Oxford Psychiatry Library

• Disability and handicap are closely linked to the aetiology of late-life depressive disorder.

• Always check for underlying physical illness and various prescribed drugs as potential causes of depressive disorder in later life.

• Vascular disease (vascular depression) is increasingly recognized as a cause of late-onset depressive disorder.

• However, in many cases of late-life depression the cause is multifactorial.

• Being a caregiver of someone with dementia is associated with a high risk of depression.

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ADHD can be assessed with

Clinical Interviews

Questionnaires and

Neuropsychological Measures

The diagnosis of ADHD is based on clinical judgment of integrated data gathered from multiple sources

Education of staff at a primary care level, and from education about ADHD is essential to ensure that children with ADHD are promptly identified and referred

A comprehensive assessment for ADHD is complex and often time consuming. Those conducting these assessments need to be well trained

The purpose of an ADHD assessment is not only to confirm or exclude the presence of ADHD but also to identify whether there are any other problems or disorders that are causing impairment

At the end of the assessment process the clinician should have developed a comprehensive formulation.

• Antidepressant drugs are effective in older patients with depressive episode, with no important differences in individual drug efficacy.

• Antidepressants are effective in depressed patients with a range of physical co-morbid conditions, although tolerability varies.

• Age should not be a barrier to receiving a psychological therapy.

• For chronic depression, combining antidepressant medication with a psychological intervention is associated with the best chance of recovery.

• CBT requires only modest modification for older people.

• Supportive psychotherapy is not ‘doing nothing’.

• There are qualitative differences in grief themes in those bereaved through suicide

• Themes include shock; disbelief; horror; how?; why?; guilt and blame; relief vs. family disaster; rejection; stigma, shame and social isolation; a wasted life; suicidal thoughts and fear of another suicide; and anger

• Practical issues include viewing the body and having sensitive funeral arrangements

• Therapists are vulnerable to similar feelings in addition to concerns about their professional competence.

• Many of the longitudinal antecedents of suicide are important social issues in their own right

• Restriction of access to means of suicide is effective and usually requires political will and legislation to introduce

• Responsible media reporting favourably influences suicide rates

• National programmes of suicide prevention are associated with a reduction in suicide

• More focussed community initiatives have also been effective.

• Circadian rhythm sleep disorders (CRSDs) are disturbances of the normal sleep–wake rhythm, and subtypes include jet lag, delayed sleep phase syndrome (DSPS), advanced sleep phase syndrome (ASPS), irregular sleep–wake rhythm, and shift work sleep disorders

• Jet lag is the most common circadian rhythm disorder and is caused by a disturbance of internal circadian rhythm due to rapid travel across multiple time zones

• Recovery from jet lag can be aided by behavioural modification; pharmacological approaches such as melatonin can also help alleviate symptoms

• DSPS is more prevalent in adolescents and young adults; ASPS is a much rarer condition than DSPS and is seen primarily in middle-aged and older adults

• Patients with shift-work sleep disorder often present in middle age after years of trouble-free working

• Current classificatory systems for depression under-estimate the level of depression among older people.

• In later life, the impact of having even just a few symptoms of depression is considerable.

• Depressive disorder in later life is linked to poor health, so that care homes and acute hospitals have an especially high prevalence.

• Depressive disorder adds to the morbidity of many major medical disorders common in later life.

• In later life, be especially vigilant for organic causes of depression.

• Two main differences in the presentation of late-life depression are that a complaint of depression may be minimized and somatic concern (hypochondriasis) is present.

• Apathy and depression differ and the former is often associated with executive cognitive problems and vascular brain disease.

• Attempted suicide in older adults closely resembles successful suicide.

• Cognitive impairment is common in late-life depression and is often irreversible.