187 Mental Health Concerns and The Older Adult
fore, lower doses of bipolar medications might be needed and are associated with good outcomes (Sajatovic et al., 2013). Lower rates of mood-stabilizing medica- tion in elderly patients will also decrease side effects and possibly ease medication longevity. Recent findings for nonphar - macological approaches to bipolar treat- ment can be applied to the older adult population. A new treatment approach utilizes peer mentors who can provide support and hope (Sajatovic et al., 2013). The treatment settings and goals for the older adult with bipolar will depend on the current mental status of the patient. Schizophrenia Like bipolar, schizophrenia is a diagno- sis expected to impact the remainder of life. Schizophrenia onset is typically in late adolescence to early adulthood, but an older adult diagnosis is possible (Boyd, 2017). Psychosis is classically associated with schizophrenia. Definition of psychosis (APA, 2022h): 1. An abnormal mental state involving significant problems with reality testing It is characterized by serious impairments or disruptions in the most fundamental higher brain functions—perception, cognition and cognitive processing, and emotions or affect—as manifested in behavioral phenomena, such as delusions, hallucinations, and significantly disorganized speech. 2. Historically, any severe mental disorder that significantly interferes with functioning and ability to perform activities essential to daily living. Psychosis requires immediate inter- vention and is handled according to workplace policy and state law for the healthcare worker. Older adults with
schizophrenia usually have improved symptoms with age and experience fewer relapses (Boyd, 2017). The health- care worker should be aware of common symptoms of schizophrenia. Schizophre- nia symptoms are classified as positive, negative, and neurocognitive (Boyd, 2017): ● Positive symptoms happen in addition to regular functioning, most commonly as hallucinations (can involve any of the five sense) and delusions (unreasonable beliefs, involving thoughts only). ● Negative symptoms are an absence of regular functioning such as flat affect and diminished emotional expression and activity. ● Neurocognitive impairment is expressed as disorganized speech, thought, or behavior. Prior to the diagnosis of schizophrenia, an assessment would include ruling out medical causes of schizophrenia symp- toms, mainly psychosis. Underlying med- ical etiology can present as psychosis in the older adult. The top five psycho - sis-inducing medical conditions to check the older adult for are substance abuse, thyroid disorders, delirium cause by infec- tion, dementia, and vitamin B12 deficien - cy (Gaddey & Holder, 2021). A thorough assessment of the older adult is prudent prior to an initial diagnosis of schizophre- nia. If the older adult with a diagnosis of schizophrenia is exhibiting symptoms out of their ordinary, a sweep for known med- ical conditions that mimic psychosis is also warranted. A differential diagnosis of brief psychotic disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) can also be considered for the older adult. Collateral information from family, friends, and caregivers would
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