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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
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
What are the main components of the period of scientific study?
- - scientists: Freud, Kraepelin, Bleuler
- - Change of view: mental illness can be alleviated
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
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
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
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)
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
What is the most prevalent mental health illnesses in the older population?
Depression and anxiety
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.
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,
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
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