03 65 yo depression Flashcards
avoid caffeine ___ hours before bedtime
4-6 hours
common causes insomnia elderly
environment meds/drugs sleep apnea RLS periodic leg movement/REM disturbances in cycle (jet lag, shift work) depression/anxiety cardiorespiratory disorders pain or pruritus gerd hyperthyroidism advances sleep phase syndrome
risk factors completed suicide
white male
rates of success increase with age
previous attempts
AI/AN
definition depression
at least 5 of 9, for at least 2 weeks depressed mood OR loss of interest or pleasure + sleep interest guilt energy concentration appetite psychomotor retardation suicidal ideation
bereavement
feelings of emptiness or loss, depressed feelings in waves, associated with thoughts of the deceased, may have positive emotions and humor, preoccupation iwth througts of the deceased, think about death as way to join the dead
RF late life depression
female social isolation widowed/divorced Lower SES comorbidities pain insomnia functional impairment cognitive impairment
Assess severity of SI
Sex Age < 19 or > 45 Depression dx Previous attempts Ethanol or other abuse Rational thinking impaired Social support lacking Organized plan No significant other Sickness
4-6 outpatient
7-10 inpatient
two dementia screening tools
mini-cog
mini-mental state exam
side effects SSRI/SNRI
HA, sleep, GI, sexual dysfunction
hyponatremia, serotonin syndrome, increased risk GI bleed
tx insomnia elderly
CBT-I
drugs: anithistamines and benzos have inc risk in elderly
can use Ambien or melatonin-recepotr agonists
managment depression -
biopsychosocial
meds 9-12 months, if recurs, 2-3 years
fluoxetine
unusually long half life
agitation, motor restlessness, decreased libido, insomnia
zoloft
frequenty used SSRI in pregnancy and breastfeeding, approved for OCD, panic and PTSD
more GI side effects
Paroxetine
strong antianxiety effects
side effects include weight gain, impotence, sedation, and constipation
most likely to cause AD discontinuation syndrome
fluvoxamine (luvox)
OCD
greater frequency of emesis
