Geriatric Medicine Flashcards
What is treatment for pseudodementia in the elderly?
- psychotherapy
- senior centers, groups
- SSRI in low dose
- nortrypteline of SSRI doesn’t work bc least anticholinergic of the TCAs
What drug is used to increase appetite and cause sedation for people that are depressed with sleep disturbances?
mirtazepine
What are the age related effects of alcohol?
- decreased alcohol dehydrogenase leading to higher BAL
2. increased CNS sensitivity to alcohol
Visual hallucinations early in dementia suggest what diagnosis?
What medication should be avoided?
Lewy body dementia- avoid antipsychotics
What antipsychotics are safest for geriatric population?
olanzapine
quetiapine
[can use short term resperidone, haloperidol]
What anxiolytics are used for psychiatric manifestations of dementia?
- low dose SSRI
2. benzos only for short-term acute episodes and monitor for paridoxical agitation
What mood stabilizers are used in dementia?
lamotrigine, valproic acid, carbamazepine
What are the IQ cut-offs for mild, moderate, severe, and profound mental retardation?
55-70 is mild
40-55 is moderate
25 to 39 is severe
under 25 is profound
A child presents with MR, obesity, almond shaped eyes and hypogonadism. What is the likely diagnosis?
Prader-Willi
What is the most common inherited cause of MR?
Fragile X resulting from FMR-1 gene defect
How long must symptoms be present for a child to be diagnosed with ODD?
What age does it usually present?
6 months of negativism, hostility and defiant behavior
Can begin as early as 3, but usually observed by age 8
What 3 things are often comorbid with ODD?
- substance abuse
- mood disorders
- ADHD
What is treatment for ODD?
- psychotherapy
2. parent management skill training
How do boys and girls with conduct disorder differ?
Boys- vandalism, setting fire, fights, stealing
Girls- running away, sexually acting out, lying
What are 4 risk factors for conduct disorder?
- punitive parenting
- biological factors
- hx of abuse
- psychosocial adversity
What is treatment for conduct disorder?
- family/community involvement
- consistent rules/consequences
- meds if aggression is present
How long and how many symptoms must be present for ADHD diagnosis?
When must symptoms present by?
at least 6 symptoms that are present for 6months in a child before the age of 12
- inattentive symptoms
- hyperactive-impulsive symptoms
- mixed
What percent of school aged children have ADHD?
5-12 percent
What is first line treatment for ADHD?
CNS stimulants:
methylphenidate (concerta, ritalin, metadate, focalin), dextroamphetamine, amphetamine salts
What non-stimulant can be used to treat ADHD?
- atomoxetine
2. clonidine, guanfacine [a2 agonists]
When must abnormalities in functioning be present for autism to be diagnosed?
By age 3, they must demonstrate:
- problems with social interaction
- impairment in communication
- repetitive and stereotyped actions
What percent of individuals with autism meet criteria for mental retardation?
70
How is Tourettes classified?
By what age?
multiple motor and at least one vocal tic with onset before age 18
-many times a day, almost every day for over 1 year
What 2 disorders are highly comorbid with tourettes?
- ADHD
2. OCD
