geriatricdepression-老年抑郁症演示教学

1DepressioninOlderPeopleGuangleiXunMentalHealthCenterofShandongProvince

2IntroductionofDepression(1)DifinitionofdepressionDepressivedisorderischaracterizedbydepressedmoodthatisoutofkeepingwiththecircumstances.Itmayvaryfromlowmoodtomelancholia,orevenstupor.Inseverecases,psychoticsymptomssuchasdelusionsandhallucinationsmaybepresent.Anxietyandmotoragitationmaybemoreprominentthandepressioninsomecases.

3IntroductionofDepression(2)CoresymptomsDepressedmoodLossofinterestorpleasureDecreasedenergy,increasedfatigueAdditionalsymptomsLossofconfidenceInappropriateandexcessiveguiltRecurrentthoughtsofdeath,suicidalthoughtsorbehaviourDiminishedevidenceofabilitytothinkorconcentrateChangeinpsychomotoractivitySleepdisturbanceAppetitechangeandcorrespondingweightchange

5GeriatricDepressionOccurredinpeopleaged65andabove.10%worldwidepopulationismadeupofolderadults.Depressivedisorderisoneofthemostcommonmentaldisordersinlaterlife.Theprevalenceofgeriatricdepressionisabout13.5%.Geriatricdepressionhasspecificfeatures,whichdonotaccordwiththerigiddiagnosticcriteria.BeekmanAT.etal.BritishJournalofPsychiatry,1999,174:307-116TypesofGeriatricDepressionEndogenousdepressionOrganicmooddisorderDysthymiaAdjustmentdisorderVasculardepression7VascularDepression—anewcategoryofgeriatricdepression(1)HypothesisDamagetoend-arteriessupplyingsubcorticalstriatal-pallidum-thalamus-corticalpathwaysdisruptstheneuro-transmittercircuitryinvolvedinmoodregulation,andmaycausedepression.8VascularDepression—anewcategoryofgeriatricdepression(2)FeaturesDepressionarisesinlatelifeReducedinsightApathyandretardationCognitiveimpairmentNeurologicalevidenceofischemicbraindamage9FeaturesofGeriatricDepression(1)Comparedwithyoung-adultdepression,thedepressioninlaterlifehasspecialclinicalfeaturesAnxietySomatizationAnxiety,somatizationmaybethemostcommonsymptoms,sometimesitcoversupthedepressedmood.Somegeriatricdepressivepatientsoftengotoseedoctorsindivisionofdigestivediseases,divisionofcardiology,departmentofneuroloy,insteadofthepsychiatry.10FeaturesofGeriatricDepression(2)ComorbidityDiabetesCushing’sdiseaseCerebrovasculardiseaseAlzheimer’sdiseaseCancerChronicinfectionsGeriatricdepressivepatientsaremoresusceptibletophysicaldisorders,andonthecontrary,physicaldisorderssuchascancer,strokeandParkinson’sdiseaseoftenleadtodepressivedisorderinolderpeople.

11FeaturesofGeriatricDepression(3)MoreseverecognitivedysfunctionMnemicdysfunctionExecutivedysfunctionAttentiondysfunctionCo-existwithdementia12FeaturesofGeriatricDepression(4)Refractorinesslongercourseoftreatmentcomorbidityofphysicaldisordersinteractionsofmedicine13RiskFactorsofGeriatricDepressionPoorhealthordisabilityIsolationorlivingaloneLackofsocialsupportNegativelifeeventsPrevioushistoryofdepressionGender14LifeEventsinGeriatricDepressionBereavementSeparationAcutephysicalillnessMedicalillnessorthreattolifeofsomeonecloseHomelessnessormovingintoanewplaceMajorfinancialcrisisNegativeinteractionswithfamilymemberorfriendLossof‘significantother’(includingapet)15ChronicStressinGeriatricDepressionDeclininghealthorhavetodependonothersSensorylossorcognitivedeclineHousingproblemsMajorproblemsaffectingfamilymemberSocioeconomicdeclineMaritaldifficultyRetirementSocialisolation16NeurobiologicalBasisofGeriatricDepression(1)NeurotransmitterchangesSerotonin(5-HT)Dopamine(DA)Noradrenaline(NE)17NeurobiologicalBasisofGeriatricDepression(2)NeuroendocrinechangesHyperactivityanddysregulationofHPAHighcortisollevelsDST(Dexamethasonesuppressiontest)18NeurobiologicalBasisofGeriatricDepression(3)StructuralbrainchangesCerebralatrophyDeepwhitematterlesionsSubcorticallesionsingraymatterDamagetothesubcortical-frontalcircuitry19NeurobiologicalBasisofGeriatricDepression(4)FunctionalbrainchangesPETSPECTRTIPeventrelatedfMRI20TreatmentinGeriatricDepression(1)PsychoeducationDepressionisatreatabledisorderAntidepressantsarenon-addictiveTheimportanceofcomplianceNottostoptreatmentwhenrecoveryhasoccurred21TreatmentinGeriatricDepression(2)AntidepressantsTricyclics(TCAs):seldomusedSelectiveserotoninreuptakeinhibitors(SSRIs)FluvoxamineFluoxetineParoxetineSertralineCitalopram,S-citalopramOthernewerantidepressantsTrazodoneMoclobemideVenlafaxineMirtazepineBupropion22TreatmentinGeriatricDepression(3)AntidepressantsStrategy:startlow,goslowEfficacy:littledifferenceinefficacybetweenanyclassofantidepressantsResponserate:50%~60%Acutetreatmentcourse:12weeksDruginteraction:citalopramhaslessinteractionsthanotherSSRIs23TreatmentinGeriatricDepression(4)ConsiderationsinselectingantidepressantSafetyTolerabilityandcompliancePriorresponsetoaparticularagentDruginteractionsComorbidity(dementia,physicaldisorder)24TreatmentinGeriatricDepression(5)OtherphysicaltreatmentsElectroconvulsivetherapy(ECT)Transcranialmagneticstimulation(TMS)Vagalnervest