EM Psych 4: Elderly

Question 1

Medications such as benzodiazepines and antipsychotics have significant side effects in older patients, such as

Answer 1

prolonged sedation
paradoxical agitation

hence, these are usually given at lower doses, and should only be used after nonpharmacologic modifications and interventions have been exhausted

Question 2

6 components of mental status exam

Answer 2

appearance, behavior, and attitude
thought
perception

mood and affect
insight and judgment
sensorium and intelligence

Question 3

Explain confusion assessment method (CAM)

Answer 3

features 1 and 2 and either 3 or 4 makes a diagnosis of delirium

features 1: acute onset of mental status changes or a fluctuating course

features 2: inattention

feature 3: disorganized thinking

feature 4: altered level of consciousness

Question 4

causes of delirium in geriatric patients

Answer 4

50%: infections such as UTI and pneumonia
40%: medications

Question 5

remarks on lorazepam

Answer 5

short-acting agent

used if benzodiazepines are really needed for elderly patients (e.g., alcohol withdrawal, seizures, catatonia) - lorazepam 0.5-1 mg

Note that benzodiazepines can cause paradoxical disinhibition and increased agitation in the elderly

Question 6

remarks on antihistamines

Answer 6

avoid these in the elderly, as these drug class has strong anticholinergic effects and can induce or worsen delirium in the elderly

Question 7

DELIRIUM mnemonic for reversible causes of delirium

Answer 7

Drugs
Electrolyte imbalance (esp dehydration and sodium)
Lack of drugs (withdrawal from chronically used sedatives such as alcohol and sleping pills; pooly controled pain/lack of analgesia)
Infection
Reduced sensory input (poor vision, poor hearing)
Intracranial
Urinary, fecal (urinary retention: cystocerebral syndrome; fecal impaction)
Myocarcial, pulmonary

Question 8

other term for dementia

Answer 8

major neurocognitive disorder

Question 9

most common type of dementia

Answer 9

Alzheimer’s disease

Question 10

Dementia now requires significant decline in one or more of the following cognitive domains:

Answer 10

learning and memory
language
executive function

complex attention
perceptual-motor
social-cognition

Question 11

remarks on lewy body dementia

Answer 11

Lewy body dementia has a gradual onset of memory deficits, and patietns will also frequently have hallucinations and parinsonian-like features.

Patients with Lewy body dementia do very poorly when given typical antipsychotics, so avoid them in these patients

Question 12

remarks on frontotemporal dementia

Answer 12

often presents in patients less than 60 y/o

associated with ADL (Apathy, Disinhibition, Language difficulties) and atrophy in the frontal and temporal lobes

Question 13

the main long-term pharmacologic therapy for patients with dementia

Answer 13

cholinesterase inhibitors such as donepezil

Question 14

the first steps in management of patients with dementia

Answer 14

screen for delirium and to identify the presence of a comorbid medical disorder

Question 15

Explain the Mini-Cog Screening Test

Answer 15

If able to to recall all 3 words -> not demented

if not able to recall any word -> demented

if able to recall only 1-2 words, do clock-drawing test. If normal -> not demented, if abnormal -> demented

Question 16

most common mental health disorders in older adults

Answer 16

major depression and alcohol use disorders

Question 17

age group with the highest rates of completed suicide of any age group

Answer 17

people over 65 y/o

Question 18

3 anticonvulsants approved to treat bipolar disorder

Answer 18

valproate, carbamazepine, lamotrigine

Question 19

remarks on schizophrenia in the elderly

Answer 19

The majority of patients with schizophrenia develop the disease in the second or third decade of life, meaning that most geriatric patients with schizophrenia have had the disorder since they were much younger