ch 28 - mental health Flashcards
most prevalent mental health problems in older population (3)
- anxiety
- severe cognitive impairment
- mood disorders
what criteria does it take for a stressor to be considered a crisis (3)
- event occurs abruptly
- event is unanticipated
- event requires skills/resources pt doesnt possess
assessment tools for mental health in older adults (3)
- cultural formation interview in DSM5
- geriatric depression scale
- mini cog
interventions for reducing stress in older adults (3)
- reminiscing
- enhancing coping skills (meditation, yoga, exercise, spirituality)
- mind body therapies
comorbidities with anxiety in later life (3)
- MDD
- cognitive decline, dementia
- substance abuse
RF anxiety disorders
- frailty
- medical illness
- loss
- pain
- lack of social support
- traumatic events
- meds
- psych illness
meds that could cause anxiety S+S
- anticholinergics
- digitalis
- theophylline
- antiHTNs
- b blockers
- corticosteroids
- OTC (cough suppressants, cold preparations)
- caffeine
- nicotine
med Tx anxiety
- first line: SSRIs
- short acting benzos
non med Tx anxiety
- cognitive behavioral therapy
- exposure therapy
- interpersonal therapy
meds that could cause depression S+S
- antiHTNs
- ACE inhibitors
- methyldopa
- antiarrhythmics
- anticholesteremics
- antibiotics
- analgesics
- corticosteroids
- digoxin
- levodopa
RF depression in older adults
- chronic illness, disability
- alzheimers and dementias
- bereavement
- caregiving
- female
- admission to long term care
- meds
- alcohol/substance abuse
- loss
somatic complains with older adults experiencing depression (4)
- insomnia
- loss of appetite, weight loss
- memory loss
- chronic pain
age related changes that contribute to higher blood alcohol level
- increased body fat, decreased lean muscle mass
- decreased liver function
- decreased kidney function
- decreased gastric enzyme
alcohol use screening tool for older adults
short michigan alcoholism screening test
warning S+S suicide (IS PATH WARM)
Ideation
Substance abuse
Purposelessness
Anxiety
Trapped
Hopelessness
Withdrawal, social
Anger
Recklessness
Mood changes
intervention for pts at high risk for suicide
hospitalization
intervention for pts at moderate risk for suicide
outpatient care
intervention for pts at low risk for suicide
full psych eval and careful monitoring
PTSD (TRAUMA)
Traumatic event Re-experiencing Arousal Unable to control Month or more Avoidance
assessment tool PTSD
impact of event scale (IES)
Tx PTSD in older adults
- cognitive behavioral therapy
- prolonged exposure therapy
- exercise
- psychospiritual interventions
- anxiolytics
early sign of alzheimers (about 20 months before Dx)
paranoia
precipitating factors paranoia
- meds
- vision/hearing loss
- social isolation
- alcoholism
- depression
- negative life events
- financial strain
- PTSD
Beliefs that guide interpretation of events and helps one make sense out of what is going on – inconsistent with
reality
-can be comforting or threatening
-month +
delusions
common delusions in older adults
- poisoning
- being robbed
- children taking assets
- being deceived by spouse
(fear and lack of trust common)
Sensory perceptions that occur in absence of external stimuli
hallucination
Tx hallucinations
- reassurance
- reduce stimuli
- trusting relationship
- listen
- antipsychotics
related illnesses that can occur with hallucinations
- dementia
- delirium
- parkinsons
- hearing/vision loss
spanish term for latin american expression of stress, usually with accident/death of family member
-intense emotional upset
attack of nerves
latino expression for distress and misfortune
- S+S similar to PTSD, anxiety and depression
- soul leaves body during frightening event causing illness
fright
combodian phrase for attack brought on by worrisome thoughts
- S+S similar to PTSD, anxiety and depression
- believe that wind substance rising in body causing sob, dizziness, tinnitus, fainting, cold extremities
wind attacks
2 benzos that should be avoided in older adults
- diazepam
- chlordiazepoxide
risk using benzos in older adults
- fall risk
- cognitive impairment
risk of using 1st gen antipsychotics in schizophrenic older adults
risk of persistent side effects (tardive dyskinesia)
what is blackbox warning for 2nd gen antipsychotics for pt with older adults
dont give to someone with dementia-related psychosis
increased risk of death
what extra assessment is needed with admin of anticonvulsants
higher risk suicide
meds that interact with alcohol
- analgesics
- antibiotics
- antidepressants
- antipsychotics
- benzos
- H2 blockers
- NSAIDs
- herbal meds
- acetaminophen
why is disulfiram avoided in older adults
risk of cardiovascular adverse effects
