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2. Geriatric Psychiatry + Neuroanatomy > CCSMH Assessment and Treatment of Delirium + CCSMH LTC Homes paper > Flashcards

CCSMH Assessment and Treatment of Delirium + CCSMH LTC Homes paper Flashcards

1
Q

is general anesthesia associated with increased post operative delirium

A

no–> not with post op delirium but yes with post op cognitive dysfunction

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2
Q

what medication has been shown to reduce incidence of delirium in older patients admitted to acute medical unit

A

melatonin–> short term, low dorse

more research needed

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3
Q

what medication seems to reduce incidence and/or severity of post op delirium in older patients

A

haldol (short term, low dose)

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4
Q

what medication seems to reduce the risk of post op delirium in those without contraindications after cardiac suergery

A

risperidone

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5
Q

is olanzapine recommended for prevention of post op delirium

A

no–> may reduce risk but if delirium DOES occur is seems to be worse and lasts longer

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6
Q

what is one way to reduce risk of delirium in mechanically ventilated patients

A

choose DEXMEDETOMEDINE as the sedative rather than benzos and propofol

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7
Q

are high or low potency antipsychotics preferred in management of delirium

A

high potency

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8
Q

what is the antipsychotic of choice in the management of delirium

A

haldol

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9
Q

in which cases is haldol not recommended

A

if preexisting parkinson disease or LBD

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10
Q

are cholinesterase inhibitor recommended for the prevention or treatment of delirium

A

no

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11
Q

how should you treat older adults with severe MDD in LTC homes? what about less severe depression?

A

severe MDD–> antidepressant included int reatment

less severe–> psychosocial interventions as first step –> if depression persists then consider antidepressant

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12
Q

what are appropriate first line antidepressants for LTC home residents

A

SSRIs (i.e citalopram, escitalopram, sertraline)

venlafaxine

mirtazapine

buproprion

duloxetine

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13
Q

social contact interventions can help manage what symptoms in LTC residents wiht dementia

A

behavioural symptoms

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14
Q

what interventions, in the domain of sensory stimulation, have increased evidence for LTC residents with dementia

A

music therapy

acupressure

therapeutic touch

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15
Q

what doses are generally considered more appropriate for citalopram and escitalopram in older adults

A

citalopram–> 20mg

escitalopram–> 10mg

*due to concern about QTc prolongation

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16
Q

what medication might be used to treat apathy associated with alzheimer’s disease

A

psychostimulants like methylphenidate

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17
Q

what two steps should be taken before using medications to manage behavioural symptoms in LTC residents

A
  1. rule out underlying medical problem *i,e delirium, pain, drug toxicity
  2. use psychosocial interventions
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18
Q

what class of medications has the best evidence for pharmacological intervention of aggression and psychosis in LTC residents

A

antipsychotics

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19
Q

what is the concern about use of antipsychotics in older adults

A

increased rates of death and cerebrovascular events as well as other adverse events

20
Q

when should antipsychotics be used in older adults

A

only if marked risk, disability or suffering associated with symptoms

21
Q

other than antipsychotics, what other class of meds (and which two meds in particular) has some evidence for reducing agitation associated with dementia

A

SSRIs–> citalopram and sertraline

*may want to try these first and then go for an AP
*remember risk of falls even at low doses of SSRIs in those with dementia

22
Q

do cholinesterase inhibitors have good evidence for treating behavioural symptoms

A

weak evidence

*evidence is also weak for memantine

23
Q

despite weak evidence for treatment of behavioural symptoms in LTC residents, in what way might memantine still be useful for behavioural symptoms of dementia

A

mayyyyy delay emergence of behavioural symptoms in those with dementia

24
Q

what population is especially at high risk for suicide

A

older men (can be up to twice that of the nation as a whole)

25
Q

what were the two most common means of suicide among older men in canada

A

hanging

firearm use

26
Q

what were the two most common means of suicide in older women

A

hanging

self poisoning

27
Q

how does lethality of self harm behaviour change with age

A

increases with advancing age

28
Q

how might older adults present with depression

A

less likely to present with dysphoria

more likely to present with SOMATIC SYMPTOMS

29
Q

what types of disorders elevate risk for suicide in older adults

A

mood

substance

psychotic

+multiple comorbid disorders increases risk

30
Q

is dementia a risk factor for suicide

A

“dementia MAY BE a risk factor but thus has NOT BEEN CLEARLY DEMONSTRATED” (page 22/40 in the 2006 guidelines)

31
Q

how does functional impairment impact the risk for suicide in older adults

A

impairment of ability to carry out ADLs may increase risk of suicide amongst older adults

32
Q

list medical illness risk factors for suicide in older adults

A

visual impairment

malignancy

neuro disorder

chronic lung disease

seizure disorder

moderate or severe pain

cancer

COPD in married adults 55 and older

33
Q

list 3 measures designed to assess suicidal features in older adults

A

harmful behaviours scale

reasons for living scale–older adults version

geriatric suicide ideation scale

34
Q

should you do amyloid imaging if there is no memory loss

A

no

35
Q

what is the definition of rapidly progressive dementia

A

develops within 12 MONTHS of first cognitive symptoms

or, in AD, if MMSE declines more than 3 points in 6 months

36
Q

list indications for CT scans in the context of suspected dementia/cognitive impairmment

A

AGE BELOW 60

GAIT DISTURBANCE

rapid, unexplained decline (within 1-2 months)

short duration of dementia (less than 2 years)

recent, significant head trauma

unexplained neuro sx i.e headache, seizure

new focal neuro signs

unusual/atypical cognitive symptoms or presentation

hx cancer

use of anticoagulants

hx bleeding disorder

hx urinary incontinence and gait disorder (rule out NPH)

37
Q

which scan is recommended first–18F-FDG PET or SPECT rCBF

A

PET first but if not avail then do SPECT

38
Q

is fMRI recommended at this time for investigating cognitive complaints

A

no

39
Q

in what context would you do PET amyloid imaging

A

as adjunct for complex, atypical presentation

*NOT for routine/investigation etc, only for research or above

40
Q

is MR spectroscopy useful

A

not yet–> may be promising in the future for predicting conversion of MCI to dementia but needs more research

41
Q

how do you manage dementia

A

symptomatically–> base management on predominant cause as most cases are mixed etiology

42
Q

list the 3 cases in which cholinesterase inhibitors are recommended

A
  1. mild-severe alzheimers disease (all 3 cholinesterase inhibitors)
  2. AD + cerebrovascular disease
  3. parkinsons disease dementia
43
Q

is there any efficacy difference between the cholinesterase inhibitors

A

no–> base selection on SE profile, ease of use, familiarity etc

44
Q

is the combination of cholinesterase inhibitors + memantine recommended?

A

insufficient evidence to recommend
BUT
appears rational and safe

45
Q

list 3 medications recommended for severe agitation, aggression and psychosis associated with dementia

A

risperidone
olanzapine
abilify

*valproate, cholinesterase inhibitors, memantine NOT recommended
*insufficient evidence for quetiapine, SSRI, trazodone for this

46
Q

when are antidepressants recommended in dementia

A

for depressive disorders that are non responsive to nonpharm tx

2. Geriatric Psychiatry + Neuroanatomy (14 decks)

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