geriatricdepression老年抑郁癥

1、1,Depression in Older People,Guanglei Xun Mental Health Center of Shandong Province,2,Introduction of Depression(1),Difinition of depressionDepressive disorder is characterized by depressed mood that is out of keeping

2、 with the circumstances. It may 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 prominen

3、t than depression in some cases.,3,Introduction of Depression(2),Core symptomsDepressed moodLoss of interest or pleasure Decreased energy, increased fatigue Additional symptomsLoss of confidenceInappropriate and ex

4、cessive guiltRecurrent thoughts of death, suicidal thoughts or behaviourDiminished evidence of ability to think or concentrateChange in psychomotor activitySleep disturbanceAppetite change and corresponding weight c

5、hange,4,Introduction of Depression(3),Duration: Symptom and severity criteria are met for at least 2 weeksSeverityimpairment of social functionindividual subjective distressundesirable outcomes on oneself,5,Geriatric

6、 Depression,Occurred in people aged 65 and above. 10% worldwide population is made up of older adults. Depressive disorder is one of the most common mental disorders in later life. The prevalence of geriatric depressi

7、on is about 13.5%.Geriatric depression has specific features, which do not accord with the rigid diagnostic criteria.,Beekman AT.et al. British Journal of Psychiatry,1999,174:307-11,6,Types of Geriatric Depression,Endog

8、enous depressionOrganic mood disorder Dysthymia Adjustment disorder Vascular depression,7,Vascular Depression — a new category of geriatric depression(1),HypothesisDamage to end-arteries supplying subcortical striat

9、al -pallidum-thalamus-cortical pathways disrupts the neuro- transmitter circuitry involved in mood regulation, and may cause depression.,8,Vascular Depression — a new category of geriatric depression(2),FeaturesDepressi

10、on arises in late lifeReduced insightApathy and retardationCognitive impairmentNeurological evidence of ischemic brain damage,9,Features of Geriatric Depression(1),Compared with young-adult depression, the depressio

11、n in later life has special clinical featuresAnxietySomatizationAnxiety, somatization may be the most common symptoms, sometimes it covers up the depressed mood. Some geriatric depressive patients often go to see doc

12、tors in division of digestive diseases, division of cardiology, department of neuroloy, instead of the psychiatry.,10,Features of Geriatric Depression(2),ComorbidityDiabetesCushing’s diseaseCerebrovascular diseaseAlz

13、heimer’s diseaseCancerChronic infectionsGeriatric depressive patients are more susceptible to physical disorders, and on the contrary, physical disorders such as cancer, stroke and Parkinson’s disease often lead to de

14、pressive disorder in older people.,11,Features of Geriatric Depression(3),More severe cognitive dysfunctionMnemic dysfunctionExecutive dysfunctionAttention dysfunctionCo-exist with dementia,12,Features of Geriatric D

15、epression(4),Refractorinesslonger course of treatmentcomorbidity of physical disordersinteractions of medicine,13,Risk Factors of Geriatric Depression,Poor health or disabilityIsolation or living aloneLack of soc

16、ial supportNegative life eventsPrevious history of depressionGender,14,Life Events in Geriatric Depression,BereavementSeparationAcute physical illnessMedical illness or threat to life of someone close Homelessness

17、 or moving into a new placeMajor financial crisisNegative interactions with family member or friendLoss of ‘significant other’(including a pet),15,Chronic Stress in Geriatric Depression,Declining health or have to dep

18、end on othersSensory loss or cognitive declineHousing problemsMajor problems affecting family memberSocioeconomic declineMarital difficultyRetirementSocial isolation,16,Neurobiological Basis of Geriatric Depressio

19、n (1),Neurotransmitter changesSerotonin (5-HT)Dopamine (DA)Noradrenaline (NE),17,Neurobiological Basis of Geriatric Depression (2),Neuroendocrine changesHyperactivity and dysregulation of HPAHigh cortisol levelsDST

20、 (Dexamethasone suppression test),18,Neurobiological Basis of Geriatric Depression(3),Structural brain changesCerebral atrophyDeep white matter lesionsSubcortical lesions in gray matterDamage to the subcortical-front

21、al circuitry,19,Neurobiological Basis of Geriatric Depression(4),Functional brain changesPETSPECTRTIPevent related fMRI,20,Treatment in Geriatric Depression (1),PsychoeducationDepression is a treatable disorderAnt

22、idepressants are non-addictiveThe importance of complianceNot to stop treatment when recovery has occurred,21,Treatment in Geriatric Depression (2),AntidepressantsTricyclics(TCAs): seldom usedSelective serot

23、onin reuptake inhibitors(SSRIs)FluvoxamineFluoxetineParoxetineSertralineCitalopram, S-citalopramOther newer antidepressantsTrazodoneMoclobemideVenlafaxineMirtazepineBupropion,22,Treatment in Geriatric Depressi

24、on (3),AntidepressantsStrategy: start low, go slowEfficacy: little difference in efficacy between any class of antidepressantsResponse rate: 50%~60%Acute treatment course: 12 weeksDrug interaction: citalopram has le

25、ss interactions than other SSRIs,23,Treatment in Geriatric Depression (4),Considerations in selecting antidepressantSafetyTolerability and compliancePrior response to a particular agentDrug interactionsComorbidity (

26、dementia,physical disorder),24,Treatment in Geriatric Depression (5),Other physical treatmentsElectroconvulsive therapy (ECT)Transcranial magnetic stimulation (TMS)Vagal nerve stimulation (VNS),25,Treatment in Geriatr

27、ic Depression (6),Psychological treatmentsCognitive behaviour therapy (CBT)Interpersonal therapyFamily therapyPsychodynamic psychotherapy,26,Treatment in Geriatric Depression (7),Other Light therapyMusic therapy,27

28、,Outcome of Geriatric Depression,The long-term outcome is similar in younger and older patients.There may be more susceptability to relapse in older patients, but relapse can response to treatment.The risk of relapse a