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What were the 5 benchmarks in the evolution of modern psychiatric care?
- 1. Enlightenment
- 2. Scientific study
- 3. psychotropic drugs
- 4. community mental health
- 5. decade of the brain
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What were the main components of the period of enlightenment?
- - Lead by Pinel (France) and Tuke (England)
- - New way of thinking that people could get better
- - Mentally ill were treated as human beings rather than wild animals
- - Concept of asylum came about in this period
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What are the main components of the period of scientific study?
- - scientists: Freud, Kraepelin, Bleuler
- - Change of view: mental illness can be alleviated
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What were the positive outcomes of introducing psychotropic drugs? What were these early drugs?
Patients who seemed beyond reach were able to come back down to a "normal" level of functioning. It improved the hospital environment, and shortened hospital stays
- Chlorpromazine (Thorazine) antipsychotic
- Lithium antimanic
- Imipramine (Tofranil) antidepressant
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What occurred during the period of community health?
- - State hospitals shut down with the Community Mental Health Centers Act (1963)
- - Lead to a deinstitutionalization of the mentally ill, and treatment centers that were closer to home
- - SSI and SSDI were given to the mentally ill, and alleviated the financial burden on the individual states because the federal government was paying most of the cost
- - Community effects: Heavy load on the emergency psychiatric services, homelessness (slipping through the cracks), and more mentally ill seen in county jails
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What occurred during the decade of the brain?
- - Increase in scientific study of the brain
- - crystallized the fact that some behaviors are caused by biologic irregularities
- - Shifted focus from blaming to what could be done
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What are the five Axis's of the DSM?
- -Axis I: Clinical disorder (e.g. schizophrenia)
- -Axis II: personality or developmental disorder (e.g BPD, Mental retardation)
- -Axis III: General medical conditions that relate to axis I or II (e.g. endocrine disorders)
- - Axis IV: Severity of psychosocial stressors (e.g divorce)
- -Axis V: Global assessment functioning (0-100. Lower the score the less functionability)
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What are some barriers to mental health care that exists for older adults?
- 1. Patient barriers: believing stereotypes that depression and memory loss are a normal part of aging (ageism)
- 2 Provider barriers: Older pts are more likely to receive care from primary care physicians than geriatric specialty providers. Providers may not recognize that mental health issues may be expressed as somatic complaints.
- 3. system-economic: medical insurance not covering the time and resources to diagnose a mental health issue
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What is the most prevalent mental health illnesses in the older population?
Depression and anxiety
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How does depression present in older adults?
They are more likely to present with memory disturbance/somatic complaints than with the feelings associated with depression.
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What are the similarities between depression and dementia? What are the differences?
Same: poor memory, disorientation, poor judgment, agitation or psychomotor retardation.
Different: Higher functioning in depression than dementia, downcast mood in depression,
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What is the assessment tool SPICES?
- S-sleep disorders
- P- problems with eating or feeding
- I- incontinence
- C- confusion
- E- evidence of falls
- S- skin breakdown
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What is the Mini-Cog assessment tool? What is it used for?
- It is used to detect Alzheimer's in patients.
- It is done by asking the pt to say 3 unrelated words and to try and remember them. The pt is then asked to draw a clock and to set the hands to a specific time. Then the pt is asked to repeat the 3 unrelated words.
1 point is given for each word remembered and 2 points for a correctly drawn clock, 0 for an incorrect clock.
- 0-2: Positive for dementia
- 3-5: negative
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