Geriatric Psych

Question 1

What are some general differences between dementia and pseudodementia?

Answer 1

dementia has an insidious onset while pseudodementia is more acute

sundowning is common in dementia, but not depression

patient is usually unaware of the problem in dementia

dementia patients will confabulate when pushed to answer a question whereas pseudodementia patients can usually answer correctly or will just insist they don’t know

Question 2

What antidepressants are generally first line in the elderly?

Answer 2

SSRIs

Question 3

If you need to use a TCA in the elderly, which one is the best choice?

Answer 3

nortriptyline because it has the least anticholinergic effects

Question 4

What med can be added to stimulate appetite and improve sleep?

Answer 4

mirtazapine

Question 5

What med can be added to help with the psychomotor slowing?

Answer 5

methylphenidate

Question 6

What’s the timeline cutoff between normal grief and prolonged grief?

Answer 6

6 months

Question 7

Besides lasting over 6 months, what are some additional a symptoms of prolonged grief?

Answer 7

need 4 of the following 8:

1. difficulty moving on with life
2. numbness/detachment
3. bitterness
4. feeling that life is empty without the deceased
5. trouble accepting the loss
6. feeling that the future holds no meaning without the deceased
7. agitation
8. difficulty trusting others since the loss

Question 8

If someone grieving also displays hopelessness, helplessness, severe guilt, worthlessness, suicidal ideation, etc., what’s the diagnosis?

Answer 8

bereavement-associated depression

Question 9

When should you offer treatment for bereavement-associated depression?

Answer 9

in patients who have 2 straight weeks of depressive symptoms 6-8 weeks after the precipitating loss

Question 10

What are some nonpharmacological treatments for behaviors in dementia?

Answer 10

musci/art/exericise/pet therapy
strict daily schedules with minimal changes to routine
continual reorientation of the patient
reduced stimuli
surround then with familiar objects

Question 11

We try to avoid antipsychotics in dementia patients as much as possible, but what are two typical options? (except in Lewy body dementia - don’t give them any!)

Answer 11

olanzapine or quetiapine

can try haloperidol or risperidone for short acting

Question 12

Why do we prefer using SSRIs for anxiety in dementia patients instead of benzos?

Answer 12

they can experience paradoxical agitation on benzos

Question 13

Describe normal sleep changes in geriatric patients.

Answer 13

1. decreased REM latency and decreased total REM
2. increased amounts in stage 1 and 2, decreased amounts in stage 3 and 4 (deep sleep)
3. frequent nocturnal awakenings
4. sleep cycle advances (earlier to bed and earlier to rise)
5. decreased amount of total sleep

Question 14

Sedative-hypnotics are more likely to cause side effects in the elderly, but if you need to a use a mediation, what are the best choices?

Answer 14

hydroxyzine (vistaril)

or trazodone