Psychiatric comorbidity and depression in older adults

Abstract

Late-life depression rarely occurs in isolation. Thus, screening for and assessment of late-life depression should always involve screening for other psychiatric disorders, including anxiety, personality disorders, and alcohol misuse. Comorbidity often makes treatment to relieve depressive symptoms more complicated, more comprehensive, and longer. Current late-life depression research indicates the strongest support for antidepressant medication and/or cognitive-behavioral therapy for comorbid anxiety, antidepressants and dialectical behavior therapy for comorbid personality disorders, and antidepressants and counseling for alcohol abuse that incorporates specific coping skills training for mood management, based on cognitive-behavioral principles. The clinician should provide sufficient psychoeducation for the older client and involve the client in treatment planning and progress evaluation. Very little research has specifically focused on treating depression and psychiatric comorbidity simultaneously, so additional research in this area is needed.

Trends in Psychotropic Use in Saskatchewan from 1983 to 2007

“…This discrepancy can be explained by 1) older adults are less likely than younger people to report having mental problems in epidemiological surveys 20 ; 2) older adults may use psychotropics to relieve physical aliments; or 3) older adults tend to have a high probability of psychiatric comorbidities, indicating more severe conditions, which may require more psychotropics. 21 The decrease in use we found between 1983 and 1989 (8.38% to 7.44%) may be explained by a shift in the drug plan coverage from a first-dollar, cost-sharing arrangement with a fixed copayment, to a family-based deductible program in 1988. The dominant growth of psychotropic use in the late 1990s is consistent with numerous factors, including, that with more consistent home-based supports, patients tend to stay home longer, the "de-insurance" of light levels of care, 11 and the introduction of new medications.…”

Acceptance and Commitment Therapy With Older Adults: Rationale and Considerations

“…Comorbidity of anxiety and depression are common and difficult to distinguish among older people (Gum & Cheavens, 2008). Other research suggests that in chronically ill, functionally impaired older adults, anxiety and depressive symptoms commonly co-occur ( r = 0.71; Petkus et al, 2010).…”

The overlap of symptomatic dimensions between frontotemporal dementia and several psychiatric disorders that appear in late adulthood

“…Patients usually report somatic complaints, hypochondria, insomnia, and apathy symptoms (lack of interest and motivation), but sadness, loss of hope and wreck are less frequent (Avery & Silverman, 1984;Brown et al, 1984). It is usual for depression to present co-morbidly with other psychiatric disorders such as anxiety, personality disorders and substance abuse (more frequently, alcohol) (Callahan et al, 1994;Gum & Cheavens, 2008;Speer & Bates, 1992). Several authors have found that reduced insight is not uncommon among these patients (Ghaemi et al, 2000;Yen et al, 2005).…”