NO
S / NO
*Unde rline d ite ms c o nstitute the fo ur ite m sc a le
nto xic a tio n a nd/ o r withdra wa l fro m c e rta in sub sta nc e s c a n le a d to de pre ssive sympto ms.
f sympto ms a re sig nific a nt e no ug h, the y ma y b e c ha ra c te rize d a s a sub sta nc e -induc e d mo o d diso rde r.
sub sta nc e s a re use d a nd ma y o r ma y no t impro ve with a b stine nc e .
a fte r a b stine nc e a nd must b e tre a te d in c o unse ling .
Substance Use & Depressive Symptoms Substance Use & Depressive Symptoms
de pre ssive sympto ms to wo rse n a nd c o mplic a te re c o ve ry fro m a de pre ssive illne ss.
he se e ffe c ts ma y a lso inte rfe re with a c lie nt's re spo nse to me dic a tio ns o r o the r the ra pe utic inte rve ntio ns.
a lc o ho l a nd/ o r drug use , ma y a lso inc re a se the risk fo r thinking a b o ut, pla nning , o r a c ting o n suic ida l tho ug hts.
Substance Use & Depressive Symptoms Substance Use & Depressive Symptoms
Substance Use & Depressive Symptoms Substance Use & Depressive Symptoms
Substance Associated Depressive Symptoms Intoxication Withdrawal Chronic Use Alcohol Depressed mood, anxiety, poor appetite, poor concentration, insomnia, restlessness, paranoia and psychosis Depressed mood and other depressive symptoms Opioids Low energy, low appetite, poor concentration Depressed mood, fatigue, low appetite, irritability, anxiety, insomnia, poor concentration Depressed mood and other depressive symptoms
Substance Associated Depressive Symptoms Intoxication Withdrawal Chronic Use Cocaine and stimulants Anxiety, low appetite, insomnia, paranoia and psychosis Depressed mood, increased sleep, increased appetite, anhedonia, loss of interest, poor concentration suicidal thoughts Depressed mood and other depressive symptoms Cannabis Anxiety, apathy, increased appetite Anxiety, irritability Low motivation, apathy Sedative‐ hypnotics Fatigue, increased sleep, apathy Anxiety, low mood, restlessness, paranoia and psychosis Depressed mood, poor memory
Substance Use & Depressive Symptoms Substance Use & Depressive Symptoms
PT
mo re e ffe c tive tha n a ntide pre ssa nts in tre a ting mo o d suic ida l ide a tio ns, a nd la c k o f inte re st, whe re a s a ntide pre ssa nts a re mo re e ffe c tive fo r a ppe tite a nd sle e p disturb a nc e s
Co g nitive Be ha vio r T he ra py (CBT ) is a n a c tive , dire c tive time -limite d a nd struc ture d pro b le m-so lving tre a tme nt a ppro a c h who se prima ry a im is sympto m re duc tio n (L a idla w e t al. 2003). E mpiric a l e vide nc e sug g e sts tha t CBT is a n e ffic a c io us tre a tme nt fo r la te life de pre ssio n.
R e c omme nde d te xts: L
a idla w e t a l, 2003 a nd Ga lla g he r-T ho mpso n, Ste ffe n, & T ho mpso n (2008) Ha ndb o o k o f Co g nitive a nd Be ha vio ura l T he ra pie s.
Inte r pe r sonal psyc hothe r apy (IPT ) is
a sho rt-te rm fo c usse d tre a tme nt pro g ra m fo r de pre ssio n (Hinric hse n & E me ry, 2005). I PT fo c use s o n 4 ma in pro b le m a re a s in its tre a tme nt a ppro a c h to de pre ssio n, the se a re : (i) g rie f; (ii) inte rpe rso na l dispute s (iii) ro le tra nsitio ns a nd (iv) inte rpe rso na l de fic its (K a re l & Hinric hse n, 2000)
R e c omme nde d te xt: Hinric hse n, G.
& Clo ug he rty, K . (2006) I nte rpe rso na l Psyc ho the ra py fo r de pre sse d o lde r a dults.
a nd live d with
Psyc ho lo g ic a l Co nse q ue nc e s
e xpe rie nc e s o f a g ing
the mse lve s a s OP, so ma yb e so me time s its no t diffe re nt!
Sadavoy talks about the 5 Cs of psychogeriatrics:
CBT and the Demographic Context CBT and the Demographic Context
T he c ur r e nt e vide nc e base for CBT with Olde r Pe ople is r e asonably str
e BUT
In psychological treatment models there are very few specific frameworks to characterize the experience of older people who develop depression Maybe it is time to develop more age specific models of CBT for older people (Laidlaw & Pachana, 2009), and consider new targets for CBT such as attitudes to ageing and wisdom enhancement (Laidlaw, 2010) Wisdom is one of the few positive attributes associated with ageing and may enhance outcome for chronic depression
sta b lishing o b je c tive a c hie va b le g o a l
mple me nting the so lutio n(s)
va lua ting the o utc o me
do ing the kinds o f thing s the y typic a lly e njo y.
e ve n wo rse .
c a ug ht up in a vic io us c yc le o f do ing le ss a nd le ss a nd fe e ling wo rse a nd wo rse .
a nd white thinking , o ve rg e ne ra lizing , c a ta stro phizing a nd pe rso na lizing .
de pre ssive tho ug ht pa tte rns.
grie f.
duc ate abo ut grie f.
xplo re the c lie nt's e xpe rie nc e with grie f.
ac ilitate grie ving.
ho ma s E . F re e se , PhD
a rno , PhD
a rno @ me dne t.uc la .e du
www.uc la isa p.o rg / c o d