geriatricdepression-老年抑郁癥課件

1、geriatricdepression-老年抑郁癥1 Depression in Older People Guanglei Xun Mental Health Center of Shandong Province geriatricdepression-老年抑郁癥 2 Introduction of Depression(1) nDifinition of depression Depressive disorder is characterized by depressed mood that is out of keeping with the circumstances. It ma

2、y vary from low mood to melancholia, or even stupor. In severe cases, psychotic symptoms such as delusions and hallucinations may be present. Anxiety and motor agitation may be more prominent than depression in some cases. geriatricdepression-老年抑郁癥 3 Introduction of Depression(2) nCore symptoms Depr

3、essed mood Loss of interest or pleasure Decreased energy, increased fatigue nAdditional symptoms Loss of confidence Inappropriate and excessive guilt Recurrent thoughts of death, suicidal thoughts or behaviour Diminished evidence of ability to think or concentrate Change in psychomotor activity Slee

4、p disturbance Appetite change and corresponding weight change geriatricdepression-老年抑郁癥 4 Introduction of Depression(3) nDuration: Symptom and severity criteria are met for at least 2 weeks nSeverity impairment of social function individual subjective distress undesirable outcomes on oneself geriatr

5、icdepression-老年抑郁癥 5 Geriatric Depression n Occurred in people aged 65 and above. n 10% worldwide population is made up of older adults. n Depressive disorder is one of the most common mental disorders in later life. n The prevalence of geriatric depression is about 13.5%. n Geriatric depression has

6、 specific features, which do not accord with the rigid diagnostic criteria. Beekman AT.et al. British Journal of Psychiatry,1999,174:307-11 geriatricdepression-老年抑郁癥 6 Types of Geriatric Depression nEndogenous depression nOrganic mood disorder nDysthymia nAdjustment disorder nVascular depression ger

7、iatricdepression-老年抑郁癥 7 Vascular Depression a new category of geriatric depression(1) nHypothesis Damage to end-arteries supplying subcortical striatal -pallidum-thalamus-cortical pathways disrupts the neuro- transmitter circuitry involved in mood regulation, and may cause depression. geriatricdepr

8、ession-老年抑郁癥 8 Vascular Depression a new category of geriatric depression(2) nFeatures Depression arises in late life Reduced insight Apathy and retardation Cognitive impairment Neurological evidence of ischemic brain damage geriatricdepression-老年抑郁癥 9 Features of Geriatric Depression(1) n Compared

9、with young-adult depression, the depression in later life has special clinical features Anxiety Somatization n Anxiety, somatization may be the most common symptoms, sometimes it covers up the depressed mood. Some geriatric depressive patients often go to see doctors in division of digestive disease

10、s, division of cardiology, department of neuroloy, instead of the psychiatry. geriatricdepression-老年抑郁癥 10 Features of Geriatric Depression(2) n Comorbidity Diabetes Cushings disease Cerebrovascular disease Alzheimers disease Cancer Chronic infections n Geriatric depressive patients are more suscept

11、ible to physical disorders, and on the contrary, physical disorders such as cancer, stroke and Parkinsons disease often lead to depressive disorder in older people. geriatricdepression-老年抑郁癥 11 Features of Geriatric Depression(3) nMore severe cognitive dysfunction Mnemic dysfunction Executive dysfun

12、ction Attention dysfunction Co-exist with dementia geriatricdepression-老年抑郁癥 12 Features of Geriatric Depression(4) nRefractoriness longer course of treatment comorbidity of physical disorders interactions of medicine geriatricdepression-老年抑郁癥 13 Risk Factors of Geriatric Depression nPoor health or

13、disability nIsolation or living alone nLack of social support nNegative life events nPrevious history of depression nGender geriatricdepression-老年抑郁癥 14 Life Events in Geriatric Depression n Bereavement n Separation n Acute physical illness n Medical illness or threat to life of someone close n Home

14、lessness or moving into a new place n Major financial crisis n Negative interactions with family member or friend n Loss of significant other(including a pet) geriatricdepression-老年抑郁癥 15 Chronic Stress in Geriatric Depression n Declining health or have to depend on others n Sensory loss or cognitiv

15、e decline n Housing problems n Major problems affecting family member n Socioeconomic decline n Marital difficulty n Retirement n Social isolation geriatricdepression-老年抑郁癥 16 Neurobiological Basis of Geriatric Depression (1) nNeurotransmitter changes Serotonin (5-HT) Dopamine (DA) Noradrenaline (NE

16、) geriatricdepression-老年抑郁癥 17 Neurobiological Basis of Geriatric Depression (2) nNeuroendocrine changes Hyperactivity and dysregulation of HPA High cortisol levels DST (Dexamethasone suppression test) geriatricdepression-老年抑郁癥 18 Neurobiological Basis of Geriatric Depression(3) nStructural brain ch

17、anges Cerebral atrophy Deep white matter lesions Subcortical lesions in gray matter Damage to the subcortical-frontal circuitry geriatricdepression-老年抑郁癥 19 Neurobiological Basis of Geriatric Depression(4) nFunctional brain changes PET SPECT RTIP event related fMRI geriatricdepression-老年抑郁癥 20 Treat

18、ment in Geriatric Depression (1) nPsychoeducation Depression is a treatable disorder Antidepressants are non-addictive The importance of compliance Not to stop treatment when recovery has occurred geriatricdepression-老年抑郁癥 21 Treatment in Geriatric Depression (2) n Antidepressants Tricyclics(TCAs):

19、seldom used Selective serotonin reuptake inhibitors(SSRIs) n Fluvoxamine n Fluoxetine n Paroxetine n Sertraline n Citalopram, S-citalopram Other newer antidepressants n Trazodone n Moclobemide n Venlafaxine n Mirtazepine n Bupropion geriatricdepression-老年抑郁癥 22 Treatment in Geriatric Depression (3)

20、n Antidepressants Strategy: start low, go slow Efficacy: little difference in efficacy between any class of antidepressants Response rate: 50%60% Acute treatment course: 12 weeks Drug interaction: citalopram has less interactions than other SSRIs geriatricdepression-老年抑郁癥 23 Treatment in Geriatric D

21、epression (4) nConsiderations in selecting antidepressant Safety Tolerability and compliance Prior response to a particular agent Drug interactions Comorbidity (dementia,physical disorder) geriatricdepression-老年抑郁癥 24 Treatment in Geriatric Depression (5) nOther physical treatments Electroconvulsive therapy (ECT) Transcranial magnetic stimulation (TMS) Vagal nerve st