Weeks 1-3

• 1. Enlightenment
• 2. Scientific study
• 3. psychotropic drugs
• 4. community mental health
• 5. decade of the brain

• - 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

• - scientists: Freud, Kraepelin, Bleuler
• - Change of view: mental illness can be alleviated

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

• - 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

• - 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

• -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)

• 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

Depression and anxiety

They are more likely to present with memory disturbance/somatic complaints than with the feelings associated with depression.

Same: poor memory, disorientation, poor judgment, agitation or psychomotor retardation.

Different: Higher functioning in depression than dementia, downcast mood in depression,

• S-sleep disorders
• P- problems with eating or feeding
• I- incontinence
• C- confusion
• E- evidence of falls
• S- skin breakdown

• 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