7. Diagnosis and Treatment of Psychiatry Condition in Geriatric Pts Flashcards
Dementia is now called Major neurocognitive disorder NCD, there is also a less severe impairment called mild NCD (formerly known as mild cognitive impairment). What is also included in the neurocognitive disorders?
Delirium
Some considerations when treating geriatric patients include multiple comorbidities, varied disease, unusual presentation of illness, differentiation normal aging vs disease**, under reporting (by patient), purpose of treatment (palliative care?) and mediaction should be?
ALWAYS started low and go slow
What type of demential is the most common, and has risk factors including female, family history, head trauma, and downs syndrome?
Alzheimer’s Dementia
Vascular dementia has risk factors of male, advanced age, hypertension and CV disease. Picks disease is frontotemporal dementia (usually in young and see atrophy), what demntia has 1)memory loss 2) parkinson like sx 3) visual hallucinations?
Lewy Body Dementia
Some reversible causes of dementia include drug-induced, thyroid disease, metabolic disorders, hematomas, and normal pressure?
hydrocephalus (ataxia/memory loss/ urine incontinenece)
Symptoms of dementia include depression, memory loss, communication, cant perform tasks, organization, coordination (inc falls), pt gets lost easily, personality changes, inappropriate behavior, and the two MC being what?
psychotic symptoms (hallucinations/delusions/paranoia) Agitation*
If a patient has dementia and depression and is elderly, look for weight loss, anxiety, irritability, sadness and social withdrawal, if they have these symptoms then what is it called?
Pseudementia
Evaluation of elderly w dementia- history and physical is the MOST important especially onset and character, along with progression, comorbid conditions, neurological exam, mental status exam, neuropsychological testing, and labs including endocrine, folate CBC, CMP, HbA1C and what, which he focused on?
B12- if their levels are 400, that is low!!! can make dementia worse
Tx of elderly with dementia: attempt to determine a cause and treat comorbid conditions, there is no magic bullet- usually give donezepil and memantine together, reduce stressm increase acitivity/diet, ***WHAT SHOULD BE AVOIDED IN ALL ELDERLY DEMENTIA PTS?
Anticholinergic medications (which impair cognitive function) such as benadryl/diphenhydramine/hydroxzine
There is a black box warning associated with all antipsychotics in the elderly, such as lanzapine, aripiprazole, risperidone and quetiapine, in which patients may experience what? lowest dose for shortest period
1.6-1.7 fold increase in mortality
Pt presents with dementia like symptoms, first should get a CBC, CMP, CT/MRI, B12/ Folate, and MMSE (mini mental status exam, a DDX would include stroke, tumor, delirium, depression, hypothyroidism, DM and?
Dementia
Tx for the patient who is older and being more forgetful and forgetting things would include treating the underlying lab abnormalities, medications such as acetylcholinesterase patch in the middle of the back so they cant take it off, behavioral modifications and most importantly?
Familt support**
Psychosis due to delirium is the 3rd MCC of psychosis in elderly patients, usually due to inappropriate drug use, withdrawal from drugs, urinary retnetion, CV problems, strokes, seizures, hemorrhages, sleep deprivation*, and what other 2 common ones?
Infection and Constipation
Psychosis due to major depressive disorder with psychotic features is the 2nd MC diagnosis in elderly patients, most likely present with persecution, guilt, poor self esteem and ?
somatic troubles (lots of pain and neuro issues that cant be solved)
What is the MC dx accounting for psychosis in the elderly, in which they have delusions, and paranoid nature such as believe items are being stolen or they are being abandoned or that their spouse/children are being disloyal?
Psychosis due to Alzheimers Dementia
