chapter 32-end Flashcards
1
Q
robert butler- middle adulthood (40-65)
A
aging
taking stock of accomplishment and setting goals for future.
reassessing commitments to family, work, and marriage.
dealig with parental illness and death
attending to all developmental tasks withou losing capacity to experiene pleasure
2
Q
george valliant- factors correlating with emotional well being in middle adulthood
A
physical health
psychosocial adjustment during college years
stable parental home
close sibling relationship durng college years
capacity to work during chilhood
3
Q
climacterium
A
during middle adulthd- decreased biological and hysiological functioning-womes menopause (40-55),
male’s hormones stay constant at 40-50, and then begin to decline, a derease in healthy sperm and seminal flid
4
Q
Paul Bhannan- types of separation at divorce
A
psychic divorce- recovery takes 2 years legal divoce- 75%(W) and 80%(M) marry within 3 years economic divorce community divorce coparental divorce
5
Q
life expectancy
A
M= 77.4, F= 82.2
6
Q
predictors for longevity
A
heriditary- 50% of fathers to people over 80 also lived past 80
other predictors- regular checkup, minimal caffeine and alcohol, work gratification and perceived sense of self as being useful, eating healthy, exercise
7
Q
changes in causes of death -CVA, MI
A
60% decline in mortality fromm CVA, 30% in coronary
8
Q
leading causes of death among older people
A
heart disease, cancer, stroke
also accidents are prevalent- e.g. falls- most commonly resulting from hypotension or arrythimia
9
Q
M:F ratio with age(per 100 females)
A
55-64: 92
65-74- 83
75-84- 67
85< - 46
10
Q
alcohol , salt, statins and longevity
A
1 oz =30 ml of alcohol a day reduce HDL and correlate with longevity
salt less than 3 gr- reduce hypertension
statins reduce CV disease in diet and exercise resistant hyperlipidemia
11
Q
aging changes- neurons
A
degenaeration mainly in superior temoral ,precentral and inferior temporal gyri.
no loss in brainstem nuclei
12
Q
aging- cellular changes
A
increased collagen and elastin
altered receptor sites and sensitivity
deacreased anabolism and catabolism of cellular transmitter substances
13
Q
immune changes in aging
A
increased autoimmune,
leukocytes unchanged but reduced T lymphocytes and their response
increased ESR
14
Q
usculoskeletal changes in aging
A
2 inch loss of height from second to 7th decade
slongation of nose and ears
deepening of thoracic cage
risk of hip fractue at age 90- 10-25%
15
Q
weight changes - aging
A
men gain till 60, then lose
women gain till 70, then lose
16
Q
crainal sutures closure- aging
A
parietomastoid suture does not attain complete closure until age 80
17
Q
grey hair- aging
A
by age 50, 50% of people are 50% grey/
caused b loss of melanin
18
Q
vision- aging
A
thickening and yellowing of optic lens
reduced peripheral visio and accomodation (presbyopia)
decreased light-dark adaptation
reduced acuity of all senses
19
Q
hearing loss- aging
A
high frequency hearing loss (presbyacusis): age 60- 25% 65- 30% 75- 50% by age 80- 65%
20
Q
neuropsychiatric- aging
A
slowed learning new material, but still complete learning
IQ stable till 80
verbal ability maintained
decreased psychomotor speed
21
Q
memory- aging
A
difficult to shift attention
encoding and simple recall diminish
recognition remains intact
22
Q
neurotransmitters -aging
A
decreased NE and increased MAO and serotonin
23
Q
brain changes - aging
A
17% decrease of brain weight by 80
wide sulci, smaller convolutions, gyral atrophy
enlarged ventricle
increased transport in BBB
decreased cerebral blood flow and oxygenation
24
Q
cardiovascular- aging
A
increased in size and weight- lipofuscin
decreased valvulaar elasticity
cardiac output maintained in absence of coronary heart disease
25
GI- aging
risk for atrophic gastritis, hiatal hernia, diverticulosis
| diminished saliva flow, constipation, reduced gi absorption
26
endrocrine changes- aging
reduced androgens and estrogen
increased LHm FSH inpostmenopause
T4, TSH normal, decreased T3
glucose tolerance test results decrease
27
respiratory functions- aging
decreased VC , cough reflex and bronchial ciliary action
28
stable personality traits
agreableness ,conscientiousness, openness to experience, neuroticism, extroversion,
A CONE
may increase agreeblenss and decreased extroversion(first letter, last letter)
29
aging- erik erikson
integrity(sastisfaction of past life) vs despair
| contenment comes with getting beyond narcissism and into intimacy and generativity
30
George Vaillant - correlates of emotional health at 65
having close brothers and sister during college and developing traits of pragmatism and dependabilityin young adulthood predict well being
deression between 21-59 -emotional problems
early traumatic experiences did not crrelate with oor adaptation
31
top 10 chronic conditions in 65+
```
arthritis
hypertension
hearing loss
heart disease
cataract
orthopedic deformities and problems
chronic sinusitis
diabetes
visual loss
varicose veins
```
32
depression in the elderly
less depression and dysthymia than youner
33
suicide rate in the elderly
high- 40/100,000
| women perceived as mentally adn men as physically ill
34
alzheimer heredity
autosomal dominant in 10-30%
35
among the elderly who consider suicide- what is the most common reason
loneliness
36
mental morbidity among patients who commit suicide
75% had depression and/or alcohol
37
methodist episcopelian
tests broca aphasia
38
cant demnstrate use of simle objects(key, match ets)
ideomotor apraxia
39
test wernickes aphasia
naming objects
40
visuospatial functioning in the elderly
some decline
41
loss of abstract thinking
ma be an early sign of dementia
42
immediate retention and recall
6 digits forwards, 5-6 digits backwards in normal people
| but can be impaired also in anxiety
43
effects of age and education on MMSE
can affect results (pg 1344)
44
effects of depression on psychomotor performance
impaired visuospatial and timed motor performance
45
tests for visuospatial functions
Bender Gestalt test
| Halstead-Reitan Battery(covers entire spectrum of information processing and cognition)
46
most common psychiatric disorders in the elderly
depression, cognitive disability,alchol, phobia,
| DeCAP
47
prevalence of dementia
5% above 65 -severe dementia, 15%- mild dementia
| 20% above 80 have severe dementai
48
delusions and hallucinations in dementias
75% of patients
49
treatable dementias
10-15%
50
subcortical dementias
NPH, wilson, huntington, parkinson, casculat
51
characteristics of subcortical dementia
movement dis,gait apraxia, psychomotor retardation, akinetic mutism, apathy
52
characteristics of cortical dementias
aphasia, agnosia, apraxia
53
prion disease- mutation
prion protein gene- PRNP- can be inherited, acquired, sporadic
54
types of prion diseases
autosomal dominant: CJB, gertsmann- straussler- scheinker, fatal familial insomnia
kuru- cannibalism and implantations(cornea, GH, gonadotropin)
CJD- 85% sporadic. 1/milion/year, mean age of onset- 65
55
depression among the elderly
15%
56
risk factors for depression in the elderly
not age!
| widow, chronic illness.
57
recurrence in late onset depression
commn
58
common features in geriatric depression
melancholic features, somatic, hypochondriasis, sleep problems- early awakening and multiple awakenings. low self esteem, self accusations (especially about sex and sinfullness), paranoid and suiciadal ideation
59
pseudodemntia among depressive elderly
| depression among dementia patients
15% pseudodementia among depressives
| 25-50% depression among dementia patients
60
schizophrenia in the elderly
among early onset schizohprenics- 20% show no active symptoms by age 65. the rest- varying impairments.
30% of all schizophrenics are residual- need chronic care.
late onset- usually paranoid type, more woman.
61
delusional disorder in the elderly
age of onset- usually 40-55. most comon-perseutory
| in one study of 65 yo and older- 4% had persecutory ideation
62
paraphrenia
lateonset delusional disorder, typically persecutory. not associated with dementia
63
prevalence of anxiety among the elderly
5.5% in 1 month.
4-8% most common-phobia.
panic- 1%
rect more severly to PTSD
64
percentage of chronic disorders among persons over 60
80%(usually arthritis and CV disease)
65
alcohol dependence in nursing homes
20%
66
percentage of alcohol and substance dis of emotional problems among the elderly
10%
67
OTC among the elderly
35%-70%, and 30% use laxatives. rule out when examining symptomotoligy
68
the single most importat factor associated with increased prevalence of sleep diso
advanced age
69
most common sleep dis. among the elderly
dyssmonias, especially: primary insomnia, nocturnal myoclonus, restless leg syndrome, sleep apnea.
70
parasomnias that almost exclusively iccur among the elderly
REM sleep behavior disorder
71
effects of alcohol on sleep
fragmantation, early awakening, aggrevate apnea
72
sleep changes in people over 65
REM: redistribution throughout the night: more REM period, but shorter and less total REM sleep
NREM: decreased delta amplitude, lower stage 3 and 4, higher 1 and 2
low amplitude of circadian rhythm, 12 hour sleep propensity ryth, shorter cycles. ,
73
suicide among the elderly
the highest than any population. rate for white men over 65- time 5 than general population,
1/3 report loneliness as a reason for considering suicide
10 of those with suicidal ideation report financial problems, poor mecial health, depression for reason.
74
suicide victims vs suicide attempts
60% of those who commit suicide- men.
75% of those who attempt- woman
among those who succeed- usually guns or hanging
among attemters- 70% -drug OD, 20%- cut,
75
precipitants for suicide
most common preciitants are physical illness and loss.
most who commited suicide had a mental dis, especially depression
more of them are widowed, and few re single/divorced/separated(as opposed to younger adults)
76
most common suicide precipitants among oung adults
problems with employment, finances and family relationships
77
do the elderly communicate about their suicidal ideation
most ofsuicide victims communicate their thought with family or friends before commiting the act
78
elder abuse
10%
79
study of psychotherapy in an old age home
less urinary incontinence, improved gait, greater mental alertness, improved memory, better hearing
80
Bernice Neugarten major conflict of old age
giving up position of authority , evaluating achievements. reconciliation with others. resolution of grief over the death of others and approaching death
81
Daniel levinson
between 50-55 transition with developmental crisism person feels incapable of changins intolerable life structure
"late adult transition"- ages 60-65, narcissists and those too invested with body appearenceare liable to become more reoccupied with death.
creative mental activity is a normal substitute for reduced physical activity
82
second and third individuation
second individuation- when adolescents leave their parents
| third- continues through adulthood
83
cavin colarusso and robert nemiroff
adult developmental process same as child, but child develops psychic structure, and adult continues evolution of existing structure.
84
trailmaking part A
information processing speed; rapid graphomotor tracking
85
WAIS digit symbol
information processing speed-rapid graphomotor tracking
86
stroop A, B
information processing speed- rapid word reading and color naming
87
finger tapping
motor dexterity:right and left finger dexterity
88
boston naming test
word retrieval
89
WAIS picture completion
visual perception
90
WAIS block design
construction ability
91
Rey-Osterieth Complex Figure
visuospatial- paper and pencil copy og complex design
92
Beery developmental test of visual motor integration
paper and pencil copy of simple to complex designs
93
logical memory subtest
immediate and delayed recall of visual designs
94
Rey-Osterieth Complex Figure 3 minute delyed recall
delayed recall of complex design
95
trailmaking part B
executive functions- rapid alterations between tasks
96
stroop C
exectuive functions- inhibition of an overlearned response
97
wisconsin card sorting test
executive functions- categorization and mental flexibility
98
design fluency
executive functions- rapid generation of novel designs
99
verbal fluency
executive functions- FAS and category- rapid word generation
100
brain death evaluations
0-2 months- 48hr interval, two cofirmatory tests
2-12 months- 24 hr interval, one confirmatory test
1-18 yrs- 12 hr interval , confirmatory test- optional
above 18- optional ,confirmatory test- optional
101
examples of brain death clinical criteria
absence of pupilary response to light, uils at midposition with respect to dilatation (4-6 mm)
absence of respiratory drive at paCO2 60 mm HG or higherm or 20 mm HG above normal baseline
coma
and more
102
causes of death amng the young
half of 1-14, and 75% of late adolescence and early adlthood- from accidents, homicides and suicides
103
preschool attitude to death
preoperational.
death is seen as a temporary absence, incomplete and reversible , like departure or sleep.
the main fear is seperation from care taker. - a fear that surfaces iin nightmaresm aggressive play, concern about death of others.
terminally ill preschoolers- may assume responsibility for their illness, as a unishment, and family seperation as rejection
104
school age attitude to death
concrete operational. recognize death as a final reality, but think it happens to old people only
between ages 6-12- active phantasies of violence, aggression, often dominated by themes of death and killing.
105
grief
צער
| subjective feeling precipitated by the death of a loved one
106
Mourning
אבל
| the process by which grief is resolvedm a societal expression of post bereavemtn behavior
107
bereavement
שכול
| the state of being deprived of someone by death and refers to being in the state of mourning
108
normal stages of response to loss
shock and denial- minutes-weeks- disbelief, numbness, protest, and then searching behaviors, yearning
acute anguish- weeks-months- somatic distress, withdrawal, preoccupation, anger, guilt
lost patterns of conduct- restless and agitated, aimless and amotivational, identification with the bereaved
resolution- months, years- returns to work, old rules, reexperience pleasure, seek companionships.
109
most lasting manifestation of grief, especially after spisal death
loneliness
110
grief process
length varies, usually 6 -12 months.
| may have waves, can reemerge later with triggers
111
anniversary reaction
reemergance of grief at date of death, or when the bereaved reaches the age of the deceased when he died.
112
patterns of complicated bereavement
chronic, hypertrophic, delayed
113
chrnoic grief
most common of complicated bereavement.
.bitterness, idealization
occurs when dependant/very close/ambivalent relationship and when social supports lacking, no friends to share surrow
114
hypertrophc grief
usually after sudden death. bereavemt. reaction is intense, withdrawal. can disrupt family. frequently long term
115
delayed grief
prolonged denial, anger and guilt may complicate it's course
116
traummatic grief
combined hypertrophic and chronic grief.
recurrent intense pangs of grief, persistent longing, intrusive images, avoidance and preoccupation with reminders of loss.
positiive memories often are blocked
a history of pschiatric illness is comon , as is a very close identity-defining relationship with the deceased.
(note- in DSM 5-it is s pecifier for complex bereavemtn regarding bereavement after violent death (e.g. suicie, homicie)
117
mortality assocaited with bereavement
highest after bereavement, especially from IHD.
greatest effect on mortality- men under 65
.
118
risk for death among widows
cirhosis and suicide increase
119
effect of bereavement on health behavior
increased alcohol consumption, smoking, use of OTC medications.
120
mental effects of bereavement
MDD, suicide, alchohol, smoking and drugs, prolonged anxiety,panic and PTSD like symptoms
121
biological effects of grief
impaired immune fuctions, decreased lymphocyte proliferation, impaired function of NK cells
122
grief therapy
one on one , group or self help.
| 30% of widows and widowers report becoming isolated after loss- grief therapy most useful for them
123
mourning in chldren
o-2 years: loss of sepach, diffuse distress
younger than 5- eating, aleeping and bowel and bladder dysfunction.
school aged- phobic, hypochondriac, withsrawan, pseudomature, reduced skill performance and peer relations
dolescents- behavioral problems, somatic symptoms, arratic mods, stoicis. boys- delinquent, girls- sexual
rates of depression in bereaved children and adolescents is as high as bereaved adults.
124
bereavement vs MDD
in bereavement- no guilt/worthlessesssuicidality/psychomotor retardation.
dysphoria triggered by reminders of deceased
onset within 2 months, and duration up to 2 months, only mild and transient functional impairment, no family or personal history of MSS
125
criterion A and B in persistent complex bereavement disorder
a. death of someone close
b. 1/4 for 12 months(adult( or 6 mnths(child):
1. persistent yearning .longing
2. intense surrow
3. preoccupation with the deceased
4. preoccupation with circumstances of the death
126
criterion C persistent complex bereavement disorder
6/12 for 12 months (adults), 6 mos(child)
1. difficulty accepting death
2. disbelief/emotional numbness
3.difficulty with positive reminisicne
4.bitterness or anger
5. maladaptive appraisals about death(e.g. self blame)
excessive aviodance of remininding.
7. desire to die to join with the deceased
8, difficulty trusting others
9. feeling alone and detatched
10. life is meaningless,cannot function without him
11. confusion about role and identity
12.difficulty to pursue interests or plan future
127
endicott substitution criteria for depression:
| changes in appetite/weight
tearfullness, depressed appearance
128
endicott substitution criteria for depression:
| sleep disturbance
social withdrawal, decreased talkativeness
129
endicott substitution criteria for depression: loss of energy
brooding, self pity, pessimism
130
endicott substitution criteria for depression: memory and concentration deficits, indecisiveness
lack of reactivity
131
symptoms of persistent vegetative states
no evidence of awareness
no responsse
no receptive or expressive language
return of sleep-wake cycles,arousal, smiling, frowning, yawning
preserved brainstem ot hypothalamic autonomic functions
bowel and bladder incontinence
variably preserved cranial nerve and spinal reflexes
132
tarasoff 1 and 2
tarasoff 1- duty to warn in case a patient is dangerous
| tarasoff 2- duty to protect in addition to warning
133
indications for seclusion and restraint
prevent imminant harm
prevent siginificant diruption to treatment program or physical surroindings
assist in treatment as part of an ongoing behavior therapy
decrease sensory ovestimulation(for seclusion)
patient's voluntary reasonable request
134
contraindications for seclusion and restraint
unless under close supervivions: extremely unstable medical/mental condition
delirious ot demented who cnnot tolerate decreased stimulation
overly suicidal patientssevere drug reaction ot OD who require moitoring
135
M'Naghten rule
unguilty if crime due to mental disorder
136
Durham rule
an accused person is not criminally responsible if the act was a product of mental health
137
risk managemtn of recovered memories(pg 1390)
neutrality, do not suggest abuse
stay clinically focused
carefully document
closely monitor supervisory and collaborative therapy relationships
clarify nontreamten roles with family members
avoid hypnosis/amobarbitl unless indicated(with consultaion only)
dont take cases you cannot handle
obtain coonsultation
don't suggest law suits
inform that more than brief therapy may be required
stop and refer if unconfortable
138
leading cases of disability -adjusted life year
HIV (12.1), MDD (5.7)
139
suicide - mental illness
```
a systematic review shoew that 98% had mental dis.
35,8%- mood dis
22.4%- substance
11.6%- personality
10.6%- schziophrenia
```
140
medications that can mimic dementia
```
anticholinergic
antihypertensive
antipsychotic
steroids
digitalis
narcotics
NSAIDS
phenytoin
polypharmacy
sedative hypnotics
```
141
mental situation that mimic dementia
anxiety
depression
maina
delusional (paranoid) disorders
142
metabolic and endocrine disorders that may resemble dementia
```
addisn
cushing
hepatic faiure
hypercarbia(COPD)
hyper/hyonatremia
hyer/hypothyroidism
hyperparathyroidism
hypoglycemia
renal failure
volue depletion
```
143
conditions that resemble dementia
fecal impaction
hospitalizaion
impaired hearing/vision
144
in WAIS R- what is and is not affected by age?
voacbulary and general knowledge may even improve with age (at least for first 7 decades)- chapter 54.2e in comprehensive text book
other test results- similarities ad digit symbol susbstitution- may change with age.
145
depression in depression in neuropsychiatric evaluation
impaired psychomotor performance, especially visuospatial functioning and timed motor performance
146
whcih part of WAIS-R is most sensitive indicator of brain damage?
performance more than verbal part.
147
delirium/confusion among the terminally ill
90%. reversible in 50%. may repond to antipsychotics or pain relievers
148
treatment of fatigue among terminally ill
stimulants
149
treatment for nausea and vomiting among terminally ill
THC.
oral- dronabinol (Marinol), 1-2 mg every 8 hours.
marijuana cigaretes more effective
150
depression or anxiety among terminally ill
use antianxiety/antidepressants. opoiods have strong antianxiety effect
151
dyspnea or cough among terminally ill
treat with: opiiids, oxygen, bronchodilaters
152
pשin for terminally ill
opiods are gold standard
153
among those considering euthenasia- what are the most common end of life concerns?
loss of autonomy-85%
decreased ability to participate in enjoyable life activities- 77%
losing control of body functions- 63%
154
4 elements of malpratice
4 Ds- duty, deviation, damage, direct causation:
1) a doctor -patient relationship existed that created a duty of care
2)a deviation from the standatd of care occured
3) patient was damaged
4) deviation directly caused the damage
giving advice on radio show- cannot be sued for malpractice
155
באלו מקרים לא חייבים הסכמת הורי לבדיקה וטיול במי שלא מלאו לו 18 שנים?
1. החלטות הקשורות להריון
2. מחלות מין
3. תלות בסמים ואלכוהול
4. מחלות מדבקות
156
policemant at the elbow law
criminal is not responsible if acted on an irresistible impulse- it could have been done even if the police were present.
157
M'Nagthen rule
persons are not guilty if crime performed under a mental illness, such that they were unaware of the naturem quality and consequences of their acts or if they were incapable of realizing that their act was wrong
to sbsolve from punshment- a delusio used in evidence must be one that, if true, would be an adequate defense. if the delusinal idea does not justify the crime- they are held resposible, guilty and punishable.
knwon as the "right-wrong" test.
