Is he mentally ill?

Insomnia is more common among older than younger people

• Insomnia is more common among older than younger people

• At least 40% of those over 65 experience some measure of insomnia

• Prone to this because of medical ailments, pain ,medications, depression, anxiety

• Also normal physical changes—as we age, we spend less time in deep and REM sleep; sleep is more readily interrupted, we have trouble falling back asleep

• Maybe 10% of elderly have sleep apnea

At any given time 6% of elderly men and 11% of elderly women (Fisher et al 2001)

• At any given time 6% of elderly men and 11% of elderly women (Fisher et al 2001)

• GAD is particularly common—up to 7% of all elderly

• Prevalence increases with age—higher among those over 85

• May be related to declining health—see higher rates in those with medical problems

• Have not been able to identify why some get anxious and others stay generally calm

• Treated with cognitive tx, benzos, prozac—just like younger people, but side effects are a risk

Prevalence of such patterns declines after 60—perhaps declining health or reduced financial status.

• Prevalence of such patterns declines after 60—perhaps declining health or reduced financial status.

• Accurate abuse data are hard to come by

• 4-7% of older people, particularly men—alcohol related disorders in a given year

• Men under 30 are 4X as likely to exhibit a behavioral problem assoc with alcohol

• Higher rates in those who are institutionalized in general medical and psych hospitals among the elderly—estimates range 15-49%

• Among those who begin drinking in old age—reaction to negative events, pressures of growing older such as living alone, unwanted retirement, death of a spouse

• Prescription drugs are another issue

• Elderly make up 13% of the population, but consume ¼ of prescription drugs
• Risk of confusing medications, missing doses is high
• Overprescription is also a problem

Psychosis is often associated with delirium or dementia

• Psychosis is often associated with delirium or dementia

• Schizophrenia actually decreases a bit—symptoms tend to diminish some with age

• Delusional disorder which typically has a prevalence of about 3/100,000—increases in the elderly

• Unclear about why this increase is there—researchers guess that it is related to deficiencies in hearing, social isolation, greater stress, or heightened poverty

Brain impairment in adults

• Brain impairment in adults

• For the most part, cell bodies and neural pathways do not regenerate

• Impairment may involved acquired and customary skills or anosognosia—capacity or realistic self-appraisal

• Impairment depends on

• Nature, location, and extent of neural damage
• Premorbid competence and personality of the individual
• Individual’s life situation
• Amount of time since the first appearance of the condition

• Diffuse vs. focal damage

• Mild to moderate diffuse damage—may impair attention; would see this type of damage with oxygen deprivation or ingestion of toxic substance like mercury
• Person may complain of memory problems due to difficulty focusing

Focal damage is to a specific region—defined trauma, stroke

• Focal damage is to a specific region—defined trauma, stroke

• Frontal lobes—one of two patterns:
• 1) behavioral inertia, apathy
• 2) impulsivity, distractibility
• Right parietal lobe—visual-motor coordination
• Temporal lobe—memory, eating, sexuality, emotions (depending on part)
• Left parietal lobe—language, writing, reading, arithmetic

• Problems we see with brain disorders

• Impairment of memory; including confabulation
• Impairment of orientation (unable to locate self in time or space)
• Impairment of learning, comprehension, and judgment
• Impairment of emotional control or modulation
• Apathy or emotional blunting
• Impairment in the initiation of behavior
• Impairment of controls over matters of propriety and ethical conduct
• Impairment of receptive and expressive language
• Impaired visuospatial ability

Affects 2 million in US each year

• Affects 2 million in US each year

• Often misdiagnosed

• More common in kids and older adults

• When elderly enter hospital for general medical condition, 1/10 shows symptoms of delirium. Another 10% will develop delirium in hospital.

• But—studies show that admission docs detect only about 1/15 cases of delirium (Cameron et al 1987)

• Acute confusional state with sudden onset, fluctuating state of awareness

• Cognitive changes like impaired informational processing
• Disturbances of the sleep cycle—worse at night—vivid dreams
• May slur
• Make perceptual errors—unfamiliar for familiar
• Paranoid delusions in 40-70%
• Swings in activity and mood
• May be fever, flushed face, dilated pupils, increased heart and bp

• Do have lucid intervals—fluctuation is key for diagnosis

• Mortality is high—up to 40% die

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