When compared with those with late-onset depression, elderly individuals with early-onset depression have:
E. Elderly people with depression may have a relapse or recurrence of a depressive disorder from adulthood (early onset) or they might have fresh onset late-life depression. Late-onset major depression includes a large subgroup of patients with neurological problems. It is possible that milder, unnoticed episodes of depression with early-onset might be a risk factor for late-life depression by contributing to brain abnormalities. When compared with elderly individuals with early-onset major depression, patients with late-onset major depression have a less frequent family history of mood disorders, a higher prevalence of disorders of dementia, a larger impairment in neuropsychological tests, a higher rate of dementia development on follow-up, more neurosensory hearing impairment, a greater enlargement in lateral brain ventricles, and more white matter hyperintensities.
Reference:
The most effective psychological intervention to reduce depression and emotional burden in caregivers of people with dementia is:
C. A systematic review of studies looking at improvements in caregiver psychological health revealed that six or more sessions of individual behavioural management therapy had the highest quality of evidence. This intervention was effective for up to 32 months after intervention. There was some evidence supporting individual and group caregiver coping sessions to reduce depression among caregivers; the benefits may last up to 3 months. Educational interventions, group behavioural management sessions, fewer than six individual behavioural management sessions, and supportive therapy were not effective interventions for reducing a caregiver’s symptoms.
Which of the following methods of psychological management of neuropsychiatric symptoms of dementia uses materials such as old newspapers and household items to stimulate memories and enable people to share and value their experiences?
A. Reminiscence therapy uses materials such as old newspapers and household items to stimulate memories and enable people to share and value their experiences. The evidence base for this therapy in improving behavioural problems is limited. It may have a modest impact on mood symptoms. Validation therapy is based on Rogerian humanistic psychology; it encourages individual uniqueness and gives the opportunity to resolve conflicts by encouraging and validating the expression of feelings and emotions. Reality orientation therapy is based on the fact that patients with dementia function poorly secondary to impairment in orientating information (day, date, weather, time, and use of names) Hence reminders can improve functioning. Cognitive stimulation therapy is similar to reality orientation therapy but aims at improving information processing rather than factual knowledge to address problems in functioning in patients with dementia. Snoezelen therapy is also called multisensory stimulation. It is grounded on the supposition that neuropsychiatric symptoms may result from periods of sensory deprivation. It combines relaxation and exploration of sensory stimuli (e.g. lights, sounds, and tactile sensations).
A 72-year-old man presents with paranoid delusions and ideas of reference.
The most common cause of new onset psychotic symptoms in this age group is:
D. Psychosis is a prominent non-cognitive symptom seen in Alzheimer’s dementia. The prevalence of psychosis in patients with Alzheimer’s dementia has been estimated at 30–50%. Psychotic symptoms are seen in 0.2–4.7% of the elderly population in the community. In nursing homes the prevalence rates are very high – 10–60%. Dementia accounts for the highest number of psychotic symptoms diagnosed among elderly people. Prospective studies have shown that 36.7% of patients with psychotic symptoms may have dementia, most likely of Alzheimer’s type.
According to the stage theory of grief, the earliest response after a natural death of a family member is:
A. Bowlby and Parkes proposed a stage theory of grief for adjustment to bereavement that included four stages: shock–numbness, yearning–searching, disorganization–despair, and reorganization. This was adapted by Kubler-Ross, who described a fi ve-stage response of terminally ill patients to impending death: denial–dissociation–isolation, anger, bargaining, depression, and acceptance (mnemonic: DABDA). A longitudinal cohort study (Yale Bereavement Study) has established that in terms of absolute frequency, disbelief was not the initial grief indicator as proposed by the original grief theory. The study found that most people endorsed acceptance as initial reaction even in the initial month after loss in cases of natural deaths. In contrast, family members of those who had a traumatic death and individuals with complicated grief disorder had signifi cantly lower levels of acceptance. It was also noted that prognostic awareness of a patient’s terminal illness for more than 6 months before death may promote acceptance of the death.
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