Functional Disorders in Older Adult Psych Flashcards
What is the difference between a functional and organic disorder?
Organic: dementia
Functional: any other psych. disease
How does depression change in OA populations? [2]
Episodes are more severe and longer lasting
Prognosis worse
Aetiology of depression in OA? [2]
- Heavily associated with physical health problems
- Breakdown, loss of, or lack of long term social bonds appears key
- Changes on brain imaging less marked, though presence of co-morbid neurovascular damage strongly associated with depressive illness
Depression in OA is broadly similar to young people, but what are some key presentations need to consider? [4]
- Psychomotor agitation (agitated depression) and slowing much more common
- Psychotic depressive syndromes much more present, think Cotard’s, nihilistic delusions regarding poverty, status
- Hallucinations and paranoia can be a more prominent component
- Somatic and anxious symptoms usually more marked than mood component
Which side effect of SSRI do you need to measure in OA as has greater risk ? [1]
Hyponatraemia
How long should you prescribe antidepressant medications in OA? [1]
Px for two years post remission as relapses are more common and intense
What do you need to consider in mania in old people? [2]
First episode mania indicating bi-polar affective disorder does happen in older people, but is not common
Single episode of mania in apparent absence of past depressive iness requires a better hx
What is important to think about suicide in older adults? [1]
Fewer attempts - but more successful
Describe what is meant by pseudodementia and how work out if dementia or not? [2]
What is aka paraphrenia? [1]
Late onset schizophrenia
How does late onset schizophrenia present [2]
Persecutory delusions the more marked symptom relating to commonplace themes e.g., spying neighbours, people entering their homes, theft, nihilism
Negative symptoms and thought form disorder are much less common
Can be very difficult to achieve symptom remission. Often highly debilitating.
How can you differentiate delirum and psychosis in older adult? [1]
Delirium - have inattention. Ask them to say the months of the years backwards (can’t)
Describe difference in PK in OA (ADME) [4]
Absorption: basically the same as young people, though mesenteric blood flow is reduced
Distribution: Low body mass and water accompanied with increase fat = longer half
Metabolism: Much reduced secondary to worsened liver blood flow and knackered livers
Excretion: Knackered kidneys = longer half life, increased sensitivity to effect
Describe the PD changes in OA for dopaminergic, cholinergic, noradrenergic and hypnotic systems [4]
Dopaminergic system: Increased sensitivity to EPSEs
Cholinergic system: Reduction in choline receptors = worse anti-cholinergic SE
Noradrenergic system: Reduced leading to greater sensitivity to mood disorders
Hypnotics: Fewer receptors = less effective and more paradoxical reactions
