Geri Psych

Question 1

How common is suicide in white geri men?

Answer 1

5x national average

Question 2

Common psych disorders in elderly

Answer 2

• depression
• anxiety
• NCD

Question 3

Four changes associated with normal aging:

Answer 3

1) decreased brain weight/ large ventricles + sulci
2) low muscle mass/ high fat
3) impaired vision and hearing
4) minor forgetfulness

Question 4

Presentation of depression in elderly

Answer 4

• memory loss

- nonspecific physical complaints

Question 5

Depression increases geri mortality in what conditions?

Answer 5

1) MI
2) stroke
3) new nursing home admissions

Question 6

Contrast forgetfulness in depression and dementia

Answer 6

• dementia: patients confabulate & lack insight to problem
• depressed: patients say they do not know, may even answer correctly if pressed. aware of problem

Question 7

Describe pseudodementia

Answer 7

presence of apparent cofnitive defects in patients with major depression

Question 8

TCA preferred in geris if TCAs must be used

Answer 8

nortyrptiline

least anticholinergic ADRs

Question 9

Benefits of mirtazapine in elderly

Answer 9

-weight gain
-sedation
(good in frail little ladies who cant sleep)

Question 10

Methylphenidate:

• benefits in elderly
• risks

Answer 10

• benefits: ^^ psychomotor function

- risks: insomnia if given late in day, risk arrhythmia

Question 11

Alternative to antidepressants in elderly

Answer 11

ECT

Question 12

How to distinguish depression from bereavement?

Answer 12

• 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.

Question 13

What are the stages of grief per Kubler Ross?

Answer 13

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

**Not everyone experiences each stage and not everyone follows this order

Question 14

How long does normal grief last?

Answer 14

usually 6 months or less

Question 15

Common substance abused in elderly?

Answer 15

16% of 65+ adults are heavy drinkers

Question 16

Why is BAC higher in elderly?

Answer 16

-lower Alcohol Dehydrogenase
-lower water content
(also note their CNS is more sensitive to alcohol)

Question 17

Med that causes higher BAC when combined with alcohol

Answer 17

-H2 blockers

Question 18

Meds that increase sedation when combined with alcohol

Answer 18

• BDZ
• Barbs
• TCA
• narcotics
• antihistamines

Question 19

Drugs that increase N/V when combined with alcohol

Answer 19

• metronidazole
• sulfonamides
• hypoglycemics

Question 20

Drugs that ^ risk of hypotension when combined with alcohol

Answer 20

• reserpine
• nitroglycerin
• hydralazine

Question 21

Drugs that ^ risk liver tox when combined with alcohol

Answer 21

• acetaminophen
• isoniazid
• phenylbutazone

Question 22

What conditions is alcohol known to worsen?

Answer 22

• diabetes
• gout
• HTN
• ulcers
• liver/cardio/endocrine/mental

Question 23

Psychotic features of AD

Answer 23

• delusions (50%)
• hallucinations (at least 25%)
• **only treat hallucinations if they are a PROBLEM

Question 24

Antipsychotics increase mortality in geris. If they must be used, what are the best choices?

Answer 24

• long term: olanzapine, quietiapine

- short term: Haldol, Risperdal

Question 25

Sleep changes assc with normal aging

Answer 25

• low REM latency and REM
• ^^ N1/2, low N3/4
• frequent waking, less overall sleep
• earlier to bed, earlier to rise

Question 26

First treatment option when geri manifests a new symptom.

Answer 26

Remove a DRUG!

Polypharmacy= MC cause new symptoms