First Aid: Geriatric Psychiatry Flashcards
What portion of the history is especially important in the geriatric population?
history of current medications
List some factors associated with normal aging.
- Decreased muscle mass/increased fat
- Decreased brain weight/enlarged ventricles and sulci
- Impaired vision and hearing
- Minor forgetfulness (benign senescent forgetfulness)
List the stages of dying (or loss of a body part).
- Denial
- Anger (blaming others)
- Bargaining
- Depression
- Acceptance
If an elderly pt presents with memory loss, what should you assess them for?
Major depression
True or false: the elderly are 2X more likely to commit suicide than the general population
true
What percentage of nursing home pt’s have depressive symptoms?
15%
What is pseudodementia?
When an elderly person with symptoms of major depression has associated problems with memory and cognitive function (can be mistaken for dementia)
Which patients are more likely to confabulate, demented or depressed?
Demented patients will confabulate, depressed pt say they do not know and when pressed will give the correct answer
Which is more likely to present acutely, dementia or pseudodementia?
pseudodementia
What is the difference in attitudes toward achievements and failures in dementia v. pseudodementia?
- Demented pt’s delight in accomplishments
- Depressed pt’s emphasize failures
Which is more likely to have sundowning, dementia or pseudodementia?
Dementia (increased confusion at night)
Do patients with dementia or pseudodementia have an awareness of their problem?
pseudodementia patients are aware of problems, demented patient are not
What medications are the elderly especially sensitive to?
- Antidepressants
- Anticholinergics
What are the treatment options for pseudodementia?
- Psychotherapy
- Low dose antidepressants (SSRIs)
- ECT (safe and effective in elderly) in place of meds
What antipsychotic used in the elderly can increase appetite and can be used for insomnia due to the sedating properties?
mirtazapine
Like eating at mirt-Donald’s
What drug given to elderly patients with psychomotor retardation as adjunct to antidepressants can cause insomnia if given in the afternoon?
Methylphenidate (Ritalin)
List the features of normal grief.
- 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)
List the features of abnormal grief.
- 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)
How does REM sleep change in the elderly?
- Increased number of REM episodes
- Shorter REM episodes than normal
- Total amount of REM sleep remains about the same
How does non-REM sleep change in the elderly?
- 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
List some primary sleep disorders.
- Primary insomnia (most common)
- Nocturnal myoclonus
- Restless leg syndrome
- Sleep apnea
Sedative hypnotics are more likely to cause what SEs in the elderly?
- Memory impairment
- Ataxia
- Paradoxical excitement
- Rebound insomnia
(why they should NOT be first-line for sleep disturbances in the elderly)
What sedative-hypnotics may be tried if behavioral therapy and sleep hygiene do not work?
- Hydroxyzine (Vistaril)
- Zopidem (Ambien)
What percent of patients >65 yo experience elder abuse?
10% (under-reported)
Who is the usual perpetrator of elder abuse?
caregiver who lives with the victim
