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Paulchen Panther
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Erstellt / Aktualisiert 24.04.2020 / 27.04.2020
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Fenster schliessen

!!! Allgemein zu D. in Elderly

  • Oft unerkannt und die Symptome als sommatische Krankheiten gesehen.
  • Incidence of MDD declines with age, but MINOR D. is much more common
  • 15-20% have D. Symptoms without meeting the criteria for D.
  • Fewer than half of depressed seniors are recognized as being depressed!
Fenster schliessen

Mood congruent vs. Mood incongruent psychotic features

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Fenster schliessen

Diagnose und differential Diagnose of late-life mood Disorders

•Bipolar and related disorders

•Major depressive disorder

•Major Depressive Disorder with Mood congruent or Mood incongruent
psychotic features

•Persistent Depressive Disorder (Dysthymia)

•Depressive Episode with insufficient symptoms (minor or
subsyndromal Depression)

•Depression Disorder Due to another medical condition

•Adjustment disorder with depressed mood

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Differential Diagnoses: Bipolar and related disorders:

 

•To meet criteria for a MANIC episode, an individual must exhibit three
or more of the following symptoms:

1)Inflated self-esteem / grandiosity

2)Decreased need for sleep

3)More talkativeness

4)Fight of ideas

5)Distractibility

6)Increased goal-directed activity or psychomotor agitation

7)Excessive involvement in pleasurable activities with potential adverse
consequences (e.g. unrestricted buying episodes)

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•Bipolar disorder varies with aging:

•Post (1978) found that most elderly individuals with bipolar disorder
exhibited a depressive mixture with manic symptomatology

•Spar (1979) reported that manic elderly individuals are atypical in
presentation, with dysphoric mood and denial of classic manic
symptoms

•Shulman (1986) described the special problem of manic delirium.
Manic episodes must be distinguished (but often with difficulty from neuro-
cognitive disorders such as delirium characterized by hallucinations, delusion,
agitation.

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•Late onset psychotic depression:

•(Smith et al. 2011): Depressed patients with illness onset at age 60 or later
had delusions more frequently than did those with earlier onset

 

•Smith et al. 2011: Individuals with delusional depression tended to be older
and respond to Electroconvulsive therapy (ECT), as opposed to tricyclic anti-
depressants

•Delusions of persecution or of having an incurable illness are
more common than delusions with guilt. If guilt predominates in the
delusional picture, it usually involves a relatively trivial episode that
occurred many years before the onset of the depressive episode and
was forgotten over time, but is currently viewed as a major
problem (Bridges, 1986)

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•Depressive Episode with insufficient symptoms
(minor or subsyndromal depression)

!!! –> IN DSM-V: Is coded “other specified depressive disorder

•This diagnosis can be assigned when an individual who has never met
criteria for a mood disorder, experiences depressed affect and at least one
other symptom of a major depressive episode that persist for at least 2
weeks

•Associations with impaired physical functioning, disability, poorer self-rated
health low social support, female gender and unmarried status
(Beckman et al. 1995)

Fenster schliessen

•Depressive Disorder Due to another medical condition

•Depressive disorders have been associated with a variety of
physical illnesses including cardiovascular disease, endocrine
disturbances, Parkinsons disease, stroke, cancer etc.

•Controversy continues over the degree to which acute or chronic
medical illnesses cause depression because of direct physiological
effects on the brain or because of a psychological reaction to
the disability and other life changes evoked by these illnesses.

•To meet criteria for “due to another medical condition” there must
be evidence that the mood disturbance is a direct pathophysiological
consequence of another medical condition.

•Otherwise a diagnosis of adjustment disorder with depressed mood

   should be made!!!