[CLMD] Diagnosis of Psychiatric Conditions in Geriatric Patients [Hill]

Question 1

How do you characterize Mild Cognitive Impairment?

Answer 1

a Modest Cognitive Decline from a previous level of performance

Does NOT interfere with daily basics (Capacity for independence)

Question 2

When treating a Geriatric pt what are some considerations you need to be cognisant of?

Answer 2

Multiple comorbidities

Varied Diseases (Degenerative dz, Cancer, etc)

Unusual presentations

Under REPORTING (depression etc)

Medication

Question 3

When working on a geriatric pt, what rule should you follow for medication?

Answer 3

Start Low and go Slow! (Be Conservative)

Question 4

When you are presented with a older pt who might have dementia – what specific entities should you consider?

Answer 4

Alzheimers (50-60%)

Vascular Dementia (15-30%)

Progessive Disorders [like Frontotemporal Dementia/Lewy Body Dementia]

Reversible Dementia causes

Question 5

What sort of pt would raise the highest risk of being diagnosed with Alzheimers?

Answer 5

Female, with family history, head trauma, Down Syndrome

Question 6

What sort of pt would raise the highest risk of the diagnosis of Vascular Dementia?

Answer 6

Male, advanced age, HTN, Cardiovascular dz

Question 7

What sort of signs should you be on the look out for when you have a patient who has Frontotemporal Dementai (Progessive disorders)

Answer 7

Changes in Personality

Socially Inappropriate

Impulsive/emotionally distant

Occurs in slightly younger pts (40-60)

Question 8

What sort of reversible causes of dementia are commonly seen?

Answer 8

Drug Induced

Thryoid dz

Metabolic Disorder (Diabetes)

Hematomas

Hydrocephalus (Normal Pressure Hydrocephalus)

Question 9

If you have a patient that is elderly and has weight loss, anxiety, irritability, sadness, and dementia –> what sort of clinical diagnosis would you attribute?

Answer 9

Depression (Pseudomentia)

**Often depression can cause dementia in older patients.

Question 10

What are some other symptoms of dementia?

Answer 10

Depression

Memory Loss

Communication problems

Difficulty with performing tasks and such

Problems with disorientation

Personality Changes

Inappropriate Behavior

Psychotic Sx (Hallucinations, delusions)

Agitation (violence)

Question 11

When evaluating an elderly pt with dementia – what sort of things should you consider?

Answer 11

H&P

Progression of Dz

Comorbid conditions

Neurological exam

Mental Status exam

Functional Status (dressing, bathing etc)

Neuropsych testing

Labs

Radiology

Question 12

What sort of labs are the best to order for an evaluation of a dementia pt?

Answer 12

CBC, CMP, Thyroid, B12, Folate, Hb1AC

Question 13

When treating Dementia in the elderly how should you approach it?

Answer 13

Attempt to rule out other causes

treat comorbid conditions

SLOW PROGRESSION

Reduce Stress

Increase Physcial Acitivty

NO BENADRYL

Question 14

What are two drugs that are given to pts with dementia to help slow the progression?

Answer 14

Donepezil (Aricept)

Memantine (Namenda)

(Helps with depression and agitation as well!)

Question 15

What should you NEVER GIVE an elderly pt with dementia?

Answer 15

Benadryl

Hydroxyzine

Question 16

What is the black box warning for using anti-psychotic medications in geriatric pts with dementia?

EX: Olanzapine, Aripiprazole, Risperidone, Quetiapine

Answer 16

Can increase Mortality

Question 17

Delirum vs Dementia?

Answer 17

Delirium – Acute

Dementia – Chronic

Question 18

What are some of the causes of Psychosis in the elderly?

Answer 18

MDD with Psychotic Features **2nd most common

Alzheimers type Dementia **most common

Question 19

What is the difference between MDD with Psychotic Features and Alzheimers type Dementia?

Answer 19

Alzheimers type dementia will have more delusions, paranoid in nature

vs

MDD with Psychotic features have more SOMATIC TROUBLES, Persecution, guilt, and poor self-esteem

Question 20

What are the Risk Factors for Substance abuse in the elderly?

Answer 20

Female

Marital Status (widowed, divorced etc)

Abscence of Hobbies

Health Concerns

higher abuse potential of Benzos and Opiates

Question 21

What are some of problems with substance abuse and the elderly?

Answer 21

Congition impairment

Depression

Sleep Problems

Falls/Fractures (vestibular problems)

Delirium

Risk of other medical conditions

Question 22

If you go Cold turkey on treating a substance abuse – what sort of problems may you encouter with an elderly pt?

Answer 22

Delirium Tremens and Death

(Ex: Benzos)

Question 23

What are some of the signs and symptoms of depression in the elderly?

Answer 23

Anxiety

Fatigue and Hypersomnolence

Somatic Complaints

Cognitive impairment

Weight loss

Insomnia

Anhedonia

Agitation

Question 24

How do you diagnose Major Depression in the elderly?

Answer 24

Anhedonia or Depressed Mood for 2 weeks

+

4 of the following:

Feelings of worthlessness

decreased ability to concentrate

fatigue

psychomotor agitation

insomnia

weight or appetite changes

recurrent thoughts of suicide

Question 25

How can you tell a demented pt vs a depressed elderly pt?

Answer 25

Depressed –> have insight, little effort

Demented –> NO insight