Geriatric Psych - Hill Flashcards
Dementia - definition
Example symptoms?
Decreased intellectual function without affecting consciousness
Memory loss, apraxia, aphasia, agnosia, loss of abstract thought, personality changes, impaired judgment
Irreversible causes of dementia
Alzheimer’s, Lewy body, Huntington, Pick’s (frontotemporal), vascular disease (infarct, etc.)
Reversible causes of dementia (pseudodementia)
**Hypothyroidism, **depression, **vitamin B12 deficiency, normal pressure hydrocephalus, neurosyphilis, hematoma, drug-induced
Dementia, urinary incontinence, ataxia
Normal pressure hydrocephalus
Elderly patient, weight loss, anxiety, irritability, sadness, social withdrawal, memory loss, dementia
Treatment? Best drug
Pseudodementia – depression-induced
Treat the depression – NORTRIPTYLINE***
Treating dementia – best approach?
Drug combo?
Drugs PLUS therapy (CBT)
Donepezil + memantine
A patient comes in with memory symptoms. FIRST thing to do?
Neuropsych testing – establish a baseline (esp. early on)
Drugs to AVOID in elderly w/ dementia
Why?
Anticholinergic – Benadryl (diphenhydramine), Hydroxyzine
Will cause impaired cognition – delirium, bad dementia
Treating psychosis in elderly dementia patient
Importance?
Atypical antipsychotic – olanzapine, aripiprazole, risperidone, quetiapine
BLACK BOX WARNING – SUDDEN DEATH
What can cause psychosis in the elderly?
Delirium – acute medical condition or drug issue
Major depressive disorder w/ psychotic features
Alzheimer’s type dementia – paranoid delusions
Treating delirium tremens in elderly
Benzos, Naltrexone
How to differentiate btwn dementia and depression in the elderly?
INSIGHT – will have insight in depression
An elderly patient with depression takes an SSRI. Caution?
Serotonin syndrome
An elderly patient with depression takes Mirtazapine. Caution?
Increased appetite
An elderly patient has depression as well as a chronic pain condition. Best drugs?
SNRIs (Venlafaxine, Duloxetine)
