Geriatric Psych

Question 1

Factors assoc with normal aging

Answer 1

• decreased brain wt / enlg’ed ventricles and sulci
• decreased muscle mass, incr fat
• impaired vision + hearing
• minor forgetfulness

Question 2

Subtle indicators to w/u elderly pt for MDD?

Answer 2

memory loss

nonspecific physical complaints

Question 3

Pseudodementia vs dementia

Answer 3

PSEUDODEMENTIA

• -> more acute onset
• -> sundowning is uncommon
• -> often answers “idk”
• -> more aware of their problems
• -> cognitive deficits improve with antidepressants

Question 4

Treatment, for pseudodementia

Answer 4

1. Supportive psychotherapy
2. Community resources (sr centers, etc)
3. LOW dose antidepressants - SSRIs&raquo_space; TCA, MAOi
   * *preferred TCA = nortriptyline (fewest anti-chol effects)
4. Mirtazapine: appetite, sleep
5. Methylphenidate (adjunct) - SE: insomnia, arrhythmias
6. ECT - safe and effective in elderly!

Question 5

What are the 5 stages of grief?

Answer 5

Denial
Anger
Bargaining
Depression
Acceptance

Question 6

What defines normal grief?

Answer 6

emotions, appetite changes, illusions

usually go away in 6 months
do not cause functional impairment

Question 7

Bereavement-associated depression

Answer 7

MDD that begins with a concrete death/loss

• look for generalized feelings of hopelessness, severe guilt and worthlessness, SI)
• 2 weeks of depressive sx –> tx with anti-depressants

Question 8

Age-related effects of alcohol (3)

Answer 8

1. reduction in alcohol dehydrogenase (cause higher BALs)
2. reduced water content (higher % alcohol in body)
3. incr CNS Sn to alcohol

Question 9

Normal sleep changes in geriatric pts

Mgmt?

Answer 9

• Decreased REM latency and total REM
• Incr stage 1+2 sleep, decr stage 3+4 sleep
• Frequent nocturnal awakenings
• Decreased amt total sleep
• Sleep cycle advances (earlier to bed, earlier to rise)

Mgmt:

1. Nonpharmacological changes
2. Trazodone&raquo_space;> BZ’s (less sedating, watch for OH)