ASSESSMENT OF DEPRESSION IN THE ELDERLY. Alina Rais, M.D. Associate Professor of Psychiatry Medical Director Geriatric Psychiatry Center University of Toledo Department of Psychiatry. Demographic of Aging. 1900 – Only 4% were 65 and older 2000 – Increased by 13% in elderly population
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IN THE ELDERLY
Alina Rais, M.D.
Associate Professor of Psychiatry
Geriatric Psychiatry Center
University of Toledo
Department of Psychiatry
Undertreated in the Elderly
Patients Percent (%)
Maddux RE, Delrhim KK, Rapaport MH. CNS Spectr. Vol 8, No 12 (Suppl 3), 2003.
Number Over 1 Year
*P,.001 after controlling for comorbidity, type of insurance, and the use of antidepressants
N=3,481 primary care patients >65 years of age
Adapted from: Luber MP, Meyers BS, Williams-Russo PG, et al Depression and service utlization in elderly primary care patients. Am J Geriatr Psychiatry 2001:2:169-176
Maddux RE, Delrahim KK, Rapaport MH. CNS Spectr. Vol 8, No 12 (Suppl 3). 2003.
Number of Suicides
In the United States, 1994
Adapted from: Hirschfeld RM, Russell JM. Assessment and treatment of suicidal patients. N Engl J Med. 1997;13:910-913.
- Female > male
- Changes in neurotransmitter activity
- Dysregulation of the HPA (hypothalamic,
- Dysregulation of thyroid function
- Decreased secretion of growth hormone
the day, nearly every day, and
a. Duration from 1-6 months
b. Duration from 6-24 months
c. Duration >24 months
- objective evidence from physical and neurological examination and laboratory tests; and/or history of cerebral disease, damage, or dysfunction, or of systemic physical disorder known to cause cerebral dysfunction; including hormonal disturbances and drug effects
- a presumed relationship between the development or exacerbation of the underlying disease and clinically significant depression
- the disturbance occurs exclusively to the direct psychological effect of alcohol or a substance use
- recovery or significant improvement of the depressive symptoms following removal or improvement of the underlying presumed cause
8) Exclusion criteria:
There has never been:
an episode or mania or hypomania;
a chronic psychotic disorder, such as schizophrenia or delusional disorders. Previous history of major depressive episode is not an exclusion criterion.
Maddux RE, Delrahim KK, Ra[a[prt <J/ CMS S[ectr/ V
Maddux RE, De;rajo, LL. Ra[a[prt <J. CMS S[pectr/ Vp; 8, No 12 (Suppl 3). 2003.
Pain GI Symptoms
Arthritis Multiple diffuse symptoms
Weight Loss Headache
Cerebrovascular disease can:
- a depressive syndrome
- left hemisphere deep white matter
- left putamen
- dorsolateral frontal region
- inferior orbitofrontal region
- medial anterior cingulate
- frontostriatal, circuitry and limbic
- damage of the catecholamine neurons by
white matter lesions in the pons
- Disruption of the orbital frontal cortex control
over the serotonergic raphe nuclei
- Executive Function
A state of reduced motivation.
- Tendency not to initiate motor activity
- Absence of motivation to initiate new activities
- Absence or reduction of emotional interest
- Absence of generative ideation
Screening Measures for Depression in Children, Depression in Dementia or CSDD)
Adolescents, Adults, and the Elderly
Measure Spanish VersionNo of Items Time to CompletePsychometric properties/cutoff
Medications Useful in Treating Depression Depression in Dementia or CSDD)
Medication Doses Ranger Uses Precautions