First Aid: Geriatric Psychiatry

Question 1

What portion of the history is especially important in the geriatric population?

Answer 1

history of current medications

Question 2

List some factors associated with normal aging.

Answer 2

• Decreased muscle mass/increased fat
• Decreased brain weight/enlarged ventricles and sulci
• Impaired vision and hearing
• Minor forgetfulness (benign senescent forgetfulness)

Question 3

List the stages of dying (or loss of a body part).

Answer 3

• Denial
• Anger (blaming others)
• Bargaining
• Depression
• Acceptance

Question 4

If an elderly pt presents with memory loss, what should you assess them for?

Answer 4

Major depression

Question 5

True or false: the elderly are 2X more likely to commit suicide than the general population

Answer 5

true

Question 6

What percentage of nursing home pt’s have depressive symptoms?

Answer 6

15%

Question 7

What is pseudodementia?

Answer 7

When an elderly person with symptoms of major depression has associated problems with memory and cognitive function (can be mistaken for dementia)

Question 8

Which patients are more likely to confabulate, demented or depressed?

Answer 8

Demented patients will confabulate, depressed pt say they do not know and when pressed will give the correct answer

Question 9

Which is more likely to present acutely, dementia or pseudodementia?

Answer 9

pseudodementia

Question 10

What is the difference in attitudes toward achievements and failures in dementia v. pseudodementia?

Answer 10

• Demented pt’s delight in accomplishments

- Depressed pt’s emphasize failures

Question 11

Which is more likely to have sundowning, dementia or pseudodementia?

Answer 11

Dementia (increased confusion at night)

Question 12

Do patients with dementia or pseudodementia have an awareness of their problem?

Answer 12

pseudodementia patients are aware of problems, demented patient are not

Question 13

What medications are the elderly especially sensitive to?

Answer 13

• Antidepressants

- Anticholinergics

Question 14

What are the treatment options for pseudodementia?

Answer 14

• Psychotherapy
• Low dose antidepressants (SSRIs)
• ECT (safe and effective in elderly) in place of meds

Question 15

What antipsychotic used in the elderly can increase appetite and can be used for insomnia due to the sedating properties?

Answer 15

mirtazapine

Like eating at mirt-Donald’s

Question 16

What drug given to elderly patients with psychomotor retardation as adjunct to antidepressants can cause insomnia if given in the afternoon?

Answer 16

Methylphenidate (Ritalin)

Question 17

List the features of normal grief.

Answer 17

• Feelings of guilt and sadness
• Mild sleep disturbance and weight loss
• Illusions (briefly seeing deceased person or hearing his or her voice)
• Attempts to resume daily activities/work
• Symptoms resolve within 1 year (worst symptoms resolve within 2 months)

Question 18

List the features of abnormal grief.

Answer 18

• Feelings of severe guilt and worthlessness
• Significant sleep disturbance and weight loss
• Hallucinations or delusions
• No attempt to resume activities
• Suicidal ideation
• Symptoms persist for more than 1 year (worst symptoms persist > 2 months)

Question 19

How does REM sleep change in the elderly?

Answer 19

• Increased number of REM episodes
• Shorter REM episodes than normal
• Total amount of REM sleep remains about the same

Question 20

How does non-REM sleep change in the elderly?

Answer 20

• Increased amount of stage 1 and 2
• Decreased in stage 3 and 4 (deep sleep)
• Increased awakening after sleep onset

*take more day naps, less sleep at night, easier to wake up

Question 21

List some primary sleep disorders.

Answer 21

• Primary insomnia (most common)
• Nocturnal myoclonus
• Restless leg syndrome
• Sleep apnea

Question 22

Sedative hypnotics are more likely to cause what SEs in the elderly?

Answer 22

• Memory impairment
• Ataxia
• Paradoxical excitement
• Rebound insomnia

(why they should NOT be first-line for sleep disturbances in the elderly)

Question 23

What sedative-hypnotics may be tried if behavioral therapy and sleep hygiene do not work?

Answer 23

• Hydroxyzine (Vistaril)

- Zopidem (Ambien)

Question 24

What percent of patients >65 yo experience elder abuse?

Answer 24

10% (under-reported)

Question 25

Who is the usual perpetrator of elder abuse?

Answer 25

caregiver who lives with the victim