Geri Psych Flashcards
How common is suicide in white geri men?
5x national average
Common psych disorders in elderly
- depression
- anxiety
- NCD
Four changes associated with normal aging:
1) decreased brain weight/ large ventricles + sulci
2) low muscle mass/ high fat
3) impaired vision and hearing
4) minor forgetfulness
Presentation of depression in elderly
- memory loss
- nonspecific physical complaints
Depression increases geri mortality in what conditions?
1) MI
2) stroke
3) new nursing home admissions
Contrast forgetfulness in depression and dementia
- dementia: patients confabulate & lack insight to problem
- depressed: patients say they do not know, may even answer correctly if pressed. aware of problem
Describe pseudodementia
presence of apparent cofnitive defects in patients with major depression
TCA preferred in geris if TCAs must be used
nortyrptiline
least anticholinergic ADRs
Benefits of mirtazapine in elderly
-weight gain
-sedation
(good in frail little ladies who cant sleep)
Methylphenidate:
- benefits in elderly
- risks
- benefits: ^^ psychomotor function
- risks: insomnia if given late in day, risk arrhythmia
Alternative to antidepressants in elderly
ECT
How to distinguish depression from bereavement?
- depression should meet MDD criteria (2 weeks of 5+ symptoms from SIGECAPS)
- bereavement may have some but not all MDD criteria, and beware, auditory hallucinations are normal.
What are the stages of grief per Kubler Ross?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
**Not everyone experiences each stage and not everyone follows this order
How long does normal grief last?
usually 6 months or less
Common substance abused in elderly?
16% of 65+ adults are heavy drinkers
Why is BAC higher in elderly?
-lower Alcohol Dehydrogenase
-lower water content
(also note their CNS is more sensitive to alcohol)
Med that causes higher BAC when combined with alcohol
-H2 blockers
Meds that increase sedation when combined with alcohol
- BDZ
- Barbs
- TCA
- narcotics
- antihistamines
Drugs that increase N/V when combined with alcohol
- metronidazole
- sulfonamides
- hypoglycemics
Drugs that ^ risk of hypotension when combined with alcohol
- reserpine
- nitroglycerin
- hydralazine
Drugs that ^ risk liver tox when combined with alcohol
- acetaminophen
- isoniazid
- phenylbutazone
What conditions is alcohol known to worsen?
- diabetes
- gout
- HTN
- ulcers
- liver/cardio/endocrine/mental
Psychotic features of AD
- delusions (50%)
- hallucinations (at least 25%)
- **only treat hallucinations if they are a PROBLEM
Antipsychotics increase mortality in geris. If they must be used, what are the best choices?
- long term: olanzapine, quietiapine
- short term: Haldol, Risperdal
Sleep changes assc with normal aging
- low REM latency and REM
- ^^ N1/2, low N3/4
- frequent waking, less overall sleep
- earlier to bed, earlier to rise
First treatment option when geri manifests a new symptom.
Remove a DRUG!
Polypharmacy= MC cause new symptoms
