Aging And Old Age Psychiatry Flashcards
Ageing is a _________ deterioration of physiological function, an intrinsic-age related process of loss of ______ and increase in ____________
progressive
viability
vulnerability
The biological age of a person is identical to their chronological age
T/F
F
The biological age of a person is not identical to the chronological age
Loneliness is a major mental health problem of older adults
T/F
T
What are the Dimensions of Healthy Ageing?
Social activity
Diet
Genes
Productive pursuits
Exercise
Aging and the life cycle
Young adulthood: ________ vs ________
Middle aged : _________ vs __________
Elderly : ________ vs __________
Intimacy; isolation
Generativity; self absorption
Integrity ; despair
Fear of death is usually a _____ life issue
Acceptance of mortality occurs in _______ life
Mid
Elderly
What are the triple D’s in Elderly
Dementia
Delirium
Depression
Delirium :
Onset
Duration
Course
Consciousness
Attention and memory
Affect
Acute
Days to weeks
Flunctuating
Impaired
Inattentive, poor memory
Variable
Dementia :
Onset
Duration
Course
Consciousness
Attention and memory
Affect
Insidious
Months to years
Slowly progressive
Clear until late in the course of
Poor memory
Variable
Depression :
Onset
Duration
Course
Consciousness
Attention and memory
Affect
Variable
Variable
Diurnal variation
Unimpaired
Difficulty concentrating
Depressed
4 other psychiatric disorders of old age
Psychosis
Anxiety-phobias
Alcohol use
High risk of suicide
Late life Depression
Has a different presentation, usually __________ or __________
Happily Sad
Suffering with a smile
Late life depression
Could be a
Late onset depression ( first time after age ___)
_______ depression
__________ depression
_____________ depression
50
Vascular
Post stroke
Psychotic
Theories behind low prevalence of major depression in elderly??
Resilience
Shared experience or Generational temperament
Flaws in diagnostic approaches
Major depression in Elderly
Disturbances in sleep, appetite and sexual functioning are always reliable indicator
T/F
F
Disturbances in sleep, appetite and sexual functioning are not always reliable indicator
Major depression in Elderly
Use of _______,________, and ________ are useful in elderly primary care settings for screening
HAM-D, MMSE and GDS
Late onset depression has (more or less?) complete response to treatment
Less
Late onset depression have :
(Better or Poorer?) prognosis
_____eased mortality
(Acute or Chronic?) Course
_________ and _________ on scans
Poorer
Increased
Chronic
Frontal and temporal Atrophy
________ onset depression have more first degree relatives with depression (__________)
Early
Genetic loading
Depression with reversible dementia, AKA __________ is now considered obsolete
Pseudodementia of depression
Depression in the elderly is associated with cognitive impairments
T/F
T
Depression with psychosis
Responds not Atall to ________
Poorly to _________ used alone
More often to combinations of ________ and __________ medications
placebos
antidepressants
antidepressants and antipsychotic
Depression with psychosis
Hospitalizations is usually indicted and _____________ is the treatment of first choice when agitation, starvation, dehydration and suicidality threaten survival
electroconvulsive therapy
Structural brain abnormalities are more frequent in patients with _____ onset depression than _____ onset depression
Late
Early
Evidence is sufficient to recommend psychotherapy as a first line treatment for depression in older adults
T/F
F
Insufficient
CBT
PST
IPT
DBT
Cognitive based therapy
Problem solving therapy
Interpersonal therapy
Dialectical behavior therapy
Depression in elderly
Although approximately ____% to ___% of elderly patients improve clinically with antidepressant therapy.
The efficacy of these agents may be lowered , mainly in those with ___________ or _________________
50; 60
vascular
neurodegenerative brain disease
______ is the most important of the non-phamarcological somatic treatments
ECT
COURSE AND PROGNOSIS
> Left untreated, late-life major depression tends to remit spontaneously after ______________ , but patients with first-episode depression with onset after age 60 have a ____% chance of recurrence within ________.
12-48 months
70
2 years.
Types of Delirium
????
Hyperactive/ Hyperalert
Hypoactive/ Hypoalert
Mixed
Prescribed medicines can cause delirium
T/F
T
Causes of delirium
I WATCH DEATH
Infections
Withdrawal
Acute metabolic
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrinopathies
Acute vascular
Toxins/drugs
Heavy metals
The mortality outcome at 6 months post discharge for delirious patients not identified was ________ times higher than the delirious patients who were identified and treated
Three
Adequate lighting is a treatment of delirium
T/F
T
Dementia is an umbrella term used to describe a range of symptoms associated with cognitive impairments
List them
Alzheimer’s
Vascular
Lewy bodies
Frontotemporal
Dementia is a syndrome due to disease of the _______, usually of a ———- and ________ nature
Brain
Chronic
Progressive
Risk factors for dementia
Age: ________ years
• Gender: ______
• Prior stroke
• Atherosclerosis
• Heart disease
• High blood pressure
• Diabetes
• Diet
60-70
female
Etiological classification o f dementia
• Neurodegenerative Diseases
• ___________ disease
> ___________ disease
• Diffuse ___________ disease
• Progressive ___________ ______
• Multisystem atrophy
• ___________ disease
• ___________ dementias
Alzheimer’s disease
> Parkinson’s disease
• Diffuse Lewy body disease
• Progressive supra-nuclear palsy
• Multisystem atrophy
• Huntington’s disease
• Frontotemporal dementias - e.g. Pick’s disease
Frontotemporal dementias e.g. _____ disease
Pick’s
Etiological classification o f dementia
•________ Diseases
•________ Disease or Trauma
• _________ Disease
•______________ Disease
• Other late-onset lysosomal storage diseases
Neurodegenerative
Structural
Vascular
Heredo-metabolic
Etiological classification of dementia
Structural Disease or Trauma
•______________
• __________
• Dementia pugilistica
Vascular Disease
•_____________
•_____________
Heredo-metabolic Disease
•_________ disease
• Other late-onset lysosomal storage diseases
Normal pressure hydrocephalus
Neoplasms
Vascular dementia
Vasculitis
Wilson’s
List 6 irreversible dementias
Alzheimer’s dementia
Lewy body dementia
Pick’s disease
Parkinson’s
Hungtington
Creutzfeldt-Jacob disease
DEMENTIA
Findings on neuroimaging
Diffuse __________
• Enlargement of ________
• Widening of ________
• Atrophy more prominent in ___________
• There can also be evidences of strokes, lacunar infarcts, and white matter hyper intensities. These complicate the picture.
brain atrophy
ventricles
sulci and gyri
hippocampus
Alzheimer’s disease VS vascular dementia
Prevalent sex
History of hypertension
Onset
Hypertension
Emotional lability
Cognitive deficits
Focal neurological signs
Women; men
Less common; more common
Gradually progressive ; episodic deterioration
Less common; more common
Less common; more common
Uniform; patchy
Uncommon; common
Behavior and psychological symptoms of dementia (BPSD) include ????
Agitation, depression and psychosis
BPSD are treatable
BPSD don’t respond well to therapy
T/F
T
F
BPSD
50 - 90% of caregivers considered _______________ as the most serious problem they encountered and a factor leading to institutionalization
physical aggression
