Assessment, Diagnosis and Treatment of Psychological Disorders in the Late Adult Population

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According to our textbook over half of the entire adult population, over the span of their lifetime, struggle with symptoms of one or more psychological disorder(s) or have a family member that is affected. Psychological disorders reflect the developmental processes that occur in life from conception through death. Whether or not a symptom or disorder will emerge in late adulthood is a reflection on the balance between risks and protective factors that begin evolving much earlier and continue throughout life(Whitbourne & Meeks, 2009). Criteria used to evaluate and judge behavior as normal or an indicator of psychological disorder include the following: Is the individual experiencing personal or subjective distress? Is the individual impaired in carrying out functions of everyday life(eating, dressing, personal care, etc.)? Is the individual at risk for harm to self or others?

Is the individual engaging in behavior(s) that are socially or culturally unacceptable?(Halgin & Whitbourne, 2008). Individuals who meet these criteria are then assessed and diagnosed using the guidelines set forth in the Diagnostical and Statistical Manual. Currently, health professionals are using the fourth revised edition of this manual. The DSM-IV-TR uses a framework which assesses individuals on five axes, also called dimensions, which should completely characterize the client who is seeking psychological help. Unfortunately, this edition of the manual does not take into account changes particular to the late or older adult. As development and change are continuous throughout life, this presents difficulties in assessing and differentially diagnosing older adults. The next edition of the manual, slated to be published in May 2013, will hopefully address this issue(American Psychiatric Association, 2000). The five axes of the DSM-IV-TR are as follows: Axis I – All major clinical syndromes, including those clusters of symptoms which form a specific pattern of disturbance, are included on this axis. These include mood disorders, anxiety disorders, schizophrenia, dementia, delirium, amnesic disorders and substance abuse problems. Axis II – This axis includes personality disorders(disturbances of a chronic nature), mental retardation and disorders which prohibit an individual from carrying out necessary activities of daily life. Axis III – The third axis includes medical conditions that may have an effect on a clients psychological health. This dimension is particularly important for assessing and diagnosing if symptoms in older adults are due simply to the fact they have lived longer, thus experiencing greater primary aging and/or secondary aging. In other words, their symptoms are attributesd, partially or entirely, to their physiological functioning, Axis IV – This axis consists of a rating of psychosocial stressors and environmental difficulties that may exist for the client. These are frequently of particular relevance to the older adult as they are statistically more likely to be affected by these types of problems. For example, many adults 65 and older have retired from work and are impacted by higher levels of poverty. They are also more likely to have experienced the loss of a significant other and the eroding of their social support system due to death. Axis V – This axis is an overall summary of an individuals level of functioning. It ranges from suicidal(1-20) to superior(91-100). This score allows professionals to quickly determine how well their clients are functioning. It is also an aid in forming plans of care, particularly interventions(Whitbourne, 2010). My new client, Mr. D. Pressed, is an 86 year-old Caucasian male. He reports that he is experiencing SOB, Stomach difficulties, memory problems and difficulty sleeping. His wife passed away recently and he is grieving. In order to correctly diagnose what conditions Mr. D. Pressed is suffering from, he must undergo an assessment of all five...
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